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CONFIDENTIAL


KENYA NATIONAL BUREAU OF STATISTICS
KENYA DEMOGRAPHIC AND HEALTH SURVEY 2008
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 _____________

INTERVIEWER VISITS

INTERVIEWER VISIT 1
DATE ______________
INTERVIEWER'S NAME _______________
RESULT** ______________

NEXT VISIT:
DATE ______
TIME _____

INTERVIEWER VISIT 2
DATE ______________
INTERVIEWER'S NAME _______________
RESULT** ______________

NEXT VISIT:
DATE ______
TIME _____

INTERVIEWER VISIT 3
DATE ______________
INTERVIEWER'S NAME _______________
RESULT** ______________

FINAL VISIT

DAY ____
MONTH ____
YEAR 200__
INT. CODE ___
FINAL RESULT ____

TOTAL NO. OF VISITS __

RESULTS___
**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 MAASAI
09 MERU
10 MIJIKENDA
11 SOMALI
12 KISWAHILI
13 ENGLISH
14 OTHER_________

SUPERVISOR
NAME __________ ___
DATE __________

FIELD EDITOR
NAME __________ ___
DATE __________

OFFICE EDITOR ____

KEYED BY ___

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

Hello. My name is ________ and I am working with the Kenya National Bureau of Statistics. We are conducting a national survey that asks 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 between 30 to 60 minutes to complete.

Whatever information you provide will be kept 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)

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 Nairobi, Mombasa, in another city or town, or in the country-side?

NAIROBI/ MOMBASA/KISUMU 1
OTHER CITY/TOWN 2
COUNTRY SIDE 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 106)
VISITOR 96 (GO TO 106)

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
COUNTRY SIDE 3
OUTSIDE KENYA 4

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, vocational, secondary, or higher?

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

110. What is the highest (standard/form/year) you completed at that level?
IF NONE, WRITE '00'.

STANDARD/FORM/YEAR __________

111. CHECK 109:

PRIMARY, POST-PRIMARY/VOCATIONAL __ (GO TO 112)
SECONDARY 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 IMPAIRED 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?

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

119. 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

SECTION 2. REPRODUCTION

201. Now I would like to ask about any children you have had during your life. I am interested in all of the children that are biologically yours, even if they are not legally yours or do not have your last name.

Have you ever fathered any children with any woman?

YES 1
NO 2 (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 __ (GO TO 216)
OTHER __ (GO TO 301)

216. What is the name of your (youngest) child?
WRITE NAME OF (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 3 (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?

COST TOO MUCH 01
FACILITY CLOSED 02
TOO FAR/NO TRANSPORTATION 03
DON'T TRUST FACILITY/POOR QUALITY SERVICE 04
NO FEMALE PROVIDER 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 WAS NECESSARY 09
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

301. Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.

Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK:
Have you ever heard of (METHOD)?

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 RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED.

THEN, FOR METHODS 02, 07, 10, AND 11, 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) 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) LACTATIONAL AMENORRHEA METHOD (LAM)
YES 1
NO 2
10) RHYTHM 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
11) WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
12) EMERGENCY CONTRACEPTION As an emergency measure after sexual intercourse, women can take special pills at any time within five days to prevent pregnancy.
YES 1
NO 2
13) 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 or partner ever used (METHOD)?

01) FEMALE STERILIZATION Women can have an operation to avoid having any more children. Have you ever had a partner who had 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. Have you ever had 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) CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
Have you ever used a condom?
YES 1
NO 2
08) FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09) LACTATIONAL AMENORRHEA METHOD (LAM)
YES 1
NO 2
10) RHYTHM 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. Have you and your partner ever used rhythm method?
YES 1
NO 2
11) WITHDRAWAL Men can be careful and pull out before climax.
Have you ever used the withdrawal method?
YES 1
NO 2
12) EMERGENCY CONTRACEPTION As an emergency measure after sexual intercourse, women can take special pills at any time within five days to prevent pregnancy.
YES 1
NO 2
13) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
METHOD 1
YES 1
NO 2
METHOD 2
YES 1
NO 2

302A. CHECK 302:

AT LEAST ONE 'YES' (EVER USED) __ (GO TO 302B)
NOT A SINGLE 'YES' (NEVER USED) __ (GO TO 303)

302B. Are you currently doing something or using any method with any partner to delay or avoid a pregnancy?

