2018 CAMEROON DEMOGRAPHIC AND HEALTH SURVEY (2018 CDHS)
MAN'S QUESTIONNAIRE
IDENTIFICATION
REGION___
DIVISION___
SUB-DIVISION___
LOCALITY___
NAME OF HOUSEHOLD HEAD___
CLUSTER NUMBER___
STRUCTURE NUMBER___
HOUSEHOLD NUMBER___
NAME AND LINE NUMBER OF MAN___
WOMAN SELECTED FOR HOUSEHOLD RELATIONS MODULE?
NO 2
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT___
NEXT VISIT
DATE___
TIME___
FINAL VISIT
DAY___
MONTH___
YEAR 2018
INT. NO. ___
RESULT___
TOTAL NUMBER OF VISITS___
FRENCH 02
FUFULDE 03
EWONDO 04
PIDGIN 05
OTHER (SPECIFY) ____ 96
LANGUAGE OF INTERVIEW
FRENCH 02
FUFULDE 03
EWONDO 04
PIDGIN 05
OTHER (SPECIFY) ____ 96
NATIVE LANGUAGE OF RESPONDENT___
FRENCH 02
FUFULDE 03
EWONDO 04
PIDGIN 05
OTHER (SPECIFY) ____ 96
INTERPRETER USED
NO 2
CONTROLLER
NAME___
NUMBER___
Hello. My name is ___. I am working with the National INSTITUTE OF STATISTICS. In collaboration with the MINISTRY OF PUBLIC HEALTH, we are conducting a survey about health and other topics all over CAMEROON. The information we collect will help the government plan 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 now?
SIGNATURE OF INTERVIEWER___
DATE___
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (GO TO END)
SECTION 1. RESPONDENT'S BACKGROUND
101. RECORD THE TIME
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.
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)
103. Just before you moved here, did you live in a city, in a town, or in a rural area?
TOWN 2
RURAL AREA 3
104. Before you moved here, which REGION did you live in?
CENTRE (EXCLUDES YAOUNDE) 02
DOUALA 03
EAST 04
FAR NORTH 05
LITTORAL (EXCLUDES DOUALA) 06
NORTH 07
NORDWEST 08
WEST 09
SOUTH 10
SOUTWEST 11
YAOUNDE 12
OUTSIDE OF CAMEROON 96
105. In what month and year were you born?
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.
107. Have you ever attended school?
NO 2 (GO TO 111)
108. What is the highest level of school you attended: primary, 1st secondary cycle, 2nd secondary cycle, or higher?
1ST SECONDARY CYCLE 2
2ND SECONDARY CYCLE 3
HIGHER 4
109. What is the highest [GRADE/FORM/YEAR] you completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.
PRIMARY
SIL/CLASS 2 01
CP/CPS/CLASS 2 02
CE1/CLASS 3 03
CE2/CLASS 4 04
CM1/CLASS 5 05
CM2/CLASS 6/7 06
SECONDARY 1ST CYCLE
6E/1ERE A.T./FORM 1 01
5E/2E A.T./FORM 2 02
4E/3E A.T./FORM 3 03
3E/4E A.T./FORM 4 04
SECONDARY 2ND CYCLE
2NDE G OU T/FORM 5 01
1ERE G OU T/LOWER 6 02
TERMINALE G OU T/UPPER 6 03
HIGHER
2E AN/2ND YEAR 02
3E AN/3RD YEAR 03
4E AN/4TH YEAR 04
HIGHER (GO 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?
ABLE TO READ ONLY PART OF THE SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) ____ 4
BLIND/VISUALLY IMPAIRED 5
CODE '1' OR '5' CIRCLED (GO TO 114)
113. Do you read a newspaper or magazine at least once a week, less than once a week, or not at all?
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?
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?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
116. Do you own a mobile telephone?
NO 2 (GO TO 118)
117. Do you use your mobile phone for any financial transactions?
NO 2
118. Do you have an account in a bank or other financial institution that you yourself use?
NO 2
119. Have you ever used the internet?
NO 2 (GO TO 122)
120. In the last 12 months, have you used the internet?
IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.
NO 2 (GO 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?
AT LEAST OCNE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
PROTESTANT 2
OTHER CHRISTIAN (SPECIFY) ____ 3
MUSLIM 4
ANIMIST 5
OTHER (SPECIFY) ____ 6
NONE 7
RECORD THE ETHNICITY AND LEAVE THE CODING BOXES EMPTY. FOR THE FOREIGNERS, RECORD "FOREIGN"
124. During the last 12 months, how many times did you travel out of your community/locality, and slept elsewhere other than your residence?
NONE 00 (GO TO 201)
125. In the last 12 months, have you been away from home for more than one month at a time?
NO 2
126. At any moment in the last 12 months, did you find yourself in a situation where, due to lack of money or other means, you worried about not having enough food to eat?
NO 2
127. At any moment in the last 12 months, did you find yourself in a situation where, due to lack of money or other means, you could not eat nutritious and healthy foods?
NO 2
128. At any moment in the last 12 months, did you find yourself in a situation where, due to lack of money or other means, you almost always ate the same thing?
NO 2
129. At any moment in the last 12 months, did you find yourself in a situation where, due to lack of money or other means, you had to skip a meal?
NO 2
130. At any moment in the last 12 months, did you find yourself in a situation where, due to lack of money or other means, you did not eat as much as you should have?
NO 2
131. At any moment in the last 12 months, did you find yourself in a situation where, due to lack of money or other means, there was nothing to eat at home?
NO 2
132. At any moment in the last 12 months, did you find yourself in a situation where, due to lack of money or other means, you were hungry but did not eat?
NO 2
132. At any moment in the last 12 months, did you find yourself in a situation where, due to lack of money or other means, you have not eaten anything all day?
