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CENTRAL BUREAU OF STATISTICS
KENYA DEMOGRAPHIC AND HEALTH SURVEY 2003
MAN'S QUESTIONNAIRE

IDENTIFICATION

PROVINCE* _________________

NAIROBI 1
CENTRAL 2
COAST 3
EASTERN 4
NYANZA 5
R.VALLEY 6
WESTERN 7
NORTHEASTERN 8

DISTRICT ___________________
LOCATION/TOWN ___________________
SUBLOCATION/WARD _______________
NASSEP CLUSTER NUMBER ______________
KDHS CLUSTER NUMBER __________________
HOUSEHOLD NUMBER _______________

LOCATION

NAIROBI/MOMBASA/KISUMU 1
NAKURU/ELDORET/THIKA/NYERI 2
SMALL TOWN 3
RURAL 4

NAME OF HOUSEHOLD HEAD _____________

NAME AND LINE NUMBER OF MAN _________________

HOUSEHOLD NUMBER __

INTERVIEWER VISITS

INTERVIEW VISIT 1 (REPEAT FOR INTERVIEW VISIT 2 AND VISIT 3)

DATE ______________
INTERVIEWER'S NAME _______________
RESULT** ______________

NEXT VISIT:
DATE ______
TIME _____

FINAL VISIT
DAY ____
MONTH ____
YEAR (2003) ___
INT. CODE ___
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

LANGUAGE OF QUESTIONNAIRE: ENGLISH

LANGUAGE OF INTERVIEW *** ______________

HOME LANGUAGE OF RESPONDENT*** ____________

WAS A TRANSLATOR USED?

YES 1
NO 2

*** LANGUAGE CODES:

01 EMBU
02 KALENJIN
03 KAMBA
04 KIKUYU
05 KISII
06 LUHYA
07 LUO
08 MASAI
09 MERU
10 MIJIKENDA
11 SOMALI
12 KISWAHILI
13 ENGLISH
14 OTHER_________

SUPERVISOR
NAME ________________

FIELD EDITOR
NAME ________________

OFFICE EDITOR __

KEYED BY ___

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

Hello. My name is ___________ and I am working with the Central Bureau of Statistics. We are conducting a national survey about the health of men, women and children. We would very much appreciate your participation in this survey. I would like to ask you some questions about yourself and your family. This information will help the government to plan health services. The survey usually takes between 30 and 40 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

Do you have any questions 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)

101. RECORD THE TIME

HOUR ______
MINUTES ______

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

NAIROBI/MOMBASA/KISUMU 1
OTHER CITY/TOWN 2
COUNTRYSIDE 3
OUTSIDE KENYA 4

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

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

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

NAIROBI/MOMBASA/KISUMU 1
OTHER CITY/TOWN 2
COUNTRYSIDE 3

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

NUMBER OF TRIPS AWAY ____
NONE 00 (GO TO 107)

106. In the last 12 months, have you been away from your home community for more than 1 month at a time?

YES 1
NO 2

107. In what month and year were you born?

MONTH _____
DOES NOT KNOW MONTH 98
YEAR ______
DOES NOT KNOW YEAR 9998

108. How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

AGE IN COMPLETED YEARS _______

109. Have you ever attended school?

YES 1
NO 2 (GO TO 113)

110. What is the highest level of school you attended:
primary, vocational, secondary, or higher?

NURSERY/KINDERGARDEN 0
PRIMARY 1
POST-PRIMARY/VOCATIONAL 2
SECONDARY/'A' LEVEL 3
COLLEGE (MIDDLE LEVEL) 4
UNIVERSITY 5

111. What is the highest (standard/form/year) you completed at that level?

STANDARD/FORM/YEAR _______

112. CHECK 110:

PRIMARY POST-PRIMARY VOCATIONAL __ (GO TO 113)
SECONDARY OR HIGHER __ (GO TO 116)

113. Now I would like you to read this sentence to me.
SHOW SENTENCES TO RESPONDENT.

IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE:
Can you read any part of the sentence to me?

CANNOT READ AT ALL 1
CAN ONLY READ PART OF SENTENCE 2
CAN READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE 4

114. 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

115. CHECK 113:

CODE '2', '3' OR '4' CIRCLED __ (GO TO 116)
CODE '1' CIRCLED __ (GO TO 117)

116. 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

117. 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

118. 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

119. Are you currently working?

YES 1 (GO TO 122)
NO 2

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

YES 1 (GO TO 122)
NO 2

121. What have you been doing for most of the time over the last 12 months?

GOING TO SCHOOL/STUDYING 1 (GO TO 129)
LOOKING FOR WORK 2 (GO TO 129)
INACTIVE 3 (GO TO 129)
COULD NOT WORK/HANDICAPPED 4 (GO TO 129)
OTHER (SPECIFY) _______ 6 (GO TO 129)

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

______________ ___

123. CHECK 122:

WORKS IN AGRICULTURE __ (GO TO 124)
DOES NOT WORK IN AGRICULTURE __ (GO TO 125)

124. 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

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

NUMBER OF MONTHS _______

126. 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 (GO TO 129)
NOT PAID 4 (GO TO 129)

127. Who mainly decides how the money you earn will be used?

RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5

128. On average, how much of your household's expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all?

ALMOST NONE 1
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL 5
NONE, HIS INCOME IS ALL SAVED 6

129. What is your religion?

ROMAN CATHOLIC 1
PROTESTANT/OTHER CHRISTIAN 2
MUSLIM 3
NO RELIGION 4
OTHER (SPECIFY) ________ 6

130. What is your ethnic group/tribe?

EMBU 01
KALENJIN 02
KAMBA 03
KIKUYU 04
KISII 05
LUHYA 06
LUO 07
MASAI 08
MERU 09
MIJIKENDA/SWAHILI 10
SOMALI 11
TAITA/TAVETA 12
OTHER (SPECIFY) ________ 96

SENTENCES FOR LITERACY TEST (Q.113)

ENGLISH
1. The child is reading a book.
2. The rains came late this year.
3. Parents must care for their children.
4. Farming is hard work.