YES 1
NO 2 (GO TO 303)

302C. Which method are you using?
CIRCLE ALL MENTIONED.

IF MORE THAN ONE METHOD MENTIONED, FOLLOW GO INSTRUCTION FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION A (GO TO 302E)
MALE STERILIZATION B
PILL C (GO TO 302E)
IUD D (GO TO 302E)
INJECTABLES E (GO TO 302E)
IMPLANTS F (GO TO 302E)
MALE CONDOM G
FEMALE CONDOM H (GO TO 302E)
LACTATIONAL AMENORRHOEA M. I (GO TO 302E)
RHYTHM METHOD L (GO TO 302E)
WITHDRAWAL M
OTHER (SPECIFY) _______________________ X (GO TO 302E)

302D. Does your wife/partner know that you are using a method of family planning?

YES 1
NO 2
DON'T KNOW 8

302E. Would you say that using contraception is mainly your decision, mainly your wife's/partner's decision, or did you both decide together?

MAINLY RESPONDENT 1
MAINLY WIFE/PARTNER 2
JOINT DECISION 3
OTHER (SPECIFY) ________ 6

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 a 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 talked about family planning with a health worker or health professional?

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 relations?

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 2 PERIODS 4
OTHER (SPECIFY) ___________ 6
DON'T KNOW 8

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.

CONTRACEPTION WOMAN'S BUSINESS
AGREE 1
DISAGREE 2
DK 8
WOMAN MAY BECOME PROMISCUOUS
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.

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

(NAME OF PLACE(S)) ________________
PUBLIC SECTOR
GOVT. HOSPITAL B
GOVT. HEALTH CENTER C
GOVERNMENT DISPENSARY D
OTHER PUBLIC (SPECIFY) ___________ E
PRIVATE MEDICAL SECTOR
FAITH-BASED, CHURCH, MISSION HOSPITAL/CLINIC F
FHOK/FPAK HEALTH CENTER/CLINIC G
PRIVATE HOSPITAL/CLINIC H
PHARMACY/CHEMIST I
NURSING/MATERNITY HOME J
OTHER PRIV. MEDICAL (SPECIFY) ________ K
OTHER SOURCE
MOBILE CLINIC L
COMMUNITY-BASED DISTRIBUTOR M
SHOP N
FRIEND/RELATIVE P
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 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'.

NAME ________
LINE NUMBER _______

ASK 408 FOR EACH PERSON.

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.

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

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 TIME WHEN STARTED LIVING WITH (FIRST) WIFE/PARTNER 95 (GO TO 417)

415. CHECK 107:

AGE 15-24 __ (GO TO 416)
AGE 25-54 __ (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 25-54 __ (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?

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 (GO TO 426)
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 sexual relationship with this (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 (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 two people], have you had sexual intercourse with any other person in the last 12 months?

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-NUMERIC 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):

CONDOM USED WITH EVERY PROSTITUTE __ (GO TO 434)
OTHER __ (GO TO 435)

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

YES 1
NO 2 (GO TO 435)

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

YES 1
NO 2 (GO TO 435)

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

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
BRAND NAME (SPECIFY) ______ __ (GO TO 439)
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 995
DON'T KNOW 998

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 11
GOVT. HEALTH CENTER 12
GOVERNMENT DISPENSARY 13
OTHER PUBLIC (SPECIFY) ___________ 16
PRIVATE MEDICAL SECTOR
FAITH-BASED, CHURCH, MISSION HOSPITAL/CLINIC 21
FHOK/FPAK HEALTH CENTER/CLINIC 22
PRIVATE HOSPITAL/CLINIC 23
PHARMACY/CHEMIST 24
NURSING/MATERNITY HOME 25
OTHER PRIV. MEDICAL (SPECIFY) ________ 26
OTHER SOURCE
MOBILE CLINIC 31
COMMUNITY-BASED DISTRIBUTOR 41
SHOP 51
FRIEND/RELATIVE 61
OTHER (SPECIFY) ___________ 96

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 C
IUD D
INJECTABLES E
IMPLANTS F
CONDOM G
FEMALE CONDOM H
LACTATION AMENORRHEA METHOD I
RHYTHM METHOD L
WITHDRAWAL M
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) or 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)/PARTNER(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?

