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A planned IPUMS system update is scheduled for Monday, December 9. The maintenance window is 10am to 1pm CST. Within that window, each site will have a brief outage of 10 or fewer minutes. This notice will be removed as soon as the update is complete.

GHANA DEMOGRAPHIC AND HEALTH SURVEY
MAN'S QUESTIONNAIRE, 2008

MINISTRY OF HEALTH, GHANA

HANA STATISTICAL SERVICE

SEPTEMBER 2008

IDENTIFICATION

LOCALITY NAME ____________
NAME OF HOUSEHOLD HEAD __________
EA NUMBER __
STRUCTURE NUMBER __
HOUSEHOLD NUMBER __
REGION __
DISTRICT __

URBAN/RURAL ___

URBAN 1
RURAL 2

CITY/LARGE TOWN/SMALL TOWN/VILLAGE __

CITY 1
LARGE TOWN 2
SMALL TOWN 3
VILLAGE 4

NAME AND LINE NUMBER OF MAN ___________

MAN SELECTED FOR DV INTERVIEW __

YES 1
NO 2

CHECK COLUMN 10 IN HOUSEHOLD QUESTIONNAIRE. IF BOX IS MARKED 'DV' RECORD 1.
MAKE SURE LINE NUMBER CORRESPONDS TO THE MAN'S LINE NUMBER SELECTED FOR DV.

INTERVIEWER VISITS 1
DATE _____
INTERVIEWER'S NAME ____
RESULT* ______

NEXT VISIT:
DATE____
TIME____

INTERVIEWER VISITS 2
DATE _____
INTERVIEWER'S NAME ____
RESULT* ______

NEXT VISIT:
DATE____
TIME____

INTERVIEWER VISITS 3
DATE _____
INTERVIEWER'S NAME ____
RESULT* ______

FINAL VISIT
DAY _____
MONTH_____
YEAR 2008
INT. CODE ____
FINAL RESULT ____

TOTAL NO. OF VISITS ______

RESULT____
*RESULT CODES:

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

LANGUAGE OF QUESTIONNAIRE: 1

LANGUAGE OF INTERVIEW ______________

HOME LANGUAGE OF RESPONDENT ____________

WAS A TRANSLATOR USED? __

YES 1
NO 2

LANGUAGE CODES:

ENGLISH 1
AKAN 2
GA 3
EWE 4
NZEMA 5
DAGBANI 6
OTHER 7 (SPECIFY)

SUPERVISOR
NAME ___
DATE ___

FIELD EDITOR
NAME ___
DATE ___

OFFICE EDITOR
NAME _____

KEYED BY
NAME _____

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT
Hello. My name is _____________________________________ and I am working for Ghana Statistical Service and Ministry of Health.

We are conducting a national survey to ask men and women about various health issues. We would very much appreciate your participation in this survey. This information will help the government to plan health services. The survey usually takes about 20 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to anyone other than members of our survey team.

Participation in this survey is voluntary, and if we should come to 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. However, we hope that you will participate in this survey since your views are important.

At this time, do you want to ask me anything about the survey? May I begin the interview now?

Signature of interviewer: __________
Date: ___________

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END INTERVIEW)

101. RECORD THE TIME.

HOUR ___
MINUTES ___

102. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN IF LESS THAN ONE YEAR, RECORD '00' YEARS.

YEARS ___
ALWAYS 95 (GO TO 104)
VISITOR 96 (GO TO 104)

103. Just before you moved here, did you live in a city, in a town, or in the countryside?

CITY 1
TOWN 2
COUNTRYSIDE 3

104. In the last 12 months, on how many separate occasions have you traveled away from your home community and slept away?

NUMBER OF TRIPS ___
NONE 00 (GO TO 106)

105. In the last 12 months, have you been away from your home community for more than one month at a time?

YES 1
NO 2

106. In what month and year were you born?

MONTH __
DON'T KNOW MONTH 98
YEAR __
DON'T KNOW YEAR 9998

107. How old were you at your last birthday?
COMPARE AND CORRECT 106 AND/OR 107 IF INCONSISTENT.

AGE IN COMPLETED YEARS ___

108. Have you ever attended school?

YES 1
NO 2 (GO TO 112)

109. What is the highest level of school you attended: primary, middle/JSS, secondary/SSS or higher?

PRIMARY 1
MIDDLE/JSS 2
SECONDARY/SSS 3
HIGHER 4

110 .What is the highest grade you completed at that level?

GRADE ____

111. CHECK 109:

PRIMARY OR MIDDLE/JSS __ (GO TO 112)
SECONDARY/SSS OR HIGHER __ (GO TO 115)

112. Now I would like you to read this sentence to me.
SHOW SENTENCES BELOW 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 PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) ____ 4
BLIND/VISUALLY IMPARED 5

113. Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)?

YES 1
NO 2

114. CHECK 112:

CODE '2', '3', OR '4' CIRCLED __ (GO TO 115)
CODE '1' OR '5' CIRCLED __ (GO TO 116)

115. Do you read a newspaper or magazine 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

116. Do you listen to the radio 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

117. Do you watch television 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

118. What is your religion?

CATHOLIC 01
ANGLICAN 02
METHODIST 03
PRESBYTERIAN 04
PENTECOSTAL/CHARISMATIC 05
OTHER CHRISTIAN 06
MUSLIM 07
TRADITIONAL/SPIRITUALIST 08
NO RELIGION 09
OTHER (SPECIFY) _____ 96

119. To which ethnic group do you belong?

AKAN 01
GA/DANGME 02
EWE 03
GUAN 04
MOLE-DAGBANI 05
GRUSSI 06
GRUMA 07
MANDE 08
OTHER (SPECIFY) _____ 96

SECTION 2. REPRODUCTION

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.

201. Have you ever fathered any children with any woman?

YES 1
NO 2 (GO TO 206)
DON'T KNOW 8 (GO TO 206)

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

YES 1
NO 2 (GO 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 (GO 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, RECORD '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 or showed signs of life but did not survive?