KISWAHILI
1. Mtoto anasoma kitabu.
2. Mvua ilichelewa mwaka huu.
3. Nilazima wazazi watunze watoto wao.
4. Ukilima ni kazi ngumu.

SECTION 2. REPRODUCTION AND PREFERENCES

201. Now I would like to ask about any children you have had. I am interested only in the children that are biologically yours. 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, WRITE '00'.

SONS AT HOME _______
DAUGHTERS AT HOME ______

204. Do you have any sons or daughters 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, WRITE '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 survived only a few hours or days?

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, WRITE '00'.

BOYS DEAD ______
GIRLS DEAD ______

208. (In addition to the children that you have just told me about), do you have any (other) sons or daughters who are biologically your children but who are not legally yours or do not have your name?

Did you have any children who died who were biologically your children but who were not legally yours or did not have your name?

IF YES, CORRECT 201-207.

YES 1
NO 2

209. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL.
IF NONE, WRITE '00'.

TOTAL ________

210. CHECK 209:

HAS HAD MORE THAN ONE CHILD __ (GO TO 211)
HAS HAD ONLY ONE CHILD __ (GO TO 213)
HAS NOT HAD ANY CHILDREN __ (GO TO 301)

211. Do the children that you have fathered all have the same biological mother?

YES 1 (GO TO 213)
NO 2

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

NUMBER OF WOMEN ____

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

AGE IN YEARS ___

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.

CIRCLE CODE 1 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 RECOGNISED, AND CODE 2 IF NOT RECOGNISED.

THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.

301. Which ways or methods have you heard about?

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

METHOD 01) FEMALE STERILISATION Women can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 02) MALE STERILISATION Men can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 03) PILL Women can take a pill every day to stop them from becoming pregnant.
YES 1
NO 2
METHOD 04) IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
METHOD 05) INJECTIONS Women can have an injection by a health provider which stops them from becoming pregnant for one or more months.
YES 1
NO 2
METHOD 06) IMPLANTS, NORPLANT 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
METHOD 07) CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
METHOD 08) FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
METHOD 09) RHYTHM OR NATURAL METHODS 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
METHOD 10) WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
METHOD 11) EMERGENCY CONTRACEPTION Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.
YES 1
NO 2
METHOD 12) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
(SPECIFY) ____
(SPECIFY) ____
NO 2

302. Have you ever used (METHOD)?

METHOD 02) MALE STERILISATION 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
METHOD 07) CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
METHOD 09) RHYTHM OR NATURAL METHODS 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
DON'T KNOW 8
METHOD 10) WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2

303. Now I would like to ask you about when a woman is most likely to get pregnant.
From one menstrual period to the next, are there certain days when a woman is more likely to get pregnant if she has sexual relations?

YES 1
NO 2 (GO TO 305)
DOES NOT KNOW 8 (GO TO 305)

304. Is this time just before her period begins, during her period, right after her period has ended, or half way between two periods?

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
JUST AFTER HER PERIOD ENDS 3
HALF WAY BETWEEN 2 PERIODS 4
OTHER (SPECIFY) ______ 6
DOES NOT KNOW 8

305. Do you think that a woman who is breastfeeding her baby can get pregnant?

YES 1
NO 2
DEPENDS 3
DOES NOT KNOW 8

306. 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.
AGREE 1
DISAGREE 2
DK 8
b) Women who use contraception may become promiscuous.
AGREE 1
DISAGREE 2
DK 8
c) A woman is the one who gets pregnant so she should be the one to get sterilised.
AGREE 1
DISAGREE 2
DK 8

307. CHECK 301(02) AND 302(02): KNOWLEDGE AND USE OF MALE STERILISATION

HAS HEARD OF MALE STERILISATION BUT IS NOT STERILISED _ (GO TO 308)
OTHER __ (GO TO 401)

308. Once you have had all the children you want, would you yourself ever consider getting sterilised?

WOULD CONSIDER 1 (GO TO 401)
WOULD NOT CONSIDER 2
UNSURE/DEPENDS 3 (GO TO 401)
WIFE ALREADY STERILIZED 4 (GO TO 401)

309. Why would you never consider getting sterilised?
PROBE: Any other reasons?

RECORD ALL REASONS MENTIONED.

AGAINST RELIGION A
BAD FOR MAN'S HEALTH B
OPERATION NOT SAFE C
LESS INTRUSIVE WAYS AVAILABLE D
MAY WANT MORE CHILDREN/MAY WANT TO REPLACE CHILD WHO DIED E
MAY REMARRY SOME DAY F
LOSS OF WAGES G
LOSS OF SEXUAL FUNCTION H
LOSS OF MANLINESS I
OTHER (SPECIFY) _______ X

SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

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

YES, CURRENTLY MARRIED 1
YES, LIVING WITH A WOMAN 2 (GO TO 404)
NO, NOT IN UNION 3 (GO TO 406)

402. Do you have one wife or more than one wife?
IF ONLY ONE WIFE, ENTER '01'.
IF MORE THAN ONE, ASK: How many wives do you currently have?