NO 2
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?
NO 2 (GO TO 206)
DON'T KNOW 8 (GO TO 206)
202. Do you have any son or daughter that you have fathered who are living with you?
NO 2 (GO TO 204)
203.
a) How many sons live with you?
b) 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?
NO 2 (GO TO 206)
205.
a) How many sons are alive but do not live with you?
b) And how many daughters are alive but do not live with you?
IF NONE, RECORD '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 other signs of life even if for a very short time?
NO 2 (GO TO 208)
DON'T KNOW 8 (GO TO 208)
207.
a) How many boys have died?
b) And how many girls have died?
IF NONE, RECORD '00'.
HAS HAD ONLY ONE CHILD (GO TO 211)
HAS NOT HAD ANY CHILDREN (GO TO 301)
210. Did all of the children you have fathered have the same biological mother?
NO 2
HAS HAD MORE THAN ONE CHILD:
a) How old were you when your first child was born?
HAS HAD ONLY ONE CHILD:
b) How old were you when your child was born?
NO LIVING CHILDREN (GO TO 301)
MORE THAN ONE LIVING CHILD:
a) How old is your youngest child?
ONLY ONE LIVING CHILD:
b) How old is your child?
(YOUNGEST) CHILD IS AGE 3 YEARS OR OLDER (GO TO 301)
MORE THAN ONE LIVING CHILD:
a) What is the name of your youngest child?
ONLY ONE LIVING CHILD:
b) What is the name of your child?
216. When (NAME)'s mother was pregnant with (NAME), did she have any antenatal check-ups?
NO 2
217. Were you ever present during any of those antenatal check-ups?
NOT PRESENT 2
218. Was (NAME) born in a hospital or health facility?
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, or nothing to drink at all?
ABOUT THE SAME 2
LESS THAN USUAL 3
NOTHING TO DRINK 4
DON'T KNOW 8
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)?
PROBE: Women can have an operation to avoid having any more children.
NO 2
02. Male Sterilization
PROBE: Men can have an operation to avoid having any more children
NO 2
03. IUD
PROBE: Women can have a loop or coil placed inside them by a doctor or nurse which can prevent pregnancy for one or more years
NO 2
04. Injectables
PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months
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
NO 2
06. Pill
PROBE: Women can take a pill every day to avoid becoming pregnant
NO 2
07. Condom
PROBE: Men can put a rubber sheath on their penis before sexual intercourse
NO 2
08. Female condom
PROBE: Women can place a sheath in their vagina before sexual intercourse
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
NO 2
10. Standard Days 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.
NO 2
11. Lactational Amenorrhea Method (LAM)
PROBE: Up to six months after childbirth, before the menstrual period has returned, women use a method requiting intensive and frequent breastfeeding day and night
NO 2
12. Rhythm / periodic abstinence Method
PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant
NO 2
13. Withdrawal
PROBE: Men can be careful and pull out before climax
NO 2
14. Have you ever heard of any other ways or methods that women or men can use to avoid pregnancy?
YES, TRADITIONL METHOD (SPECIFY) ____ B
NO Y
302. In the last few months have you:
a) Heard about family planning on the radio?
NO 2
b) Seen anything about family planning on the television?
NO 2
c) Read about family planning in the newspaper or magazine?
NO 2
d) Received a voice or text message about family planning on a mobile phone?
NO 2
e) Seen anything about family planning on banners or billboards?
NO 2
303. In the last few months, have you discussed family planning with a health worker or health professional?
NO 2
304. Now would I 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?
NO 2 (GO TO 306)
DON'T KNOW 8 (GO TO 306)
305. Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?
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?
NO 2
DON'T KNOW 8
307. I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.
a) Contraception is a woman's concern and a man should not have to worry about it
DISAGREE 2
DON'T KNOW 8
b) Women who use contraception may become promiscuous
DISAGREE 2
DON'T KNOW 8
SECTION 4. MARRIAGE AND SEXUAL ACTIVITY
401. Are you currently married or living together with a women as if married?
YES, LIVING WITH A WOMAN 2
NO, NOT IN UNION 3
402. Have you ever been married or lived together with a woman is if married?
YES, LIVED WITH A WOMAN 2
NO 3
403. What is your marital statues now: are you widowed, divorced, or separated?
DIVORCED 2
SEPARATED 3
404. Is your (wife/partner) living with you now or is she staying elsewhere?
STAYING ELSEWHERE 2
405. Do you have other wives or do you live with other women as if married?
NO (ONLY ONE WIFE) 2
406. Altogether, how many wives or live in partners do you have?
ONE WIFE/PARTNER:
a) Please tell me the name of (your wife/the woman you are living with as if married).
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
RECORD THE NAME AND THE INE 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.
LINE NUMBER___
408. How old was (NAME) on her last birthday?
MORE THAN ONE WIFE/PARTNER (GO TO 411)
410. Have you been married or lived with a woman only once or more than once?
ONLY ONCE 2
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?
DON'T KNOW MONTH 98
YEAR___
DON'T KNOW YEAR 9998
412. How old were you when you first started living with her?
413. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUIING, MAKE EFFORT TO ENSURE
414. I would like to ask 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?
AGE IN YEARS___
415. I would like to ask you 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.
WEEKS AGO___ 2
MONTHS AGO___ 3
YEARS AGO ___ 4
(GO TO 417)
416. When was the last time you had sexual intercourse with this person?
WEEKS AGO___ 2
MONTHS AGO___ 3
YEARS AGO ___ 4
417. The last time you had sexual intercourse with this person, was a condom used?
NO 2 (GO TO 419)
418. Was condom used every time you had sexual intercourse with this person in the last 12 months?
NO 2
419. What was your relationship to this person with whom you had sexual intercourse?
IF GIRLGRIEND: Were you living together as if married?