YES 1
NO 2 (GO TO 208)
DON'T KNOW 8 (GO 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 CHILDREN ___

209. CHECK 208:

HAS HAD MORE THAN ONE CHILD __ (GO TO 210)
HAS HAD ONLY ONE CHILD __ (GO TO 212)
HAS NOT HAD ANY CHILDREN __ (GO TO 301)

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

YES 1 (GO TO 212)
NO 2

211. In all, how many women have you fathered children with?

NUMBER OF WOMEN___

212. How old were you when your (first) child was born?

AGE IN YEARS ___

213. CHECK 203 AND 205:

AT LEAST ONE LIVING CHILD __ (GO TO 214)
NO LIVING CHILDREN __ (GO TO 301)

214. How old is your (youngest) child?

AGE IN YEARS ___

215. CHECK 214:

(YOUNGEST) CHILD IS AGE 0-3 YEARS ____
OTHER ____ (GO TO 301)

216. What is the name of your (youngest) child?

(NAME OF (YOUNGEST) CHILD) ___________

217. When (NAME)'s mother was pregnant with (NAME), did she have any antenatal check-ups?

YES 1
NO 2 (GO TO 219)
DON'T KNOW 8 (GO TO 219)

218. Were you ever present during any of those antenatal check-ups?

PRESENT 1
NOT PRESENT 2

219. Was (NAME) born in a hospital or health facility?

HOSPITAL/HEALTH FACILITY 1 (GO TO 221)
OTHER 2

220. What was the main reason why (NAME)'s mother did not deliver in a hospital or health facility?

COSTS TOO MUCH 01
FACILITY NOT OPEN 02
TOO FAR/NO TRANSPORTATION 03
DON'T TRUST FACILITY/POOR QUALITY SERVICE 04
NO FEMALE PROVIDER AT FACILITY 05
NOT THE FIRST CHILD 06
CHILD'S MOTHER DID NOT THINK IT WAS NECESSARY 07
HE DID NOT THINK IT WAS NECESSARY 08
FAMILY DID NOT THINK IT NECESSARY 09
FAMILY/HUSBAND DID NOT ALLOW 10
NOT CUSTOMARY 11
S/HE DID NOT KNOW WHERE TO GO 12
HE COULD NOT ACCOMPANY HER 13
INCONVENIENT SERVICE HOURS 14
LONG WAITING LINE 15
OTHER (SPECIFY) _____ 96
DON'T KNOW 98

221. When a child has diarrhea, how much should he or she be given to drink: more than usual, the same amount as usual, less than usual, or should he or she not be given anything 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

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.

301. Which ways or methods have you heard about?

FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?

CIRCLE CODE IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.

CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE IF NOT RECOGNIZED. THEN, FOR METHODS 02, 07, 11, AND 12, ASK 302 IF 301 HAS CODE 1 CIRCLED.

01) FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES 1
NO 2
02) MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2
03) PILL Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04) IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05) INJECTABLES Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
06) IMPLANTS Women can have several 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
07) MALE CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09) DIAPHRAGM Women can place a thin flexible disk in their vagina before sexual intercourse.
YES 1
NO 2
10) FOAM OR JELLY Women can place a suppository, jelly, or cream in their vagina before sexual intercourse.
YES 1
NO 2
11) RHYTHM (CALENDAR) METHOD 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.
YES 1
NO 2
12) WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
13) LACTATIONAL AMENORRHEA METHOD (LAM)
YES 1
NO 2
14) EMERGENCY CONTRACEPTION As an emergency measure after unprotected sexual intercourse, women can take special pills at any time within five days to prevent pregnancy.
YES 1
NO 2
15) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
SPECIFY METHOD ONE _____
NO 2
YES 2
SPECIFY METHOD TWO _____
NO 2

302. Have you ever used (METHOD)?

02) MALE STERILIZATION Men can have an operation to avoid having any more children: Have you ever had an operation to avoid having any more children?
YES 1
NO 2
07) MALE CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
11) RHYTHM (CALENDAR) METHOD 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.
YES 1
NO 2
12) WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
13) LACTATIONAL AMENORRHEA METHOD (LAM)
YES 1
NO 2
15) OTHER METHOD 1
YES 1
NO 2
OTHER METHOD 2
YES 1
NO 2

303. In the last few months have you:

Heard about family planning on the radio?
Seen about family planning on the television?
Read about family planning in newspaper or magazine?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2

304. In the last few months, have you discussed the practice of family planning with health worker or health professional?

YES 1
NO 2

304A. In the last few months, have you discussed the practice of family planning with your wife/ cohabiting partner?

YES 1
NO 2

305. 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 if she has sexual intercourse?

YES 1
NO 2 (GO TO 307)
DON'T KNOW 8 (GO TO 307)

306. 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

307. Do you think that a woman who is breastfeeding her baby can become pregnant?

YES 1
NO 2
DEPENDS 3
DON'T KNOW 8

308. I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.

a) Contraception is women's business and a man should not have to worry about it.
b) Women who use contraception may become promiscuous.
c) Having too many children may be dangerous for a woman
d) It is better not to have more children than we can afford
e) Children in smaller families are more likely to succeed

CONTRACEPTION WOMAN'S BUSINESS
AGREE 1
DISAGREE 2
DK 8
WOMAN MAY BECOME PROMISCUOUS
AGREE 1
DISAGREE 2
DK 8
DANGEROUS FOR WOMAN
AGREE 1
DISAGREE 2
DK 8
CHILDREN NOT AFFORD
AGREE 1
DISAGREE 2
DK 8
CHILDREN SUCCEED
AGREE 1
DISAGREE 2
DK 8

309. CHECK 301 (07) KNOWS MALE CONDOM

YES ___ (GO TO 310)
NO ___ (GO TO 401)

310. Do you know of a place where a person can get condoms?

YES 1
NO 2 (GO TO 401)

311. Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ___________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST/CHIPS C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER/OUTREACH/PEER EDUCATOR ______ F
OTHER PUBLIC (SPECIFY) _____ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
PRIVATE DOCTOR I
PHARMACY J
CHEMICAL/DRUG STORE K
FP/PPAG CLINIC L
MATERNITY HOME M
OTHER PRIVATE MEDICAL (SPECIFY) ____ N
OTHER SOURCE
SHOP/MARKET O
CHURCH P
COMMUNITY VOLUNTEER Q
FRIEND/RELATIVE 4
OTHER (SPECIFY) _____ X

312. If you wanted to, could you yourself get a condom?

YES 1
NO 2

SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

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

YES, CURRENTLY MARRIED 1 (GO TO 404)
YES, LIVING WITH A WOMAN 2 (GO 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 (GO TO 413)

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

WIDOWED 1 (GO TO 410)
DIVORCED 2 (GO TO 410)
SEPARATED 3 (GO 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 more than one wife or woman you live with as if married?