NUMBER OF WIVES _____

403. Are there any other women with whom you live as if married?

YES 1
NO 2 (GO TO 405)

404. Are you living with one (other) woman or more than one (other) woman as if married?
IF ONE LIVE-IN PARTNER, ENTER '01'.

IF MORE THAN ONE, ASK: How many women are you living with as if you were married?

NUMBER OF LIVE-IN PARTNERS ______

405. Apart from the woman/women you have already mentioned, do you currently have any other regular or occasional sexual partners?

REGULAR PARTNER(S) ONLY 1 (GO TO 409)
OCCASIONAL PARTNER(S) ONLY 2 (GO TO 409)
REGULAR AND OCCASIONAL PARTNERS 3 (GO TO 409)
NO OTHER PARTNER 4 (GO TO 409)

406. Do you currently have regular, occasional, or no sexual partners?

REGULAR PARTNER(S) ONLY 1
OCCASIONAL PARTNER(S) ONLY 2
REGULAR AND OCCASIONAL PARTNERS 3
NO SEXUAL PARTNER 4

407. Have you ever been married or lived with a woman?

YES, USED TO BE MARRIED 1
YES, LIVED WITH A WOMAN 2
YES, BOTH 3
NO 4 (GO TO 416)

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

WIDOWED 1 (GO TO 411)
DIVORCED 2 (GO TO 411)
SEPARATED 3 (GO TO 411)

409. WRITE THE LINE NUMBERS FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE/PARTNER REPORTED IN QUESTIONS 402 AND 404 ONLY.

IF A WIFE/PARTNER IS NOT LISTED IN THE HOUSEHOLD SCHEDULE, ENTER '00' IN THE LINE NUMBER BOXES. THE NUMBER OF LINES FILLED IN MUST BE EQUAL TO THE NUMBER OF WIVES AND PARTNERS.

(IF RESPONDENT HAS MORE THAN FIVE WIVES/PARTNERS USE ADDITIONAL QUESTIONNAIRE(S).

CHECK 402 AND 404
SUM OF 402 AND 404 = 01 ___
Please tell me the name of your wife/partner.

NAME ______
LINE NUMBER IN HHD.QUEST ____

SUM OF 402 AND 404 GREATER THAN 01 __
Please tell me the name of each wife/partner that you live with as if married, starting with the one you lived with first.

NAME ___
LINE NUMBER IN HHD.QUEST ____

410. CHECK 409:

ONLY ONE WIFE/PARTNER __ (GO TO 411)
MORE THAN ONE WIFE/PARTNER __ (GO TO 412)

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

ONCE 1 (GO TO 414)
MORE THAN ONCE 2 (GO TO 413)

412. Have you ever been married to or lived as if married to any woman other than those you have just mentioned?

YES 1
NO 2 (GO TO 414)

413. In total, how many women have you been married to or lived with as if married in your whole life?

NUMBER OF WOMEN _____

414. CHECK 409 AND 411:

ONLY ONE WIFE/PARTNER AND 411=ONCE __
In what month and year did you start living with your wife/partner?

OTHER ___
Now we will talk about your first wife/partner. In what month and year did you start living with her?

MONTH _________
DOES NOT KNOW MONTH 98
YEAR ________ (GO TO 416)
DOES NOT KNOW YEAR 9998

415. How old were you when you started living with her?

AGE ________

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

How old were you when you first had sexual intercourse with a woman (if ever)?

NEVER 00 (GO TO 448)
AGE IN YEARS _______
FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE/PARTNER 95

416A. CHECK 108:

15-24 YEARS OLD __ (GO TO 416B)
25-54 YEARS OLD __ (GO TO 417)

416B. The first time you had sexual intercourse, did you use a condom?

YES 1
NO 2

417. When was the last time you had sexual intercourse with a woman?
RECORD 'YEARS AGO' ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO.
IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1 __
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __ (GO TO 445)

418. The last time you had sexual intercourse with a woman, did you use a condom?

YES 1
NO 2 (GO TO 420)

419. What was the main reason you used a condom on that occasion?

WANTED TO PREVENT DISEASE 1 (GO TO 424)
WANTED TO PREVENT PREGNANCY 2 (GO TO 424)
WANTED TO PREVENT BOTH STD/HIVAND PREGNANCY 3 (GO TO 424)
DID NOT TRUST PARTNER/THOUGHT SHE HAD OTHER PARTNERS 4 (GO TO 424)
PARTNER REQUESTED/INSISTED 5 (GO TO 424)
OTHER (SPECIFY) _______ 6 (GO TO 424)

420. CHECK 302(02):

RESPONDENT NOT STERILISED __ (GO TO 421)
RESPONDENT STERILISED __ (GO TO 424)

421. The last time you had sexual intercourse with a woman, did you or she do something or use any method to avoid a pregnancy?