IF YES, RECORD '2'
IF NO, RECORD '3'
LIVE IN PARTNER 2
GIRLGRIEND 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?
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 TIMES IS 95 OR MORE, RECORD '95'.
DON'T KNOW 98
423. Apart from this person, have you had sexual intercourse with any other person in the last 12 months?
NO 2 (GO TO 425)
IF AT THIRD-TO-LAST SEXUAL PARTNER, GO TO 424.
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 TIMES IS 95 OR MORE, RECORD '95'.
DON'T KNOW 98
NO PARTNERS ARE SEX WORKERS (GO TO 427)
426. CHECK 419 AND 417 (ALL COLUMNS):
OTHER (GO TO 431)
427. In the last 12 months, did you pay anyone in exchange for having sexual intercourse?
NO 2
428. Have you ever paid anyone in exchange for having sexual intercourse?
NO 2 (GO TO 431)
429. The last time you paid someone in exchange for having sexual intercourse, was a condom used?
NO 2 (GO 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?
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?
NO 2
432. Have you ever given any gifts or other goods in order to have sex or become sexually involved with anyone?
NO 2
433. In total, with how many different people have you had sexual intercourse with in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, RECORD '95'.
DON'T KNOW 98
434. CHECK 417: MOST RECENT PARTNER (FIRST COLUMN)
NO CONDOM USED (GO TO 438)
NOT ASKED (GO TO 438)
436. From where did you obtain the condom last time?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLET O DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
PUBLIC SECTOR
GOVERNMENT HEALTH CENTER/INTEGRATED HEALTH CENTER/DISPENSARY 12
HEALTH/COMMUNITY WORKER 13
OTHER PUBLIC SECTOR (SPECIFY) ___ 16
PRIVATE MEDICAL SECTOR
PRIVATE LAY/HOSPITAL CLINIC 22
CONFESSIONAL HEALTH CENTER/DISPENSARY 23
DOCTOR'S OFFICE 24
PHARMACY 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ___
OTHER SOURCE
KIOSK/BOX 32
ITINERANT SELLAR 33
BAR/NIGHT CLUB 34
PARTNER HAD A CONDOM 35
FRIEND/RELATIVE 36
OTHER (SPECIFY) ___ 96
DON'T KNOW 98
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?
NO 2 (GO TO 440)
DON'T KNOW 8 (GO TO 440)
438. The last time you had sex did you or your partner use any method to avoid or prevent a pregnancy?
NO 2 (GO TO 440)
DON'T KNOW 8 (GO TO 440)
439. What method did you or your partner use?
MALE STERILIZATION B (GO TO 501)
IUD C (GO TO 501)
INJECTABLES D (GO TO 501)
IMPLANTS E (GO TO 501)
PILL F (GO TO 501)
CONDOM G (GO TO 501)
FEMALE CONDOM H (GO TO 501)
EMERGENCY CONTRACEPTION I (GO TO 501)
STANDARD DAYS METHOD J (GO TO 501)
LACTATIONAL AMENORRHEA METHOD K (GO TO 501)
RHYTHM METHOD L (GO TO 501)
WITHDRAWAL M (GO TO 501)
OTHER MODERN METHOD X (GO TO 501)
OTHER TRADITIONAL METHOD Y (GO TO 501)
440. Do you know of a place where you can obtain a method of family planning?
NO 2
SECTION 5. FERTILITY PREFERENCES
501. CHECK 401:
CURRENTLY MARRIED OR LIVING WITH A PARTNER (GO TO 502)
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (GO TO 514)
MAN STERILIZED (GO TO 514)
ONE WIFE/PARTNER (GO TO 504)
MORE THAN ONE WIFE/PARTNER (GO TO 509)
504. Is your (wife/partner) currently pregnant?
NO 2 (GO TO 507)
DON'T KNOW 8 (GO 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 to have any more children?
NO MORE 2 (GO TO 514)
UNDECIDED/DON'T KNOW (GO TO 514)
506. After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?
YEARS___2 (GO TO 514)
SOON/NOW 993 (GO TO 514)
OTHER (SPECIFY) ____ 996 (GO TO 514)
DON'T KNOW 998 (GO TO 514)
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 ou prefer not to have any children?
NO MORE/NONE 2 (GO TO 514)
SAYS COUPLE CAN'T GET PREGNANT 3 (GO TO 514)
WIFE/PARTNER STERILIZED 4 (GO TO 514)
UNDECIDED/DON'T KNOW 8 (GO TO 514)
HAS FATHERED CHILDREN:
a) How long would you like to wait from now before the birth of another child?
HAS NOT FATHERED CHILDREN:
b) How long would you like to wait from now before the birth of a child?
YEARS___2 (GO TO 514)
SOON/NOW 993 (GO TO 514)
SAYS COUPLE CAN'T GET PREGNANT 994 (GO TO 514)
OTHER (SPECIFY) ___ 996 (GO TO 514)
DON'T KNOW 998 (GO TO 514)
509. Are any of your (wives/partners) currently pregnant?
NO 2 (GO TO 512)
DON'T KNOW 8 (GO 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 to not have any more children?
NO MORE 2 (GO TO 514)
UNDECIDED/DON'T KNOW 8 (GO 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?
YEARS___2 (GO TO 514)
SOON/NOW 993 (GO TO 514)
SAYS COUPLE CAN'T GET PREGNANT 994 (GO TO 514)
OTHER (SPECIFY) ___ 996 (GO TO 514)
DON'T KNOW 998 (GO TO 514)
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?