YES 1
NO 2 (GO TO 407)

406. Altogether, how many wives do you have or other partners do you live with as if married?

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS __

407. CHECK 405:

ONE WIFE/PARTNER: Please tell me the name of your wife (the woman you are living with as if married).

MORE THAN (NAME) ONE WIFE/PARTNER: Please tell me the name of each of your current wives (and/or of each woman you are living with as if married).

RECORD THE NAME AND THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE AND LIVE-IN PARTNER.

IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

ASK FOR EACH PERSON.

NAME ___
LINE NUMBER ___

408. How old was (NAME) on her last birthday?

AGE____

409. CHECK 407:

ONE WIFE/PARTNER __ (GO TO 410)
MORE THAN ONE WIFE/PARTNER __ (GO TO 411A)

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

ONLY ONCE 1
MORE THAN ONCE 2 (GO TO 411A)

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

411A. Now I would like to ask a question about your first wife/partner. In what month and year did you start living with your first wife/partner?

MONTH __
DON'T KNOW MONTH 98
YEAR __ (GO TO 413)
DON'T KNOW YEAR 9998

412. How old were you when you first started living with her?

AGE____

413. CHECK FOR THE PRESENCE OF OTHERS.
BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

Now I would like to ask you some questions about sexual activity in order to gain a better understanding of some important life issues.

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

NEVER HAD SEXUAL INTERCOURSE 00
AGE IN YEARS __ (GO TO 417)
FIRST ITME WHEN STARTED LIVING WITH (FIRST) WIFE/PARTNER 95 (GO TO 417)

415. CHECK 107:

AGE 15-24 __ (GO TO 416)
AGE 25-59 __ (GO TO 501)

416. Do you intend to wait until you get married to have sexual intercourse for the first time?

YES 1 (GO TO 501)
NO 2 (GO TO 501)
DON'T KNOW/UNSURE 8 (GO TO 501)

417. CHECK 107:

AGE 15-24 __ (GO TO 418)
AGE 25-59 __ (GO TO 419)

418. The first time you had sexual intercourse, was a condom used?

YES 1
NO 2
DON'T KNOW/DON'T REMEMBER 8

419. 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 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___ (GO TO 435)

420. Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question. (GO TO 422)

421. When was the last time you had sexual intercourse with this person?
[Exclude Last Sexual Partner]

DAYS 1 ___
WEEKS 2 ___
MONTHS 3 ___

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

YES 1
NO 2 (GO TO 424)

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

YES 1
NO 2

424. What was your relationship to this (second/third) 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 (GO TO 426)
LIVE-IN PARTNER 2
GIRLFRIEND NOT LIVING WITH RESPONDENT 3
CASUAL ACQUAINTANCE 4
PROSTITUTE 5
OTHER (SPECIFY) ____ 6

425. For how long (have you had/did you have) a sexal relationship with this (last/second/third) person?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.

DAYS 1 ___
MONTHS 2 ___
YEARS 3 ___

426. The last time you had sexual intercourse with this (last/second/third) person, did you or this person drink alcohol?

YES 1
NO 2 (GO TO 428)

427. Were you or your partner drunk at that time? IF YES: Who was drunk?

RESPONDENT ONLY 1
PARTNER ONLY 2
RESPONDENT AND PARTNER BOTH 3
NEITHER 4

428. Apart from [this person/these people], have you had sexual intercourse with any other person in the last 12 months?
[Exclude Last Third-To-Last Sexual Partner]

YES 1 (GO BACK TO 421 IN NEXT COLUMN)
NO 2 (GO TO 430)

429. In total, with how many different people have you had sexual intercourse in the last 12 months?

IF NON-NUMBERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'.

NUMBER OF PARTNERS LAST 12 MONTHS __
DON'T KNOW 98

430. CHECK 424 (ALL COLUMNS):

AT LEAST ONE PARTNER IS PROSTITUTE __ (GO TO 431)
NO PARTNERS ARE PROSTITUTES __ (GO TO 432)

431. CHECK 424 AND 422 (ALL COLUMNS):

OTHER __ (GO TO 434A)
CONDOM USED WITH EVERY PROSTITUTE __ (GO TO 434)

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

YES 1
NO 2 (GO TO 434A)

433. The last time you paid someone in exchange for having sexual intercourse, was a (male/female) condom used?

YES 1
NO 2 (GO TO 434A)

434. Was a condom used during sexual intercourse every time you paid someone in exchange for having sexual intercourse in the last 12 months?

YES 1
NO 2
DK 8

434A. 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 GREATER THAN 95, WRITE '95.'

NUMBER OF PARTNERS IN MONTH __
DON'T KNOW 98

435. In total, with how many different people have you had sexual intercourse in your lifetime?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95.'

NUMBER OF PARTNERS IN LIFETIME __
DON'T KNOW 98

436. CHECK 422, MOST RECENT PARTNER (FIRST COLUMN):

CONDOM USED __ (GO TO 437)
NOT ASKED __ (GO TO 442)
NO CONDOM USED __ (GO TO 442)

437. You told me that a condom was used the last time you had sex. May I see the package of condoms you were using at that time?
RECORD NAME OF BRAND IF PACKAGE SEEN.