MONTHS 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?

MONTHS 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?

NUMBER BOYS __
NUMBER GIRLS __
NUMBER EITHER __
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 (GO TO 607)
SOMEONE ELSE'S LAND 4 (GO TO 607)
OTHER (SPECIFY) ___________ 6 (GO TO 607)

606A. Think back over the past year. Were there any times when your household did not have enough food to eat? How often did it happen that people went hungry because there was not enough food?

NEVER/SELDOM/ONLY A FEW TIMES 1
OFTEN 2
ALWAYS/EVERY DAY 3

606B. Do you believe there is sufficient land here for your children to stay and live?

YES 1
NO 2

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 and when?
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

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 717)

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

708A. Is there anything else a person can do to avoid getting AIDS or the virus?

YES 1
NO 2 (GO TO 709)
DON'T KNOW 8 (GO TO 709)

708B. What can a person do? Anything else?
CIRCLE ALL MENTIONED.

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEX PARTNER 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
OTHERS (SPECIFY) ____________ W
OTHERS (SPECIFY) ____________ X
DON'T KNOW Z

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

YES 1
NO 2
DON'T 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 her baby:
During pregnancy?
During delivery?
By breastfeeding?

DURING PREG
YES 1
NO 2
DK 8
DURING DELIVERY
YES 1
NO 2
DK 8
BREASTFEEDING
YES 1
NO 2
DK 8

712. CHECK 711:

AT LEAST ONE 'YES' __ (GO TO 712A)
OTHER __ (GO TO 713)

712A. 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

713. CHECK 401:

YES, CURRENTLY MARRIED/LIVING WITH A WOMAN __ (GO TO 714)
FORMERLY MARRIED/LIVED WITH A WOMAN __ (GO TO 714)
NEVER MARRIED/NEVER LIVED WITH A WOMAN __ (GO TO 714A)

714. Have you ever talked with (your wife/the woman you are with) about ways to prevent getting the virus that causes AIDS?

YES 1
NO 2

714A. 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

715. 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

716. 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

716A. 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
SHOULD NOT BE ALLOWED 2
DK/NOT SURE/DEPENDS 8

716B. Should children age 12-14 years be taught about using condoms to avoid getting 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?

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

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

IS NOT HAVING SEX A (GO TO 716B4)
USES CONDOM 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)
OTHERS (SPECIFY) _______ X (GO TO 716B4)

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

DOES NOT USE CONDOM A
HAS MORE THAN ONE SEX PARTNER B
PARTNER HAS OTHER PARTNERS C
HOMOSEXUAL CONTACTS D
HAD BLOOD TRANSFUSION/INJECTION E
OTHERS (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 ever 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 ir required?

ASKED FOR 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
NO 2

716C4. Where was the test done?

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 ____________

IF NURSING/MATERNITY HOME, ASK IF IT IS RUN BY A CHURCH OR MISSION. IF SO, CIRCLE CODE '21'.

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 717)
GOVT. HEALTH CENTER/CLINIC 12 (GO TO 717)
GOVERNMENT DISPENSARY 13 (GO TO 717)
OTHER PUBLIC (SPECIFY) _______ 16 (GO TO 717)
PRIVATE MEDICAL SECTOR
MISSIONARY/CHURCH HOSP./CLINIC 21 (GO TO 717)
FPAK HEALTH CENTER/CLINIC 22 (GO TO 717)
PRIVATE HOSPITAL/CLINIC 23 (GO TO 717)
VCT CENTRE 24 (GO TO 717)
NURSING/MATERNITY HOMES 25 (GO TO 717)
BLOOD TRANSFUSION SERVICES 26 (GO TO 717)
OTHER PRIVATE MEDICAL (SPECIFY) ___________ 27 (GO TO 717)
OTHER (SPECIFY) _______________________ 96 (GO TO 717)

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

YES 1
NO 2
DK/NOT SURE 8

716E. Do you know of a place where people can go to get tested for the AIDS virus?