NO MORE/NONE 2 (GO TO 514)
SAYS COUPLE CAN'T GET PREGNANT 3 (GO TO 514)
WIFE/PARTNER STERILIZED 4 (GO TO 514)
UNDECIDED/DON'T KNOW 8 (GO TO 514)
HAS FATHERED CHILDREN:
a) How long would you like to wait from now before the birth of another child?
HAS NOT FATHERED CHILDREN:
b) How long would you like to wait from now before the birth of a child?
YEARS___2
SOON/NOW 993
SAYS COUPLE CAN'T GET PREGNANT 994
OTHER (SPECIFY) ___ 996
DON'T KNOW 998
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?
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
NUMBER___
OTHER (SPECIFY) ___ 96 (GO 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 OF GIRLS___
EITHER___
OTHER (SPECIFY) ___ 96
SECTION 6. EMPLOYMENT AND GENDER ROLES
601. Have you done any work in the last seven days?
NO 2
602. Although you did not work in the last seven days, do you have a job or business from which you were absent for leave, illness, vacation, or any other such reason?
NO 2
603. Have you done any work in the last 12 months?
NO 2 (GO TO 607)
604. What is your occupation? That is, what kind of work do you mainly do?
605. Do you usually work throughout the year, or do you work seasonally, or only once in a while?
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 AND KIND 2
IN KIND ONLY 3
NOT PAID 4
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (GO TO 612)
OTHER (GO TO 610)
609. Who usually decides how the money you earn will be used: you, your (wife/partner) or you and your (wife/partner) jointly?
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
OTHER (SPECIFY) ___ 6
611. Who usually makes decisions about making major household purchases?
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
OTHER (SPECIFY) ___ 6
612. Do you own this or any other house either alone or jointly with someone else?
JOINTLY ONLY 2
BOTH ALONE AND JIONTLY 3
DOES NOT OWN 4 (GO TO 615)
612A. How likely are you to lose your property rights on this house or any other of your houses in the next 5 years?
SOMEWHAT LIKELY 2
NOT LIKELY 3 (GO TO 612C)
612B. What is the source of potential loss of your property rights on this house or any other of your houses?
LOCAL AUTHORITIES 2
COMMERCIAL INTERESTS 3
FAMILY MEMBERS OR OTHER INDIVIDUALS 4
612C. Do you have any rights to exclusively or jointly bequeath this house or any other of your houses?
YES, JOINTLY ONLY 2
YES, BOTH ALONE AND JOINTLY 3
NO 4
613. Do you have a title deed for any house that you own?
NO 2 (GO TO 615)
DON'T KNOW 8 (GO TO 615)
613A. What is the type of title deed over this house?
NO 2
DOES NOT KNOW 8
613B. What type of title deed do you have?
SALE CERTIFICATE B
LAND CERTIFICATE C
OTHER DOCUMENT (SPECIFY) ____ X
614. Is your name on the title deed?
NO 2
DON'T KNOW 8
615. Do you own any agricultural or non-agricultural land either alone or jointly with someone else?
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4 (GO TO 618)
615A. Do you have tenure rights on agricultural land or non-agricultural land?
YES, NON-AGRICULTURAL LAND 2
YES, FOR BOTH TYPES OF LAND 3
NO 4 (GO TO 618)
LEASEHOLD 2
OTHER (SPECIFY) ____6
615C. How likely are you to lose your property rights or your rights of using your land(s) in the next 5 years?
SOMEWHAT LIKELY 2
NOT LIKELY 3 (GO TO 615E)
615D. What is the source of the potential loss of your property right or right of using this (these) land(s)?
LOCAL AUTHORITIES 2
COMMERCIAL INTERESTS 3
FAMILY MEMBERS OR OTHER INDIVIDUALS 4
615E. Do you have the right to exclusively or jointly bequeath your land?
YES, JOINTLY ONLY 2
YES, BOTH ALONE AND JOINTLY 3
NO 4
616. Do you have a title deed for any land you own?
YES, NON-AGRICULTURAL LAND 2
YES, BOTH TYPES OF LAND 3
NO 4 (GO TO 618)
DON'T KNOW 8 (GO TO 618)
616A. What type of title deed over the land do you have?
ATTESTATION/SALE CERTIFICATE B
LAND CERTIFICATE C
OTHER DOCUMENT (SPECIFY) ___X
617. Is your name on the title deed?
NO 2
DON'T KNOW 8
617A. Can I see the title deed?
YES, ATTESTATION/SALE CERTIFICATE SEEN B
YES, LAND CERTIFICATE SEEN C
YES, OTHER DOCUMENT SEEN D
NO, NO DOCUMENT SEEN E
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?
NO 2
DON'T KNOW 8
b) If she neglects the children?
NO 2
DON'T KNOW 8
c) If she argues with him?
NO 2
DON'T KNOW 8
d) If she refuses to have sex with him?
NO 2
DON'T KNOW 8
e) If she burns the food?
NO 2
DON'T KNOW 8
701. Now I would like to talk about something else. Have you ever heard of HIV or AIDS?
NO 2 (GO TO 727)
702. HIV is the 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?
NO 2
DON'T KNOW 8
703. Can you people get HIV from mosquito bites?
NO 2
DON'T KNOW 8
704. Can people reduce their chance of getting HIV by using a condom every time they have sex?
NO 2
DON'T KNOW 8
705. Can people get HIV by sharing food with a person who has HIV?
NO 2
DON'T KNOW 8
706. Can people get HIV because of witchcraft or other supernatural means?
NO 2
DON'T KNOW 8
707. Is it possible for a healthy-looking person to have HIV?
NO 2
DON'T KNOW 8
708. Can HIV be transmitted from a mother to her baby:
NO 2
DON'T KNOW 8
b) During delivery?