YES 1
NO 2 (GO TO 423)
UNSURE/DON'T KNOW 8 (GO TO 424)

422. What method was used?
IF MORE THAN ONE METHOD USED, RECORD THE HIGHEST METHOD ON THE LIST.

FEMALE STERILISATION 01 (GO TO 424)
PILL 03 (GO TO 424)
IUD 04 (GO TO 424)
INJECTABLES 05 (GO TO 424)
IMPLANTS 06 (GO TO 424)
FEMALE CONDOM 08 (GO TO 424)
RHYTHM, NATURAL METHOD 09 (GO TO 424)
WITHDRAWAL 10 (GO TO 424)
OTHER (SPECIFY) ______ 96 (GO TO 424)
DON'T KNOW 98 (GO TO 424)

423. What is the main reason a method was not used?

CASUAL PARTNER, DOESN'T CARE 11
CONTRACEPTION IS WOMEN'S BUSINESS 12
WOMAN IS MENOPAUSAL/HAD HYSTERECTOMY 23
COUPLE INFERTILE/SUB-FERTILE 24
WOMAN WAS PREGNANT 25
WOMAN WAS AMENORRHEIC 26
WOMAN WAS BREASTFEEDING 27
WANTED (MORE) CHILDREN 28
RESPONDENT OPPOSED 31
WOMAN OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) _______ 96
DOES NOT KNOW 98

424. What is your relationship to the woman with whom you last had sex?

IF WOMAN IS 'GIRLFRIEND' OR 'FIANCE', ASK:
Was your girlfriend/fiancé living with you when you last had sex?

IF YES, RECORD '01'.
IF NO, RECORD '02'.

WIFE/LIVE-IN PARTNER 01 (GO TO 426)
WOMAN IS GIRLFRIEND/FIANCE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX WORKER 06
OTHER (SPECIFY) ________ 96

425. For how long have you had (or did you have) a sexual relationship with this woman?
IF ONLY HAD SEX WITH THIS WOMAN ONCE, WRITE '01' DAYS.

DAYS 1 _____
WEEKS 2 _____
MONTHS 3 _____
YEARS 4 _____

426. Have you had sex with any other woman in the last 12 months?

YES 1
NO 2 (GO TO 445)

427. The last time you had sexual intercourse with another woman, did you use a condom?

YES 1
NO 2 (GO TO 429)

428. What is the main reason you used a condom on that occasion?

WANTED TO PREVENT DISEASE 1 (GO TO 433)
WANTED TO PREVENT PREGNANCY 2 (GO TO 433)
WANTED TO PREVENT BOTH STD/HIV AND PREGNANCY 3 (GO TO 433)
DID NOT TRUST PARTNER/THOUGHT SHE HAD OTHER PARTNERS 4 (GO TO 433)
PARTNER REQUESTED/INSISTED 5 (GO TO 433)
OTHER (SPECIFY) ________ 6 (GO TO 433)

429. CHECK 302(02):

RESPONDENT NOT STERILISED __ (GO TO 430)
RESPONDENT STERILISED __ (GO TO 433)

430. The last time you had sexual intercourse with this woman, did you or she do something or use any method to avoid a pregnancy?

YES 1
NO 2 (GO TO 432)
UNSURE/DON'T KNOW 8 (GO TO 433)

431. What method was used?
IF MORE THAN ONE METHOD USED, CIRCLE THE HIGHEST METHOD ON THE LIST.

FEMALE STERILISATION 01 (GO TO 433)
PILL 03 (GO TO 433)
IUD 04 (GO TO 433)
INJECTABLES 05 (GO TO 433)
IMPLANTS 06 (GO TO 433)
FEMALE CONDOM 08 (GO TO 433)
RHYTHM, NATURAL METHOD 09 (GO TO 433)
WITHDRAWAL 10 (GO TO 433)
OTHER (SPECIFY) _____ 96 (GO TO 433)
DON'T KNOW 98 (GO TO 433)

432. What is the main reason a method was not used?

CASUAL PARTNER, DOESN'T CARE 11
CONTRACEPTION IS WOMEN'S BUSINESS 12
WOMAN IS MENOPAUSAL/HAD HYSTERECTOMY 23
COUPLE INFERTILE/SUB-FERTILE 24
WOMAN WAS PREGNANT 25
WOMAN WAS AMENORRHEIC 26
WOMAN WAS BREASTFEEDING 27
WANTED (MORE) CHILDREN 28
RESPONDENT OPPOSED 31
WOMAN OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) ____ 96
DOES NOT KNOW 98

433. What is your relationship to this other woman?
IF WOMAN IS 'GIRLFRIEND' OR 'FIANCE', ASK:

Was your girlfriend/fiancé living with you when you last had sex?
IF YES, RECORD '01'.
IF NO, RECORD '02'.

WIFE/LIVE-IN PARTNER 01 (GO TO 435)
WOMAN IS GIRLFRIEND/FIANCE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX WORKER 06
OTHER (SPECIFY) _____ 96

434. For how long have you had (or did you have) a sexual relationship with this woman?
IF ONLY HAD SEX WITH THIS WOMAN ONCE, WRITE '01' DAYS.

DAYS 1 _______
WEEKS 2 ______
MONTHS 3 _____
YEARS 4 _____

435. Other than these two women, have you had sex with any other woman in the last 12 months?

YES 1
NO 2 (GO TO 445)

436. The last time you had sexual intercourse with this third woman, did you use a condom?

YES 1
NO 2 (GO TO 438)

437. What is the main reason you used a condom on that occasion?

WANTED TO PREVENT DISEASE 1 (GO TO 442)
WANTED TO PREVENT PREGNANCY 2 (GO TO 442)
WANTED TO PREVENT BOTH STD/HIV AND PREGNANCY 3 (GO TO 442)
DID NOT TRUST PARTNER/THOUGHT SHE HAD OTHER PARTNERS 4 (GO TO 442)
PARTNER REQUESTED/INSISTED 5 (GO TO 442)
OTHER (SPECIFY) _____ 6 (GO TO 442)

438. CHECK 302(02):

RESPONDENT NOT STERILISED __ (GO TO 439)
RESPONDENT STERILISED __ (GO TO 442)

439. The last time you had sexual intercourse with this third woman, did you or she do something or use any method to avoid a pregnancy?