PACKAGE SEEN 1 (GO TO 439)
BRAND NAME (SPECIFY) _____
DOES NOT HAVE/NOT SEEN 2

438. Do you know the brand name of the condom used at that time?
RECORD NAME OF BRAND.

BRAND NAME ____ (SPECIFY)
DON'T KNOW 98

439. How many condoms did you get the last time?

NUMBER OF CONDOMS ___
DON'T KNOW 998

440. The last time you obtained the condoms, how much did you pay in total, including the cost of the condom(s) and any consultation you may have had?

COST ___.___
FREE 99.95
DON'T KNOW 99.98

441. Where did you get the condom the last time?

PROBE TO IDENTIFY TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ______________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC 11
GOVT. HEALTH CENTER 12
GOVT. HEALTH POST/CHPS 13
FAMILY PLANNING CLINIC 14
MOBILE CLINIC 15
FIELDWORKER/OUTREACH/PEER EDUCATOR 16
OTHER PUBLIC (SPECIFY) ____ 17
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 20
PRIVATE DOCTOR 21
PHARMACY 22
CHEMICAL/DRUG STORE 23
FP/PPAG CLINIC 24
MATERNITY HOME 25
OTHER PRIVATE MEDICAL (SPECIFY) _____ 26
OTHER SOURCE
SHOP/MARKET 31
CHURCH 32
COMMUNITY VOLUNTEER 33
FRIEND/RELATIVE 34
OTHER (SPECIFY) _____ 96
DON'T KNOW 98

442. CHECK 302 (02): RESPONDENT EVER STERILIZED

NO ___ (GO TO 443)
YES ___ (GO TO 501)

443. 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
NO 2 (GO TO 501)
DON'T KNOW 8 (GO TO 501)

444. 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
PILL B
IUD C
INJECTABLES D
IMPLANTS E
FEMALE CONDOM F
DIAPHRAGM G
FOAM/JELLY H
LAM I
RHYTHM METHOD J
WITHDRAWAL K
OTHER (SPECIFY) _____ X

SECTION 5. FERTILITY PREFERENCES

501. CHECK 407:

ONE OR MORE WIVES/PARTNERS ___ (GO TO 502)
QUESTION NOT ASKED __ (GO TO 508)

502. CHECK 302:

MAN NOT STERILIZED __ (GO TO 503)
MAN STERILIZED __ (GO TO 508)

503. (Is your wife (partner)/Are any of your wives (partners)) currently pregnant?

YES 1
NO 2
DON'T KNOW 8

504. CHECK 503:

NO WIFE/PARTNER PREGNANT OR DON'T KNOW:
Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

WIFE(WIVES)/PARTNER(S) PREGNANT:
Now I have some questions about the future. After the child(ren) you and your (wife(wives)/partner(s)) are expecting now, 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 (GO TO 508)
COUPLE INFECUND 3 (GO TO 508)
WIFE (WIVES)/PARTER(S) STERILIZED 4 (GO TO 508)
UNDECIDED/DON'T KNOW 8 (GO TO 508)

505. CHECK 407:

ONE WIFE/PARTNER __ (GO TO 506)
MORE THAN ONE WIFE/PARTNER __ (GO TO 507)

506. CHECK 503:

WIFE/PARTNER NOT PREGNANT OR DON'T KNOW:
How long would you like to wait from now before the birth of (a/another) child?

WIFE/PARTNER PREGNANT
After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

MONTH 1 __ (GO TO 508)
YEARS 2 __ (GO TO 508)
SOON/NOW 993 (GO TO 508)
COUPLE INFECUND 994 (GO TO 508)
OTHER (SPECIFY) ____ 996 (GO TO 508)
DON'T KNOW 998 (GO TO 508)

507. How long would you like to wait from now before the birth of (a/another) child?

MONTH 1 __
YEARS 2 __
SOON/NOW 993
HE/ALL HIS WIVES/PARTNERS ARE INFECUND 994
OTHER (SPECIFY) ____ 996
DON'T KNOW 998

508. CHECK 203 AND 205:

HAS LIVING CHILDREN:
If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?

NO LIVING CHILDREN:
If you could choose exactly the number of children to have in your whole life, how many would that be?

PROBE FOR A NUMERIC RESPONSE.

NONE 00 (GO TO 601)
NUMBER __
OTHER (SPECIFY) ____ 96 (GO TO 601)

509. How many of these children would you like to be boys, how many would you like to be girls and for how many would the sex not matter?

BOYS NUMBER ___
GIRLS NUMBER ___
EITHER NUMBER ___
OTHER (SPECIFY) ____ 96

SECTION 6. EMPLOYMENT AND GENDER ROLES

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

YES 1 (GO TO 604)
NO 2

602. Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, or any other such reason?

YES 1 (GO TO 604)
NO 2

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

YES 1
NO 2 (GO TO 613)

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

_______________ ___
_______________
_______________

605. CHECK 604:

WORKS IN AGRICULTURE __ (GO TO 606)
DOES NOT WORK IN AGRICULTURE __ (GO TO 607)

606. 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

607. Do you do this work for a member of your family, for someone else, or are you self-employed?

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

608. 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

609. 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

610. CHECK 407:

ONE OR MORE WIVES/PARTNERS __ (GO TO 611)
QUESTION NOT ASKED __ (GO TO 613)

611. CHECK 609:

CODE 1 OR 2 CIRCLED __ (GO TO 612)
OTHER __ (GO TO 613)

612. Who usually decides how the money you earn will be used: mainly you, mainly your (wife (wives)/partner(s)), or you and your (wife (wives)/partner(s)) jointly?

RESPONDENT 1
WIFE (WIVES)/PARTNER(S) 2
RESPONDENT AND WIFE (WIVES)/PARTNER(S) JOINTLY 3
OTHER (SPECIFY) ___ 6

613. In a couple, who do you think should have the greater say in each of the following decisions: the husband, the wife or both equally:

a) making major household purchases?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
b) making purchases for daily household needs?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
c) deciding about visits to the wife's family or relatives?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
d) deciding what to do with the money she earns for her work?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
e) deciding how many children to have?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8

614. I will now read you some statements about pregnancy. Please tell me if you agree or disagree with them.

a) Childbearing is a woman's concern and there is no need for the father to get involved.
b) It is crucial for the mother's and child's health that a woman have assistance from a doctor or nurse at delivery.