NO 2
DON'T KNOW 8
c) By breastfeeding?
NO 2
DON'T KNOW 8
OTHER (GO 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?
NO 2
DON'T KNOW 8
711. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
712. Have you ever been tested for HIV?
NO 2 (GO TO 716)
713. How many months ago was your most recent HIV test?
TWO OR MORE YEARS 95
714. Did you get the results of the test?
NO 2 (GO TO 715)
714A. What was the result of the test?
NEGATIVE 2
INDETERMINATE 3
DECLINED TO ANSWER 4
DON'T KNOW 8
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
PUBLIC SECTOR
GOVERNMENT HEALTH CENTER/INTEGRATED HEALTH CENTER/DISPENSARY 12 (GO TO 718)
HEALTH/COMMUNITY WOTKER 13 (GO TO 718)
STAND-ALONE HTH CENTER 14 (GO TO 718)
MOBILE HTC SERVICES/CNLS 15 (GO TO 718)
OTHER PUBLIC SECTOR (SPECIFY) ___ 16 (GO TO 718)
PRIVATE MEDICAL SECTOR
PRIVATE LAY HOSPITAL/CLINIC 22 (GO TO 718)
CONFESSIONAL HEALTH CENTER/DISPENSARY23 (GO TO 718)
MEDICAL CABINET 24 (GO TO 718)
PHARMACY 25 (GO TO 718)
STAND-ALONE HTC CENTER 26 (GO TO 718)
MOBILE HTC SERVICES/CNLS 27 (GO TO 718)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ____ 28 (GO TO 718)
OTHER SOURCE
WORK PLACE 32 (GO TO 718)
CORRECTIONAL FACILITY 33 (GO TO 718)
SCHOOL/CULTURAL CENTER 34 (GO TO 718)
OTHER (SPECIFY) ____ 96
716. Do you know of a place where people can go to get an HIV test?
NO 2 (GO TO 718)
717. Where is that?
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.
PUBLIC SECTOR
GOVERNMENT HEALTH CENTER/INTEGRATED HEALTH CENTER/DISPENSARY B
HEALTH/COMMUNITY WORKER C
STAND-ALONE HTC CENTER D
MOBILE HTC SERVICES/CNLS E
OTHER PUBLIC SECTOR (SPECIFY) ___ F
PRIVATE MEDICAL SECTOR
PRIVATE LAY HOSPITAL/CLINIC H
CONFESSIONAL HEALTH CENTER/DISPENSARY I
MEDICAL CABINET J
PHARMACY K
STAND-ALONE HTC CENTER L
MOBILE HTC SERVICES/CNLS M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ___ N
OTHER SOURCE
WORKPLACE P
CORRECTIONAL FACILITY Q
SCHOOL/CULTURAL CENTER R
OTHER (SPECIFY) ____ X
718. Have you heard of test kits people can use to test themselves for HIV?
NO 2 (GO TO 720)
719. Have you ever tested yourself for HIV using a self-test kit?
NO 2
720. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
721. Do you think children living with HIV should be allowed to attend school with children who do not have HIV
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
722. Do you think people hesitate to take an HIV test because they are afraid of how other people will react if the test result is positive for HIV?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
723. Do people talk badly about people living with HIV, or who are thought to be living with HIV?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
724. Do people living with HIV, or thought to be living with HIV, lose respect of other people?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
725. Do you agree or disagree with the following statement: I would be ashamed if someone in my family had HIV
DISAGREE 2
DON'T KNOW/NOT SURE/DEPENDS 8
726. Do you fear that you could get HIV if you come into contact with the saliva of a person living with HIV?
NO 2
SAYS HE HAS HIV 3
DON'T KNOW/NOT SURE/DEPENDS 8
HEARD ABOUT HIV OR AIDS
a) Apart from HIV, have you heard about other infections that can be transmitted through sexual contact?
NOT HEARD ABOUT HIV OR AIDS
b) Have you heard about infections that can be transmitted through sexual contact?
NO 2
NEVER HAD SEXUAL INTERCOURSE (GO TO 736)
729. CHECK 727: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?
NO (GO 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?
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?
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 on or near your penis?
NO 2
DON'T KNOW 8
734. The last time you have (PROBLEM FROM 730/731/732), did you seek any kind of advice or treatment?
NO 2 (GO TO 736)
735. Where did you go?
Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
PUBLIC SECTOR
GOVERNMENT HEALTH CENTER/INTEGRATED HEALTH CENTER/DISPENSARY B
HEALTH/COMMUNITY WORKER C
STAND-ALONE HTC CENTER D
MOBILE HTC SERVICES/CNLS E
OTHER PUBLIC SECTOR (SPECIFY) ___ F
PRIVATE MEDICAL SECTOR
PRIVATE LAY HOSPITAL/CLINIC H
CONFESSIONAL HEALTH CENTER/DISPENSARY I
MEDICAL CABINET J
PHARMACY K
STAND-ALONE HTC CENTER L
MOBILE HTC SERVICES/CNLS M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ___ N
OTHER SOURCE
WORKPLACE P
CORRECTIONAL FACILITY Q
SCHOOL/CULTURAL CENTER R
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?
NO 2
DON'T KNOW 8
737. Is a wife justified in refusing to have sex with her other husband when she knows he has sex with other women?
NO 2
DON'T KNOW 8
SECTION 8. OTHER HEALTH ISSUES
801. Some men are circumcised, that is, the foreskin is completely removed from the penis. Are you circumcised?
NO 2 (GO TO 805)
DON'T KNOW 8 (GO TO 805)
802. How old were you when you got circumcised?
DURING CHILDHOOD (LESS THAN 5 YEARS OLD) 95
DON'T KNOW 98
803. Who did the circumcision?
HEALTH WORER/PROFESSIONAL 2
OTHER 3
DON'T KNOW 8
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.