YES 1
NO 2 (GO TO 441)
UNSURE/DON'T KNOW 8 (GO TO 442)

440. What method was used?
IF MORE THAN ONE METHOD USED, RECORD THE HIGHEST METHOD ON THE LIST.

FEMALE STERILISATION 01 (GO TO 442)
PILL 03 (GO TO 442)
IUD 04 (GO TO 442)
INJECTABLES 05 (GO TO 442)
IMPLANTS 06 (GO TO 442)
FEMALE CONDOM 08 (GO TO 442)
RHYTHM, NATURAL METHOD 09 (GO TO 442)
WITHDRAWAL 10 (GO TO 442)
OTHER (SPECIFY) ________ 96 (GO TO 442)
DON'T KNOW 98 (GO TO 442)

441. What is the main reason a method was not used?

CASUAL PARTNER, DOESN'T CARE 11
CONTRACEPTION IS WOMEN'S BUSINESS 12
WOMAN IS MENOPAUSAL/HAD HYSTERECTOMY 23
COUPLE INFERTILE/SUB-FERTILE 24
WOMAN WAS PREGNANT 25
WOMAN WAS AMENORRHEIC 26
WOMAN WAS BREASTFEEDING 27
WANTED (MORE) CHILDREN 28
RESPONDENT OPPOSED 31
WOMAN OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) ________ 96
DOES NOT KNOW 98

442. What is your relationship to this woman?

IF WOMAN IS 'GIRLFRIEND' OR 'FIANCE', ASK:
Was your girlfriend/fiancé living with you when you last had sex?

IF YES, RECORD '01'. IF NO, RECORD '02'.

WIFE/LIVE-IN PARTNER 01 (GO TO 444)
WOMAN IS GIRLFRIEND/FIANCE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX WORKER 06
OTHER (SPECIFY) ____ 96

443. For how long have you had (or did you have) a sexual relationship with this woman?
IF ONLY HAD SEX WITH THIS WOMAN ONCE, WRITE '01' DAYS.

DAYS 1 ____
WEEKS 2 ___
MONTHS 3 ___
YEARS 4 ___

444. In total, with how many different women have you had sex in the last 12 months?

NUMBER OF PARTNERS _____

445. Have you ever paid for sex?

YES 1
NO 2 (GO TO 448)

446. How long ago was the last time you paid for sex?

DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___

447. The last time that you paid for sex, did you use a condom on that occasion?

YES 1
NO 2

448. Do you know of a place where one can get condoms?

YES 1
NO 2 (GO TO 451)

449. What places do you know of where a person can get condoms? Any other place?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. RECORD ALL MENTIONED.

(NAME OF PLACE) ________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTRE B
GOVERNMENT DISPENSARY C
OTHER PUBLIC (SPECIFY) ______ D
PRIVATE MEDICAL SECTOR
MISSION, CHURCH HOSP./CLINIC F
FPAK HEALTH CENTRE/CLINIC G
PRIVATE HOSPITAL OR CLINIC H
PHARMACY/CHEMIST I
NURSING/MATERNITY HOME K
OTHER PRIVATE MEDICAL (SPECIFY) _______ L
MOBILE CLINIC M
COMMUNITY-BASED DISTRIBUTOR N
SHOP/KIOSK O
FRIENDS/RELATIVES Q
OTHER (SPECIFY) _______ X

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

YES 1
NO 2
DOES NOT KNOW/UNSURE 8

451. CHECK 302(07), 416B, 418, 427, 436, AND 447: EVER USED A CONDOM?

AT LEAST ONE 'YES' HAS USED CONDOM __ (GO TO 452)
NO 'YES' NEVER USED CONDOMS __ (GO TO 460)

452. How old were you when you used a condom for the first time?

AGE AT FIRST USE ____
DOES NOT REMEMBER 98

453. Why did you use a condom that first time?
PROBE: Any other reason?
RECORD ALL REASONS MENTIONED.

TO AVOID PREGNANCY A
TO AVOID GETTING AIDS/HIV B
TO AVOID GETTING AN STD C
TO AVOID INFECTING PARTNER D
TO EXPERIMENT/TRY A CONDOM E
OTHER (SPECIFY) _______ X

454. Have you ever experienced any problems with using condoms?
IF YES: What problems have you experienced?
PROBE: Any other problems?
CIRCLE ALL PROBLEMS MENTIONED.

TOO EXPENSIVE A
EMBARRASSING TO BUY/OBTAIN B
DIFFICULT TO DISPOSE OF C
DIFFICULT TO PUT ON/TAKE OFF D
SPOILS THE MOOD E
DIMINISHES PLEASURE F
WIFE PARTNER OBJECTS/DOES NOT LIKE G
WIFE/PARTNER GOT PREGNANT H
INCONVENIENT TO USE/MESSY I
CONDOM BROKE J
OTHER (SPECIFY) _______ X
NO PROBLEM Y

455. What brand of condom do you usually use?
ASK TO SEE CONDOM PACKET IF BRAND NOT KNOWN.

DUREX 1
ROUGH RIDER 2
SURE 3
TRUST 4
NO BRAND 5
OTHER (SPECIFY) _____ 6
DON'T KNOW BRAND 8

456. Where do you usually get the condoms?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
(NAME OF PLACE) ________

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTRE B
GOVERNMENT DISPENSARY C
OTHER PUBLIC (SPECIFY) ______ D
PRIVATE MEDICAL SECTOR
MISSION, CHURCH HOSP./CLINIC F
FPAK HEALTH CENTRE/CLINIC G
PRIVATE HOSPITAL OR CLINIC H
PHARMACY/CHEMIST I
NURSING/MATERNITY HOME K
OTHER PRIVATE MEDICAL (SPECIFY) _______ L
MOBILE CLINIC M
COMMUNITY-BASED DISTRIBUTOR N
SHOP/KIOSK O
FRIENDS/RELATIVES Q
OFFICE R
OTHER (SPECIFY) _______ X