CHILDBEARING WOMAN'S CONCERN
AGREE 1
DISAGREE 2
DK 8
DOCTOR/NURSE'S ASSISTANCE CRUCIAL
AGREE 1
DISAGREE 2
DK 8

615. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

If she goes out without telling him?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she burns the food?

GOES OUT
YES 1
NO 2
DK 8
NEGL. CHILDREN
YES 1
NO 2
DK 8
ARGUES
YES 1
NO 2
DK 8
REFUSES SEX
YES 1
NO 2
DK 8
BURNS FOOD
YES 1
NO 2
DK 8

616. Do you think that if a woman refuses to have sex with her husband when he wants her to, he has the right to...

a) Get angry and reprimand her?
YES 1
NO 2
DON'T KNOW/DEPENDS 8
b) Refuse to give her money or other means of support?
YES 1
NO 2
DON'T KNOW/DEPENDS 8
c) Use force and have sex with her even if she doesn't want to?
YES 1
NO 2
DON'T KNOW/DEPENDS 8
d) Have sex with another woman?
YES 1
NO 2
DON'T KNOW/DEPENDS 8

SECTION 7. HIV/AIDS

Now I would like to talk about something else.

701. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 733)

702. 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 the AIDS virus by using a condom every time they have sex?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

706. Can people reduce their chance of getting the AIDS virus by not having sexual intercourse at all?

YES 1
NO 2
DON'T KNOW 8

707. Can people get the AIDS virus because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

708. Is it possible for a healthy-looking person to have the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

709. Can the virus that causes AIDS be transmitted from a mother to her baby:

During pregnancy?
During delivery?
By breastfeeding?

DURING PREG
YES 1
NO 2
DON'T KNOW 8
DURING DELIVERY
YES 1
NO 2
DON'T KNOW 8
BREASTFEEDING
YES 1
NO 2
DON'T KNOW 8

710. CHECK 709:

AT LEAST ONE 'YES' __ (GO TO 711)
OTHER __ (GO TO 712)

711. Are there any special drugs that a doctor or a nurse can give to a woman infected with the AIDS virus to reduce the risk of transmission to the baby?

YES 1
NO 2
DON'T KNOW 8

712. Have you heard about special antiretroviral drugs (USE LOCAL NAME) that people infected with the AIDS virus can get from a doctor or a nurse to help them live longer?

YES 1
NO 2
DON'T KNOW 8

712A. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

713. I do not want to know the results, but have you ever been tested to see if you have the AIDS virus?

YES 1
NO 2 (GO TO 718)

714. When was the last time you were ever tested?

LESS THAN 12 MONTHS AGO 1
12-23 MONTHS AGO 2
2 OR MORE YEARS AGO 3

715. The last time you were tested, did you ask for the test, was it offered to you and you accepted, or was it required?

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

716. I do not want to know the results, but did you get the results of the test?

YES 1
NO 2

717. Where was the test done?

PROBE TO IDENTIFY TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ______________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC 11 (GO TO 720)
GOVT. HEALTH CENTER 12 (GO TO 720)
GOVT. HEALTH POST/CHPS 13 (GO TO 720)
STAND-ALONE VCT CENTER 14 (GO TO 720)
FAMILY PLANNING CLINIC 15 (GO TO 720)
MOBILE CLINIC 16 (GO TO 720)
FIELDWORKER/OUTREACH/PEER EDUCATOR 17 (GO TO 720)
OTHER PUBLIC (SPECIFY) ____ 18 (GO TO 720)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 21 (GO TO 720)
STAND-ALONE VCT CENTER 22 (GO TO 720)
PHARMACY 23 (GO TO 720)
CHEMICAL/DRUG STORE 24 (GO TO 720)
FP/PPAG CLINIC 25 (GO TO 720)
MATERNITY HOME 26 (GO TO 720)
OTHER PRIVATE MEDICAL (SPECIFY) _____ 27 (GO TO 720)
OTHER (SPECIFY) _____ 96 (GO TO 720)

718. Do you know of a place where people can go to get tested for the AIDS virus?

YES 1
NO 2 (GO TO 720)

719. Where is that? Any other place?

PROBE TO IDENTIFY TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ______________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST/CHPS C
STAND-ALONE VCT CENTER D
FAMILY PLANNING CLINIC E
MOBILE CLINIC F
FIELDWORKER/OUTREACH/PEER EDUCATOR G
OTHER PUBLIC (SPECIFY) ____
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H/I
STAND-ALONE VCT CENTER J
PHARMACY K
CHEMICAL/DRUG STORE L
FP/PPAG CLINIC M
MATERNITY HOME N
OTHER PRIVATE MEDICAL (SPECIFY) _____ O
OTHER (SPECIFY) _____ X

720. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

721. If a member of your family got infected with the AIDS virus, would you want it to remain a secret or not?

YES, REMAIN A SECRET 1
NO 2
DK/NOT SURE/DEPENDS 8

722. If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

723. In your opinion, if a female teacher has the AIDS virus, but is not sick, should she be allowed to continue teaching in the school?

SHOULD BE ALLOWED 1
SHOUD NOT BE ALLOWED 2
DK/NOT SURE/DEPENDS 8

731. Should children age 12-14 years be taught about using condoms to avoid getting AIDS?

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

732. Should children age 12-14 years be taught to wait until they get married to have sexual intercourse in order to avoid getting AIDS?

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

733. CHECK 701:

HEARD ABOUT AIDS:
Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

NOT HEARD ABOUT AIDS:
Have you heard about infections that can be transmitted through sexual contact?

YES 1
NO 2

734. CHECK 414:

HAS HAD SEXUAL INTERCOURSE __ (GO TO 735)
HAS NOT HAD SEXUAL INTERCOURSE __ (GO TO 742)

735. CHECK 733: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES 1 (GO TO 736)
NO 2 (GO TO 737)

736. Now I would like to ask you some questions about your health in the last twelve months. During the last twelve months have you had a sexually transmitted disease?