NONE 00 (GO TO 808)
806. Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?
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.
NONE 00 (GO TO 808)
807. The last time you got an injection from a health worker, did he/she take the syringe and needle from a new unopened package?
NO 2
DON'T KNOW 8
808. Do you currently smoke tobacco every day, some days, or not at all?
SOME DAYS 2
NOT AT ALL 3 (GO TO 810)
809. In the past, have you ever smoked tobacco every day?
NO 2 (GO TO 812)
810. In the past, have you ever smoked tobacco every day, some days, or not at all?
SOMEDAYS 2 (GO TO 813)
NOT AT ALL 3 (GO 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 REPORTS USING THE PRODUCT BUT NOT EVERY DAY, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.
b) Hand-rolled cigarettes?
c) Kreteks?
d) Pipes full of tobacco?
e) Cigars, cheroots, or cigarillos?
f) Number of water pipe sessions?
g) Any others? (SPECIFY) ____
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 REPORTS USING THE PRODUCT BUT NOT EVERY WEEK, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.
b) Hand-rolled cigarettes
c) Kreteks?
d) Pipes full of tobacco?
e) Cigars, cheroots, or cigarillos?
f) Number of water pipe sessions?
g) Any others? (SPECIFY) ____
813. Do you currently use smokeless tobacco every day, some days, or not at all?
SOME DAYS 2 (GO TO 815)
NOT AT ALL 3 (GO TO 816)
814. On average, how many times a day do you use the following products? Also, let me know if you use the product, but not every day.
IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY DAY, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.
b) Snuff, by nose?
c) Chewing tobacco?
d) Betel quid with tobacco?
e) Any others? (SPECIFY) ____
ALL SKIP TO 816.
815. On average, how many times a week do you use the following products?
IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY WEEK, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.
b) Snuff, by nose?
c) Chewing tobacco?
d) Betel quid with tobacco?
e) Any others? (SPECIFY) ____
ALL SKIP TO 818.
816. In the past, have you ever used smokeless tobacco every day?
NO 2 (GO TO 818)
817. In the past, have you ever used smokeless tobacco every day, some days, or not at all?
SOME DAYS 2
NOT AT ALL 3
818. CHECK 808, 810, 813, AND 816:
NOT A SINGLE 'EVERY DAY' OR 'SOME DAY" (GO TO 820)
819. How old were you the first time you smoked tobacco or used smokeless tobacoo?
DON'T KNOW YEAR 98
820. How often does anyone smoke inside your house? Would you say daily, weekly, monthly, less often than once a month, or never?
WEEKLY 2
MONTHLY 3
LESS OFTEN THAN ONCE A MONTH 4
NEVER 5
821. Do you work outside your home?
NO/NOT WORKING 2 (GO TO 824)
822. Do you usually work indoors or outdoors?
OUTDOORS 2(GO TO 824)
INDOORS AND OUTDOORS 3
823. In the last 30 days, has any one smoked inside the room where you work?
NO 2
DON'T KNOW 8
NOT AT ALL (GO TO 828)
825. In the last 12 months, have you tried to stop smoking?
NO 2
826. Have you consulted a doctor or any other health professional in the last 12 months?
NO 2 (GO TO 828)
827. During a consultation with a doctor or another health professional in the last 12 months, have been advised to stop smoking?
NO 2
828. In the last 30 days, have you seen any information on the harmful effects of cigarettes or smoking cessation incitements in newspapers or magazines?
NO 2
DON'T KNOW 8
829. In the last 30 days, have you seen or heard any information on the harmful effects of ciarettes or smoking cessation incitements on television?
NO 2
DON'T KNOW 8
830. In the last 30 days, have you seen health warnings on cigarette packs?
NO 2
DON'T KNOW 8
830. In the last 30 days, have you seen or health warnings on cigarette packs?
NO 2
HAVE NOT SEEN ANY CIGARETTE PACKS 8
NOT AT ALL (GO TO 833)
832. In the last 30 days, have health warnings on cigarette packs made you want to quit smoking?
NO 2
833. In the past 30 days, have you seen advertisements on cigarettes or promotional signs for cigarettes in marketplace?
NO 2
834. In the last 30 days, have you seen or heard any of the following types of promotion for cigarettes?
NO 2
b) Discounted price for cigarettes?
NO 2
c) Coupons for price discount on cigarettes?
NO 2
d) Gifts or discount on other products for the purchase of cigarettes?
NO 2
e) Clothing or other items bearing the name or logo of a brand of cigarettes?
NO 2
f) Promotion for cigarettes by mail?
NO 2
BOTH '811a) AND 812a) ARE '0' OR BLANK (GO TO 838)
836. The last time you bought cigarettes/packs of cigarettes or cigarette cartridges for your personal use, how much did you buy?
PACKS 2
NUMBER OF CIGARETTES PER CARTON___
CARTRIDGES 3
NUMBER OF CIGARETTES PER CARTON___
OTHER CARTONS 6
NUMBER OF CIGARETTES PER CARTON___
DON'T KNOW 998
837. In total, how much did you spend for the purchase?
DON'T KNOW 99998
838. Are you covered by any health insurance?
NO 2 (GO TO 901)
839. What type of health insurance are you covered by?
RECORD ALL MENTIONED.
HEALTH INSURANCE THROUGH EMPLOYER B
SOCIAL SECURITY C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
OTHER (SPECIFY) ____ X
SECTION 9. NON-COMMUNICABLE DISEASES
901. Have you ever had your blood pressure measured by a doctor or other health worker?
NO 2
DON'T KNOW 8
902. Have you ever been told by a doctor or other health worker that you have high blood pressure or hypertension?
NO 2 (GO TO 906)
903. In the past 12 months, have you been told by a doctor or other health worker that you have high blood pressure or hypertension?