457. How much do you usually pay for a packet of condoms?

COST PER PACKET ________
FREE 995 (GO TO 460)
DOES NOT KNOW 998 (GO TO 460)

458. How many condoms are in each packet?

NUMBER _____

459. Do you think that at this price condoms are inexpensive, just affordable, or too expensive?

INEXPENSIVE 1
JUST AFFORDABLE 2
TOO EXPENSIVE 3

460. I will now read you some statements about condom use. Please tell me if you agree or disagree with each.

a) Condoms diminish a man's sexual pleasure.
AGREE 1
DISAGREE 2
DK 8
b) It's okay to re-use a condom if you wash it.
AGREE 1
DISAGREE 2
DK 8
c) Condoms protect against disease.
AGREE 1
DISAGREE 2
DK 8
d) Buying condoms is embarrassing.
AGREE 1
DISAGREE 2
DK 8
e) A woman has no right to tell a man to use a condom.
AGREE 1
DISAGREE 2
DK 8
f) Condoms contain HIV.
AGREE 1
DISAGREE 2
DK 8

461. In your opinion, is it acceptable or unacceptable for condoms to be advertised:

on the radio?
on the TV?
in newspapers?

ON THE RADIO
ACCEPTABLE 1
NOT ACCEPTABLE 2
DK/UNSURE 8
ON THE TV
ACCEPTABLE 1
NOT ACCEPTABLE 2
DK/UNSURE 8
NEWSPAPERS
ACCEPTABLE 1
NOT ACCEPTABLE 2
DK/UNSURE 8

SECTION 5. FERTILITY PREFERENCES

501. CHECK 401:

CURRENTLY MARRIED OR LIVING TOGETHER __ (GO TO 502)
NOT MARRIED ___ (GO TO 505)

502. Is your wife/partner currently pregnant?
IF MORE THAN ONE WIFE/PARTNER, ASK: Are any of your wives/partners currently pregnant?

YES 1
NO 2
NOT SURE 3

503. CHECK 502:

WIFE NOT PREGNANT/ NOT SURE (CODE '2' OR '3') __
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?

YES, WIFE PREGNANT (CODE '1') __
Now I have some questions about the future. After the child you 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 505)
WIFE CANNOT GET PREGNANT 3 (GO TO 505)
UNDECIDED/DON'T KNOW 8 (GO TO 505)

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

MONTHS 1 _____
YEARS 2 _____
SOON/NOW 993
WIFE CANNOT GET PREGNANT 994
AFTER MARRIAGE 995
OTHER (SPECIFY) _____ 996
DOES NOT KNOW 998

505. 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 507)
NUMBER ___
OTHER (SPECIFY) _______96 (GO TO 507)

506. 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?

NUMBER BOYS ___
NUMBER GIRLS ___
NUMBER EITHER ___
OTHER (SPECIFY) _______96

507. Would you say that you approve or disapprove of couples using a method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2
DON'T KNOW/UNSURE 8

508. In the last few months have you heard about family planning:

On the radio?
On the television?
In a newspaper or magazine?

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

509. In the last few months, have you discussed family planning with a health worker or health professional?

YES 1
NO 2

SECTION 6. HEALTH ISSUES

601. Now I would like to ask you some questions about health. When a child has diarrhea, should he or she be given less to drink than usual, about the same amount, or more to drink than usual?

LESS 1
ABOUT THE SAME 2
MORE 3
DOES NOT KNOW 8

602. Have you ever heard of a special product called [LOCAL NAME FOR ORS] you can get for the treatment of diarrhea?

YES 1
NO 2

603. Now please tell me about yourself. Do you smoke cigarettes or use tobacco?
IF YES: What type of tobacco do you smoke?
CIRCLE ALL TYPES MENTIONED.

YES, CIGARETTES A
YES, PIPE B
YES, OTHER TOBACCO C
NO Y

604. CHECK 603:

CODE 'A' CIRCLED __ (GO TO 605)
CODE 'A' NOT CIRCLED __ (GO TO 606)

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

CIGARETTES ________

606. Have you ever drunk any kind of alcohol like beer, wine, whiskey, gin, vodka, etc.?

YES 1
NO 2 (GO TO 701)

607. In the last month, on how many days did you drink any alcohol-containing beverage?
IF EVERY DAY, RECORD '30'.

NUMBER OF DAYS ____
NONE 95

SECTION 7. AIDS AND OTHER SEXUALLY-TRANSMITTED DISEASES

701. Now I would like to talk about something else.
Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 720)

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

YES 1
NO 2 (GO TO 709)
DOES NOT KNOW 8 (GO TO 709)

703. What can a person do?
Anything else?
RECORD ALL MENTIONED.

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEX PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH DRUG USERS H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING RAZORS/BLADES K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM TRADITIONAL HEALER N
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
DOES NOT KNOW Z