YES 1
NO 2
DON'T KNOW 8

737. Sometimes men experience an abnormal discharge from their penis. During the last twelve months, have you had an abnormal discharge from your penis?

YES 1
NO 2
DON'T KNOW 8

738. Sometimes men have a sore or ulcer on or near their penis. During the last twelve months have you had a sore or ulcer on or near your penis?

YES 1
NO 2
DON'T KNOW 8

739. CHECK 736, 737 AND 738:

HAS HAD AN INJECTION (ANY 'YES') __ (GO TO 740)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW __ (GO TO 742)

740. The last time you had (PROBLEM FROM 736/737/738), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 724)

741. Where did you go? Any other place?

PROBE TO IDENTIFY TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ______________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST/CHPS C
FAMILY PLANNING CLINIC D
STAND-ALONE VCT CENTER E
FIELDWORKER/OUTREACH/PEER EDUCATOR F
OTHER PUBLIC (SPECIFY) ____ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
STAND-ALONE VCT CENTER I
PHARMACY J
CHEMICAL/DRUG STORE K
FP/PPAG CLINIC L
MATERNITY HOME M
OTHER PRIVATE MEDICAL (SPECIFY) _____ N
OTHER (SPECIFY) _____ X
SHOP/MARKET O
FRIEND/RELATIVE P
TRADITIONAL PRACTITIONER Q
OTHER (SPECIFY) ____ X

742. Husband and wives do not always agree in everything. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in refusing to have sex with him?

YES 1
NO 2
DON'T KNOW 8

743. 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

744. Is a wife justified in refusing to have sex with her husband when she is tired or not in the mood?

YES 1
NO 2
DON'T KNOW 8

745. Is a wife justified in refusing to have sex with her husband when she knows her husband has sex with other women?

YES 1
NO 2
DON'T KNOW 8

SECTION 8. OTHER HEALTH ISSUES

801. Have you ever heard of an illness called tuberculosis or TB?

YES 1
NO 2 (GO TO 805)

802. How does tuberculosis spread from one person to another? PROBE: Any other ways?
RECORD ALL MENTIONED.

THROUGH THE AIR WHEN COUGHING OR SNEEZING A
THROUGH SHARING UTENSILS B
THROUGH TOUCHING A PERSON WITH TB C
THROUGH FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER (SPECIFY) ____ X
DON'T KNOW Z

803. Can tuberculosis be cured?

YES 1
NO 2
DON'T KNOW 8

804. If a member of your family got tuberculosis, would you want it to remain a secret or not?

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

805. Some men are circumcised. Are you circumcised?

YES 1
NO 2
DON'T KNOW 8

806. 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 GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ___
NONE 00 (GO TO 810)

807. 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 GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ___
NONE 00 (GO TO 810)

808. The last time you had an injection given to you by a health worker, where did you go to get the injection?

PROBE TO IDENTIFY TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ______________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC 11
GOVT. HEALTH CENTER 12
GOVT. HEALTH POST/CHPS 13
STAND-ALONE VCT CENTER 14
MOBILE CLINIC 15
FIELDWORKER/OUTREACH/PEER EDUCATOR 16
OTHER PUBLIC (SPECIFY) ____ 17
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 21
STAND-ALONE VCT CENTER 22
PHARMACY 23
CHEMICAL/DRUG STORE 24
OTHER PRIVATE MEDICAL (SPECIFY) _____ 26
OTHER PLACE
AT HOME 31
OTHER (SPECIFY) ____ 96

809. Did the person who gave you that injection take the syringe and needle from a new, unopened package?

YES 1
NO 2
DON'T KNOW 8

810. Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 812)

811. In the last 24 hours, how many cigarettes did you smoke?

CIGARETTES ___

812. Do you currently smoke or use any other type of tobacco?

YES 1
NO 2 (GO TO 813A)

813. What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.

PIPE A
CHEWING TOBACCO B
SNUFF C
CIGAR D
OTHER (SPECIFY) ____ X

813A. Do you consume alcoholic beverages?

YES 1
NO 2 (GO TO 814)

813B. In the last 7 days (a week) did you drink an alcoholic beverage?
IF 'YES', PROBE: How many times?

ONCE 01
2-3 TIMES 02
4 TIMES OR MORE 03
NONE 04

813C. How often do you get drunk: often, only sometimes, or never?

OFTEN 01
SOMETIMES 02
NEVER 03

814. Do you have any health insurance or are you a member of a mutual health organization?

YES 1
NO 2 (GO TO 821)

815. What type of health insurance?
RECORD ALL MENTIONED.

NATIONAL/DISTRICT HEALTH INSURANCE (NHIS) A
HEALTH INSURANCE THROUGH EMPLOYER B
MUTUAL HEALTH ORGANIZATION/COMMUNITY-BASED HEALTH INSURANCE C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
OTHER (SPECIFY) ____ X

815A. CHECK 815:

CODE 'A' FOR NHIS NOT CIRCLED __ (GO TO 815B)
CODE 'A' FOR NHIS CIRCLED __ (GO TO 815C)

815B. Why have you not registered with the National Health Insurance Scheme (NHIS)? RECORD ALL MENTIONED.

NOT HEARD OF NHIS A (GO TO 815I)
CANNOT AFFORD PREMIUM B (GO TO 815I)
DO NOT TRUST C (GO TO 815I)
DON'T NEED HEALTH INSURANCE D (GO TO 815I)
NHIS DOES NOT COVER HEALTH SERVICES I NEED E (GO TO 815I)
OTHER (SPECIFY) ____ X (GO TO 815I)

815C. Did you pay your NHIS membership yourself?

YES, PAID MYSELF 01
YES, PAID BY A RELATIVE/FRIEND 02
YES, PAID BY A EMPLOYER/SSNIT 03
NO, EXEMPT AS ELDERLY (70+) 04
NO, EXEMPT AS PENSIONER 05
NO, EXEMPT AS INDIGENT (POOR) 06
NO, OTHER (SPECIFY) _____ 96

815D. Do you hold a valid National Health Insurance Scheme (NHIS) card?
IF ANSWER IS 'YES', REQUEST TO SEE THE CARD.