NO 2
904. Has a doctor or other healthcare worker prescribed medication to control your blood pressure?
NO 2
905. Are you taking medication to control your blood pressure?
NO 2
906. Have you ever had your blood sugar measured by a doctor or other health worker?
NO 2
DON'T KNOW 8
907. Have you ever been told by a doctor or other health worker that you have high blood sugar or diabetes?
NO 2 (GO TO 911)
908. In the past 12 months, have you been told by a doctor or other health worker that you have high blood sugar or diabetes?
NO 2
909. Has a doctor or other healthcare worker prescribed medication to control your high blood sugar or diabetes?
NO 2
910. Are you taking medication to control your high blood sugar or diabetes?
NO 2
911. Have you ever been told by a doctor or other health worker that you have heart disease or a chronic heart condition?
NO 2 (GO TO 913)
912. Are you receiving any treatment for your heart disease or chronic heart condition?
NO 2
913. Have you ever been told by a doctor or other health worker that you have lung disease or a chronic lung condition?
NO 2 (GO TO 915)
914. Are you receiving treatment for your lung disease or heart condition?
NO 2
915. Have you ever been told by a doctor or other health worker that you have cancer or a tumor?
NO 2 (GO TO 917)
916. Are you receiving any treatment for cancer or a tumor?
NO 2
917. Have you ever been told by a doctor or other health worker that you have depression?
NO 2 (GO TO 919)
918. Are you receiving treatment for depression?
NO 2
919. Have you ever been told by a doctor or other health worker that you have arthritis?
NO 2 (GO TO 921)
920. Are you receiving any treatment for arthritis?
NO 2
921. Have you ever been told by a doctor or other health worker that you have any other chronic disease, that is, any other disease that is long lasting?
NO 2 (GO TO 1000)
922. Are you receiving treatment for (CHRONIC DISEASE FROM 921)?
NO 2
SECTION 10. HOUSEHOLD RELATIONS
1000. CHECK COVER PAGE: MAN SELECTED FOR HOUSEHOLD RELATIONS MODULE?
MAN NOT SELECTED (GO TO 1033)
1001. CHECK FOR PRESENCE OF OTHERS: DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.
PRIVACY NOT POSSIBLE 2 (GO TO 1032)
1001A. READ TO THE RESPONDENT: Now I would like to ask you 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 CAMEROON. 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. 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.
FORMERLY MARRIED/LIVING WITH A WOMAN (READ IN PAST TENSE AND USE 'LAST' WITH 'WIFE/PARTNER') (GO TO 1003)
NEVER MARRIED/NEVER LIVED WITH A WOMAN (GO TO 1016)
1003. 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) (wife/partner)
NO 2
DON'T KNOW 8
b) She frequently (accuses/accused) you of being unfaithful?
NO 2
DON'T KNOW 8
c) She (does/did) not permit you to meet your male friends?
NO 2
DON'T KNOW 8
d) She (tries/tried) to limit your contact with your family?
NO 2
DON'T KNOW 8
e) She (insists/insisted) on knowing where you (are/were) at all times?
NO 2
DON'T KNOW 8
1004. Now I need to ask some more questions about your relationship with your (last) (wife/partner).
a) say or do something to humiliate you in front of others?
NO 2 (GO TO 1004b)
b) threaten to hurt or harm you or someone you care about?
NO 2 (GO TO 1004c)
c) insult you or make you feel bad about yourself?
NO 2 (GO TO 1005)
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
IF NOT AT 1004c), GO BACK TO 1004A, NEXT QUESTION.
1005.
A. Did your (last) (wife/partner) ever do any of the following things to you:
NO 2 (GO TO 1005b)
b) slap you?
NO 2 (GO TO 1005c)
c) twist your arm or pull your hair?
NO 2 (GO TO 1005d)
d) punch you with her fist or with something that could hurt you?
NO 2 (GO TO 1005e)
e) kick you, drag you, or beat you up?
NO 2 (GO TO 1005f)
f) strangled or burned you?
NO 2 (GO TO 1005g)
g) threaten or attack you with a knife, gun, or other weapon?
NO 2 (GO TO 1005h)
h) physically force you to have sexual intercourse with her when you did not want to?
NO 2 (GO TO 1005i)
i) physically force you to perform any sexual acts you did not want to?
NO 2 (GO TO 1005j)
j) force you with threats or in any other way to perform sexual acts you did not want to?
NO 2 (GO TO 1006)
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
IF NOT AT 1005j), GO TO 1005A, NEXT QUESTION.
NOT A SINGLE 'YES' (GO TO 1009)
1007. How long after you first (got married/started living together) with your (last) (wife/partner) did (this/any of these things) first happen?
IF LESS THAN ONE YEAR, RECORD '00'
BEFORE MARRIAGE/BEFORE LIVING TOGETHER #
1008. Did the following ever happen as a result of what your (last) (wife/partner) did to you:
NO 2
b) You had eye injuries, sprains, dislocations, or burns?
NO 2
c) You had deep wounds, broken bones, broken teeth, or any other serious injury?
NO 2
1009. Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) (wife/partner) at times when she was not already beating or physically hurting you?
NO 2 (GO TO 1011)
1010. In the last 12 months, how often have you done this to your (last) (wife/partner): often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
1011. Does (did) your (last) (wife/partner) drink alcohol?
NO 2 (GO TO 1013)
1012. How often does (did) she get drunk: often, only sometimes, or never?
SOMETIMES 2
NEVER 3
1013. Are (were) you afraid of your (last) (wife/partner): most of the time, sometimes, or never?
SOMETIMES AFRAID 2
NEVER AFRAID 3
MARRIED ONLY ONCE (GO TO 1016)
1015.