704. Can people reduce their chances of getting the AIDS virus by having just one sex partner who has no other partners?

YES 1
NO 2
DOES NOT KNOW 8

705. Can a person get the AIDS virus from mosquito or other insect bites?

YES 1
NO 2
DOES NOT KNOW 8

706. Can people reduce their chances of getting the AIDS virus by using a condom every time they have sex?

YES 1
NO 2
DOES NOT KNOW 8

707. Can a person get the AIDS virus by sharing utensils with a person who has AIDS?

YES 1
NO 2
DOES NOT KNOW 8

708. Can people reduce their chances of getting the AIDS virus by not having sex at all?

YES 1
NO 2
DOES NOT KNOW 8

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

YES, POSSIBLE 1
NO, NOT POSSIBLE 2
DOES NOT KNOW 8

710. Do you know someone personally who has the virus that causes AIDS or someone who died of AIDS?

YES 1
NO 2

711. Can the virus that causes AIDS be transmitted from a mother to a child?

YES 1
NO 2 (GO TO 713)
DOES NOT KNOW 8 (GO TO 713)

712. Can the virus that causes AIDS be transmitted from a mother to her child...

During pregnancy?
During delivery?
By breastfeeding?

DURING PREGNANCY
YES 1
NO 2
DK 8
DURING DELIVERY
YES 1
NO 2
DK 8
BY BREASTFEEDING
YES 1
NO 2
DK 8

712A. Can a mother who is infected with the AIDS virus reduce the risk of giving the virus to the baby by taking certain drugs during pregnancy?

YES 1
NO 2
DOES NOT KNOW 8

713. CHECK 401:

YES, CURRENTLY MARRIED/LIVING WITH A WOMAN __ (GO TO 714)
NO, NOT MARRIED OR LIVING WITH A WOMAN __ (GO TO 714A)

714. Have you ever talked with (your wife/woman you are living with) about ways to prevent getting the virus that causes AIDS?
IF MORE THAN ONE WIFE/PARTNER, ASK ABOUT ANY OF HIS WIVES/PARTNERS.

YES 1
NO 2

714A. Would you buy fresh vegetables from a vendor who has the AIDS virus?

YES 1
NO 2
DOES NOT KNOW/UNSURE 8

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

YES, KEEP IT SECRET 1
NO 2
DOES NOT KNOW/UNSURE 8

716. If a relative of yours became sick with the virus that causes AIDS, would you be willing to care for her or him in your own household?

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

716A. If a female teacher has the AIDS virus, should she be allowed to continue teaching in school?

CAN CONTINUE 1
SHOULD NOT CONTINUE 2
DON'T KNOW/UNSURE/DEPENDS 8

716B. Should children aged 12-14 be taught about using a condom to avoid AIDS?

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

716B1. Do you think your chances of getting AIDS are small, moderate, great, or no risk at all?

SMALL 1
MODERATE 2 (GO TO 716B3)
GREAT 3 (GO TO 716B3)
NO RISK AT ALL 4
HAS AIDS 5 SKIP (TO 716B4)

716B2. Why do you think that you have (no risk/a small chance) of getting AIDS?
Any other reasons?
CIRCLE ALL MENTIONED.

IS NOT HAVING SEX A (GO TO 716B4)
USES CONDOMS B (GO TO 716B4)
HAS ONLY ONE PARTNER C (GO TO 716B4)
LIMITS THE NUMBER OF PARTNERS D (GO TO 716B4)
PARTNER HAS NO OTHER PARTNERS E (GO TO 716B4)
OTHER (SPECIFY) ______ X (GO TO 716B4)

716B3. Why do you think that you have a (moderate, great) chance of getting AIDS?
Any other reasons?
CIRCLE ALL MENTIONED.

DOES NOT USE CONDOMS A
HAS MORE THAN 1 SEX PARTNER B
PARTNER HAS OTHER PARTNERS C
HOMOSEXUAL CONTACTS D
HAD BLOOD TRANSFUSION/INJECTION E
OTHER (SPECIFY) _______ X

716B4. Have you ever heard of VCT?

YES 1
NO 2

716C. 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 716D)

716C1. When was the last time you were tested?

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

716C2. 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

716C3. I do not want to know the results, but did you get the results of the test?

YES 1 (GO TO 716FX)
NO 2 (GO TO 716FX)

716D. Would you want to be tested for the AIDS virus?

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

716E. Do you know a place where you could go to get an AIDS test?

YES 1
NO 2 (GO TO 717)

716F. Where can you go for the test?

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVT.HEALTH CENTRE/CLINIC 12
GOVERNMENT DISPENSARY 13
OTHER PUBLIC (SPECIFY) _________ 16
PRIVATE MEDICAL SECTOR
MISSION/CHURCH HOSP.CLINIC 21
FPAK HEALTH CENTRE/CLINIC 22
PRIVATE HOSPITAL/CLINIC 23
VCT CENTRE 24
NURSING/MATERNITY HOME 26
BLOOD TRANSFUSION SERVICE 31
OTHER (SPECIFY) ______ 96

716FX. Where did you go for the test?
IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) _________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVT.HEALTH CENTRE/CLINIC 12
GOVERNMENT DISPENSARY 13
OTHER PUBLIC (SPECIFY) _________ 16
PRIVATE MEDICAL SECTOR
MISSION/CHURCH HOSP.CLINIC 21
FPAK HEALTH CENTRE/CLINIC 22
PRIVATE HOSPITAL/CLINIC 23
VCT CENTRE 24
NURSING/MATERNITY HOME 26
BLOOD TRANSFUSION SERVICE 31
OTHER (SPECIFY) ______ 96

717. (Apart from AIDS), have you heard about (other) infections that can be transmitted through sexual contact?