YES, CARD SEEN 1 (GO TO 815F)
YES, CARD NOT SEEN 2 (GO TO 815F)
NO 3

815E. Why do you not have a valid NHIS card?

REGISTERED, NOT PAID FULLY 1 (GO TO 815I)
REGISTERED, CARD NOT RECEIVED 2 (GO TO 815I)
REGISTERED, WAITING PERIOD 3 (GO TO 815I)
NOT RENEWED REGISTRATION 4 (GO TO 815G)
LOST NHIS CARD 5 (GO TO 815I)
OTHER (SPECIFY) ______ 6 (GO TO 815I)

815F. How many weeks did it take you to obtain your NHIS card?

NUMBER OF WEEKS __ (GO TO 815I)
DON'T KNOW 98 (GO TO 815I)

815G. Do you plan to renew the NHIS card?

YES 1 (GO TO 815I)
NO 2
DON'T KNOW/NOT SURE 8 (GO TO 815I)

815H. Why do you not want to renew the NHIS card? Anything else?
RECORD ALL MENTIONED.

HAVE NOT BEEN SICK A
PREMIUM EXPENSIVE B
STILL PAY OUT OF POCKET C
WORSE QUALITY CARE WITH CARD D
WAITING TIME FOR CARD LONG E
USED SERVICES NOT COVERED F
DID NOT USE ANY HEALTH SERVICES G
USE CLINICS OR TRADITIONAL PRACTITIONERS NOT COVERED H
OTHER (SPECIFY) ____ X

815I. Do you have to pay out of pocket for drugs and services?

YES 1
NO 2
SOMETIMES 3

815J. Are there any services that you need from a health provider that are not covered by NHIS?

YES 1
NO 2 (GO TO 815L)

815K. What are these services? Anything else?
RECORD ALL MENTIONED.

FAMILY PLANNING A
LABORATORY INVESTIGATION B
CARE FOR NEWBORN FOR UP TO 3 MONTHS C
PROSTATE CANCER SCREENING/TREATMENT D
OTHER (SPECIFY) ____ X

815L. In your opinion, do NHIS card holders get better/same/worse service than others?

BETTER 1
SAME 2
WORSE 3
DON'T KNOW/NOT SURE 8

815M. In your opinion, did you receive good service last time you were treated at a clinic or hospital? IF NO, PROBE

YES 1
NO, WAITING TIMES WERE TOO LONG 2
NO, STAFF NOT POLITE 3
NO, DID NOT RECEIVE ENOUGH INFORMATION ABOUT ILLNESS AND TREATMENT 4
OTHER (SPECIFY) _____ 6

I am going to ask you about the time you spent being physically active in the last 7 days. This is about the activities you do at work, as part of your house and yard work, to get from place to place in your spare time, exercise or sport.

Now, think about all the vigorous activities which take hard physical effort that you did in the past 7 days: activities that make you breathe much harder than normal and may include heavy lifting, digging, jogging, or fast bicycling. Think about only those physical activities that you did at least 15 minutes at a time.

821. In the last 7 days, on how many days did you do vigorous physical activities that lasted for at least 15mins each time?
IF 'NONE' RECORD '0'.

NUMBER OF DAYS ___
DON'T KNOW 8

822. How many hours do you rest a day, including naps and sleep both during the day and night?

1-3 HOURS 1
4-6 HOURS 2
7-9 HOURS 3
10 AND MORE HOURS 4
DON'T KNOW 8

Now I would like to ask you about liquids and foods that you consume.

823. How many glasses of water do you drink in one day on average?
IF MORE THAN 9, RECORD '9', IF 'NONE' RECORD '0'

NUMBER OF GLASSES ___

824. In a typical week, on how many days do you eat fruits, for example, mangoes, paw paw, banana, orange, avocados, tomatoes, passion fruit, etc?
IF 'NONE' RECORD '0'.

NUMBER OF DAYS ___
DON'T KNOW/NOT SURE 8 (GO TO 826)

825. On a day when you eat fruits, how many servings do you eat on average?
IF 'NONE' RECORD '0'.

NUMBER OF SERVINGS __
DON'T KNOW/NOT SURE 8

826. In a typical week, on how many days do you eat vegetables, for example carrots, cabbage, dark green leafy vegetables (e.g. kontomire), pumpkin, squash, etc?
IF 'NONE' RECORD '0'.

NUMBER OF DAYS ___
DON'T KNOW/NOT SURE 8 (GO TO 900)

827. On a day when you eat vegetables, how many servings do you eat on average?
IF 'NONE' RECORD '0'.

NUMBER OF SERVINGS ___
DON'T KNOW/NOT SURE 8

SECTION 9. DOMESTIC VIOLENCE

900. CHECK HH Q.138 AND COVER PAGE OF WOMAN'S QUESTIONNAIRE:

MAN SELECTED FOR THIS SECTION __ (GO TO 901)
MAN NOT SELECTED __ (GO TO 935)

901. CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.

PRIVACY OBTAINED 1 (GO TO PARAGRAPH BELOW)
PRIVACY NOT POSSIBLE 2 (GO TO 934)

READ TO THE RESPONDENT

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

902. CHECK 401 AND 402:

CURRENTLY MARRIED/LIVING WITH A WOMAN __ (GO TO 903)
FORMERLY MARRIED/LIVED WITH A MAN __ (READ IN PAST TENSE, GO TO 903)
NEVER MARRIED/NEVER LIVED WITH A WOMAN __(GO TO 914)

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

a) She (is/was) jealous or angry if you (talk/talked) to other women?
b) She frequently (accuses/accused) you of being unfaithful?
c) She (does/did) not permit you to meet your male friends?
d) She (tries/tried) to limit your contact with your family?
e) She (insists/insisted) on knowing where you (are/were) at all times?
f) She frequently (complains/complained) that you don't provide enough money?
g) She frequently (refuses/refused) to cook and (denies/denied) you food?
h) She frequently (refuses/refused) or (denies/denied) to have sexual intercourse with you when you want her to?