YES 1
NO 2 (GO TO 717)

716F. Where is that? Any other place?

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 ____________

IF NURSING/MATERNITY HOME, ASK IF IT IS RUN BY A CHURCH OR MISSION. IF SO, CIRCLE CODE 'E'.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTRE/CLINIC B
GOVERNMENT DISPENSARY C
OTHER PUBLIC (SPECIFY) _______ D
PRIVATE MEDICAL SECTOR
MISSIONARY/CHURCH HOSP./CLINIC E
FPAK HEALTH CENTER/CLINIC F
PRIVATE HOSPITAL/CLINIC G
VCT CENTRE H
NURSING/MATERNITY HOMES I
BLOOD TRANSFUSION SERVICES J
OTHER PRIVATE MEDICAL (SPECIFY) ___________ K
OTHER (SPECIFY) _______________________ X

717. 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 (GO TO 719A)

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

ABDOMINAL PAIN A
GENITAL DISCHARGE/DRIPPING B
FOUL SMELL/DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMATION 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
OTHERS (SPECIFY) ___________ W
OTHERS (SPECIFY) ___________ X
NO SYMPTOMS Y
DOES NOT KNOW Z

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

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL SMELL/DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMATION 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 L
OTHERS (SPECIFY) ___________ W
OTHERS (SPECIFY) ___________ X
NO SYMPTOMS Y
DOES NOT KNOW Z

719A. CHECK 414:

HAS HAD SEXUAL INTERCOURSE __ (GO TO 719A1)
HAS NOT HAD SEXUAL INTERCOURSE __ (GO TO 801)

719A1. CHECK 717: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES __ (GO TO 719B)
NO __ (GO TO 719C)

719B. 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

719C. 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

719D. 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

719E. CHECK 719B, 719C AND 719D

HAS HAD AN INFECTION (ANY 'YES') __ (GO TO 719F)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW __ (GO TO 801)

719F. 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. Where did you go? Any other place?

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

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

(NAME OF PLACE(S)) ______________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTRE/CLINIC B
GOVERNMENT DISPENSARY C
OTHER PUBLIC (SPECIFY) _______ D
PRIVATE MEDICAL SECTOR
MISSIONARY/CHURCH HOSP./CLINIC E
FPAK HEALTH CENTER/CLINIC F
PRIVATE HOSPITAL/CLINIC G
VCT CENTRE H
NURSING/MATERNITY HOMES I
BLOOD TRANSFUSION SERVICES J
OTHER PRIVATE MEDICAL (SPECIFY) ___________ K
OTHER SOURCE
TRADITIONAL HEALER L
SHOP/PHARMACY M
FRIENDS OR RELATIVES N
OTHER (SPECIFY) _______________________ X

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

YES, INFORMED ALL PARTNERS 1
NO, INFORMED NONE 2
INFORMED SOME NOT ALL 3
DID NOT HAVE A PARTNER 4 (GO TO 801)

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

YES 1
NO 2 (GO TO 801)
DID NOT HAVE A PARTNER 3 (GO TO 801)

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

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

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 814)

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

PIPE A
CHEWING TOBACCO B
SNUFF C
OTHER (SPECIFY) ___________ X

814. Are you covered by any health insurance?

YES 1
NO 2 (GO TO 820)

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

MUTUAL HEALTH ORGANIZATION/COMMUNITY BASED HEALTH INSURANCE A
HEALTH INSURANCE THROUGH EMPLOYER B
SOCIAL SECURITY C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
OTHER (SPECIFY) ___________ X

820. 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 SUPERVISOR: ____________________
DATE: _____________________

EDITOR'S OBSERVATIONS
_____________________________________________

NAME OF EDITOR: ______________________
DATE: _______________________