A. So far we have been talking about the behavior of your (current/last) (wife/partner). Now I want to ask you about the behavior of any previous (wife/partner).
NO 2 (GO TO 1015b)
b) Did any previous (wife/partner) physically force you to have intercourse or perform any other sexual acts against your will?
NO 2 (GO TO 1015c)
c) Did any previous (wife/partner) humiliate you in front of others, threaten to hurt you or someone you care about, or insult you or make you feel bad about yourself?
NO 2 (GO TO 1016)
B. How long ago did this last happen?
12+ MONTHS AGO 2
DON'T REMEMBER 3
IF NOT AT 1015c), GO BACK TO 1015A, NEXT QUESTION.
EVER MARRIED/EVER LIVED WITH A WOMAN:
a) From the time you were 15 years old has anyone other than (your/any) (wife/partner) hit you, slapped you, kicked you, or done anything else to hurt you physically?
NEVER MARRIED/NEVER LIVED WITH A WOMAN:
b) From the time you were 15 years old, has anyone hit you, slapped you, kicked you, or done anything else to hurt you physically?
NO 2 (GO TO 1022)
REFUSED TO ANSWER/NO ANSWER 2 (GO TO 1022)
1017. Who has hurt you in this way?
Anyone else?
RECORD ALL MENTIONED.
FATHER/STEP-FATHER B
SISTER/BROTHER C
DAUGHTER/SON D
OTHER RELATIVE E
CURRENT GIRLFRIEND F
FORMER GIRLFRIEND G
MOTHER-IN-LAW H
FATHER-IN-LAW I
OTHER IN-LAW J
TEACHER K
EMPLOYER/SOMEONE AT WORK L
POLICE/SOLDIER/GENDARME M
OTHER (SPECIFY) ___ X
1018. In the last 12 months, how often has (this person/have these persons) physically hurt you: often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
NEVER MARRIED/NEVER LIVED WITH A WOMAN (GO TO 1022B)
1022A. Now I want to ask you about things that may have been done to you by someone to you be someone other than (your/any) (wife/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 when you did not want to?
NO 2 (GO TO 1024A)
REFUSED TO ANSWER/NO ANSWER (GO TO 1024A)
1022B. 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?
NO 2 (GO TO 1026)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1026)
1023. Who was the person who was forcing you the very first time this happened?
FORMER WIFE/PARTNER 02
CURRENT/FORMER GIRLFRIEND 03
MOTHER/STEP-MOTHER 04
SISTER/STEP-SISTER
OTHER RELATIVE 06
IN-LAW 07
OWN FRIEND/ACQUAINTANCE 08
FAMILY FRIEND 09
TEACHER 10
EMPLOYER/SOMEONE AT WORK 11
POLICE/SOLDIER/GENDARME 12
PRIEST/RELIGIOUS LEADER 13
STRANGER 14
OTHER (SPECIFY) ___ 96
EVER MARRIED/EVER LIVED WITH A WOMAN:
a) In the last 12 months, has anyone other than (your/any) (wife/partner) physically forced you to have sexual intercourse when you did not want to?
NEVER MARRIED/NEVER LIVED WITH A WOMAN:
b) In the last 12 months has anyone physically forced you to have sexual intercourse when you did not want to?
NO 2 (GO TO 1025)
1024A. CHECK 1005A (h-j), 1015A(b), 1022A AND 1022B:
NOT A SINGLE 'YES' (GO TO 1026)
EVER MARRIED/EVER LIVED WITH A WOMAN:
a) How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts by anyone, including (your/any) wife/partner?
NEVER MARRIED/NEVER LIVED WITH A WOMAN:
b) How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?
DON'T KNOW #
1026. CHECK 1005(a-j), 1015(a,b), 1016, 1022A, AND 1022B:
NOT A SINGLE 'YES' (GO TO 1030)
1027. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?
NO 2 (GO TO 1029)
1028. From whom have you sought help?
Anyone else?
RECORD ALL MENTIONED.
WIFE'S/PARTNER'S FAMILY B (GO TO 1030)
CURRENT/FORMER WIFE/PARTNER C (GO TO 1030)
CURRENT/FORMER GIRLFRIEND D (GO TO 1030)
FRIEND E (GO TO 1030)
NEIGHBOR F (GO TO 1030)
RELIGIOUS LEADER G (GO TO 1030)
DOCTOR/MEDICAL PERSONNEL H (GO TO 1030)
POLICE/SOLDIER/GENDARME I (GO TO 1030)
LAWYER J (GO TO 1030)
SOCIAL SERVICE ORGANIZATION K (GO TO 1030)
OTHER (SPECIFY) ___ X (GO TO 1030)
1029. Have you ever told anyone about this?
NO 2
1030. As far as you know, did your father ever beat your mother?
NO 2
DON'T KNOW 8
THANK THE RESPONDENT FOR HIS COOPERATION AND REASSURE HIM ABOUT THE CONFIDENTIALITY OF HIS ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE HOUSEHOLD RELATIONS MODULE.
1031. DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LSITEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?
YES, MORE THAN ONCE 2
NO 3
OTHER FEMALE ADULT
YES, MORE THAN ONCE 2
NO 3
MALE ADULT
YES, MORE THAN ONCE 2
NO 3
1032. INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE HOUSEHOLD RELATIONS MODULE_____
MINUTES___
COMMENTS ABOUT INTERVIEW____
COMMENTS ON SPECIFIC QUESTIONS___
ANY OTHER COMMENTS___
SUPERVISOR'S OBSERVATIONS___
EDITOR'S OBSERVATIONS___