JEALOUS
YES 1
NO 2
DK 8
ACCUSES
YES 1
NO 2
DK 8
NOT MEET FRIENDS
YES 1
NO 2
DK 8
NO FAMILY
YES 1
NO 2
DK 8
WHERE YOU ARE
YES 1
NO 2
DK 8
MONEY
YES 1
NO 2
DK 8
DENIES FOOD
YES 1
NO 2
DK 8
DENIES SEX
YES 1
NO 2
DK 8

Now if you will permit me, I need to ask some more questions about your relationship with your (last) wife/partner.

If we should come to any question that you do not want to answer, just let me know and we will go on to the next question.

904. A (Does/did) your (last) wife/partner ever:

a) say or do something to humiliate you in front of others?
YES 1
NO 2
b) threaten to hurt or harm you or someone close to you?
YES 1
NO 2
c) insult you or make you feel bad about yourself?
YES 1
NO 2
d) scream and shout at you?
YES 1
NO 2

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

a) say or do something to humiliate you in front of others?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
b) threaten to hurt or harm you or someone close to you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
c) insult you or make you feel bad about yourself?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3
d) scream and shout at you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3

905. A (Does/did) your (last) wife/partner ever do any of the following things to you:

a) push you, shake you, or throw something at you?
YES 1
NO 2
b) slap you?
YES 1
NO 2
c) twist your arm?
YES 1
NO 2
d) punch you with her fist or with something that could hurt you?
YES 1
NO 2
e) kick you, drag you or beat you up?
YES 1
NO 2
f) try to choke you or burn you on purpose?
YES 1
NO 2
g) threaten or attack you with a knife, gun, or any other weapon?
YES 1
NO 2
h) killed or pulled your external genitalia?
YES 1
NO 2

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

a) push you, shake you, or throw something at you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
b) slap you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
c) twist your arm?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
d) punch you with her fist or with something that could hurt you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
e) kick you, drag you or beat you up?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
f) try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
g) threaten or attack you with a knife, gun, or any other weapon?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
h) killed or pulled your external genitalia?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3

906. CHECK 905A (a-h):

AT LEAST ONE 'YES' __ (GO TO 907)
NOT A SINGLE 'YES' __ (GO TO 909)

907. How long after you first got married to/started living with your (last) wife/partner did (this/any of these things) first happen?
IF LESS THAN ONE YEAR, RECORD '00'.

NUMBER OF YEARS ____
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95

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

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

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

YES 1
NO 2 (GO TO 912)

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

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

912. Does (did) your wife/partner drink alcohol?

YES 1
NO 2 (GO TO 914)

913. How often does (did) she get drunk: often, only sometimes, or never?

OFTEN 1
SOMETIMES 2
NEVER 3

914. CHECK 401 AND 402:

EVER MARRIED/LIVED WITH A MAN:
From the time you were 15 years old has anyone other than your (current/last) wife/partner hit, slapped, kicked, or done anything else to hurt you physically?

NEVER MARRIED/ NEVER LIVED WITH A MAN
From the time you were 15 years old has anyone ever hit, kicked, slapped, or done anything else to hurt you physically?

YES 1
NO 2 (GO TO 928)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 928)

915. Who has hurt you in this way? Anyone else?
RECORD ALL MENTIONED.

MOTHER/STEP-MOTHER A
FATHER/STEP-FATHER B
SISTER/BROTHER C
DAUGHTER/SON D
OTHER RELATIVE E
FORMER WIFE/PARTNER F
CURRENT GIRLFRIEND G
FORMER GIRLFRIEND H
MOTHER-IN-LAW I
FATHER-IN-LAW J
OTHER-IN-LAW K
TEACHER L
EMPLOYER/SOMEONE AT WORK M
POLICE/SOLDIER N
MALE FRIEND O
STRANGER P
OTHER (SPECIFY) _____ X

916. In the last 12 months how often have you been hit, slapped, kicked, or physically hurt by this/these person(s): often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

928. CHECK 905A (a-h) AND 914:

AT LEAST ONE 'YES' __ (GO TO 929)
NOT A SINGLE 'YES' __ (GO TO 932)

929. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help to stop (the/these) person(s) from doing this to you again?

YES 1
NO 2 (GO TO 931)

930. From whom have you sought help? Anyone else?
RECORD ALL MENTIONED.

OWN FAMILY A (GO TO 932)
WIFE/PARTNER'S FAMILY B (GO TO 932)
CURRENT/LAST/LATE WIFE/PARTNER C (GO TO 932)
MALE FRIEND E (GO TO 932)
FEMALE FRIEND F (GO TO 932)
NEIGHBOR G (GO TO 932)
RELIGIOUS LEADER H (GO TO 932)
DOCTOR/MEDICAL PERSONNEL I (GO TO 932)
POLICE J (GO TO 932)
LAWYER K (GO TO 932)
SOCIAL SERVICE ORGANIZATION L (GO TO 932)
COMMUNITY LEADER/LOCAL ADMIN M (GO TO 932)
OTHER (SPECIFY) _____ X (GO TO 932)

931. Have you ever told any one else about this?

YES 1
NO 2

932. As far as you know, did your father ever beat your mother?

YES 1
NO 2

932A. As far as you know, did your mother ever beat your father?

YES 1
NO 2
DON'T KNOW 8

THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HIS ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.

933. DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

WIFE
YES ONCE 1
YES, MORE THAN ONCE 2
NO 3
OTHER FEMALE ADULT
YES ONCE 1
YES, MORE THAN ONCE 2
NO 3
MALE ADULT
YES ONCE 1
YES, MORE THAN ONCE 2
NO 3

934. INTERVIEWER'S COMMENTS / EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE

____________________________

935. 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
____________________________________________
____________________________________________
____________________________________________

NAME OF SUPERVISOR: ____________________ DATE: _____________________

EDITOR'S OBSERVATIONS
_____________________________________________
____________________________________________
____________________________________________

NAME OF EDITOR: ______________________ DATE: _______________________