YES 1
NO 2 (GO TO 719A)

718. If a man has a sexually transmitted disease, what symptoms might he have?
Any others?
CIRCLE ALL MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE/DRIPPING B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
IMPOTENCE/NO ERECTION L
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
NO SYMPTOMS Y
DON'T KNOW Z

719. If a woman has a sexually transmitted disease, what symptoms might she have?
Any others?
CIRCLE ALL MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
HARD TO GET PREGNANT/HAVE A CHILD L
OTHER (SPECIFY) _______ W
OTHER (SPECIFY) _____ X
NO SYMPTOMS Y
DON'T KNOW Z

719A. CHECK 416:

HAS HAD SEXUAL INTERCOURSE __ (GO TO 719B)
HAS NOT HAD SEXUAL INTERCOURSE __ (GO TO 720)

719B. 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 sexually-transmitted disease?

YES 1
NO 2
DON'T KNOW 8

719C. Sometimes, men experience an abnormal discharge from their penis. During the last 12 months, have you had an abnormal discharge from your penis?

YES 1
NO 2
DON'T KNOW 8

719D. Sometimes men have a sore or ulcer on or near their penis. During the last 12 months, have you had a sore or ulcer on or near your penis?

YES 1
NO 2
DON'T KNOW 8

719E. CHECK 719B/719C/719D:

HAS HAD AN INFECTION __ (GO TO 719F)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW __ (GO TO 720)

719F. The last time you had (PROBLEM(S) FROM 719B/719C/719D), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 719H)

719G. The last time you had (PROBLEM(S) FROM 719B/719C/719D), did you do any of the following? Did you...

Go to a clinic, hospital or private doctor?
Consult a traditional healer?
Seek advice or buy medicines in a shop or pharmacy?
Ask for advice from friends or relatives?

CLINIC/HOSPITAL
YES 1
NO 2
TRADITIONAL HEALER
YES 1
NO 2
SHOP/PHARMACY
YES 1
NO 2
FRIENDS/RELATIVES
YES 1
NO 2

719H. When you had (PROBLEM(S) FROM 719B/719C/719D), did you tell the person(s) with whom you were having sex?

YES 1
NO 2
SOME/NOT AT ALL 3
DID NOT HAVE A PARTNER 4 (GO TO 720)

719I. When you had (PROBLEM(S) FROM 719B/719C/719D), did you do anything to avoid infecting your sexual partner(s)?

YES 1
NO 2 (GO TO 720)
PARTNER(S) ALREADY INFECTED 3 (GO TO 720)

719J. What did you do to avoid infecting your partner(s)? Did you...

Use medicine?
Stop having sex?
Use a condom when having sex?

USE MEDICINE
YES 1
NO 2
STOP SEX
YES 1
NO 2
USE CONDOM
YES 1
NO 2

720. Are you circumcised?

YES 1
NO 2

721. In many communities, girls are also circumcised. In your community, is female circumcision practiced?

YES 1
NO 2

722. CHECK 203 AND 205:

HAS AT LEAST ONE LIVING DAUGHTER __ (GO TO 723)
HAS NO LIVING DAUGHTER __ (GO TO 801)

723. Has your eldest daughter been circumcised?

YES 1 (GO TO 801)
NO 2
DOES NOT KNOW 8 (GO TO 801)

724. Do you plan to have your eldest daughter circumcised?

YES 1
NO 2
DOES NOT KNOW 8

SECTION 8. ATTITUDES TOWARDS WOMEN

801. 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 large household purchases?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DK/DEPENDS 8
b) making small daily household purchases?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DK/DEPENDS 8
c) deciding when to visit family, friends or relatives?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DK/DEPENDS 8
d) deciding what to do with the money she earns for her work?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DK/DEPENDS 8
e) deciding how many children to have and when to have them?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DK/DEPENDS 8

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

a) If she goes out without telling him?
YES 1
NO 2
DK/DEPENDS 8
b) If she neglects the children?
YES 1
NO 2
DK/DEPENDS 8
c) If she argues with him?
YES 1
NO 2
DK/DEPENDS 8
d) If she refuses to have sex with him?
YES 1
NO 2
DK/DEPENDS 8
e) If she burns the food?
YES 1
NO 2
DK/DEPENDS 8

803. When a wife knows her husband has a sexually transmitted disease, is she justified in asking her husband to use a condom?

YES 1
NO 2
DOES NOT KNOW 8

804. Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband if...

a) She is tired and not in the mood?
YES 1
NO 2
DK/DEPENDS 8
b) She has recently given birth?
YES 1
NO 2
DK/DEPENDS 8
c) She knows her husband has sex with other women?
YES 1
NO 2
DK/DEPENDS 8
d) She knows her husband has a sexually transmitted disease?
YES 1
NO 2
DK/DEPENDS 8

805. 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
DK/DEPENDS 8
b) Refuse to give her money or other means of financial support?
YES 1
NO 2
DK/DEPENDS 8
c) Use force and have sex with her even if she does not want to?
YES 1
NO 2
DK/DEPENDS 8
d) Go and have sex with another woman
YES 1
NO 2
DK/DEPENDS 8

806. RECORD THE TIME

HOUR _____
MINUTES _____

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:
__________________________________

COMMENTS ON SPECIFIC QUESTIONS:
_______________________________

ANY OTHER COMMENTS:
_______________________________

SUPERVISOR'S OBSERVATIONS

_______________________________

NAME OF THE SUPERVISOR:__________
DATE:____________________

EDITOR'S OBSERVATIONS

_______________________________

NAME OF EDITOR:________________________

DATE:_____________________