CONFIDENTIAL

IDENTIFICATION

PROVINCE* _________________

DISTRICT _____________________
LOCATION/TOWN ____________________
SUBLOCATION/WARD _________________
NASSEP CLUSTER NUMBER _______________
KDHS CLUSTER NUMBER __________________
HOUSEHOLD NUMBER _______________________

LOCATION

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 NUMBER OF VISITS __

**RESULT CODES:

LANGUAGE

LANGUAGE OF QUESTIONNAIRE: ENGLISH

LANGUAGE OF INTERVIEW *** ______________ __

HOME LANGUAGE OF RESPONDENT*** ____________ __

WAS A TRANSLATOR USED?

*** LANGUAGE CODES:

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.

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?

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

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

106. In what month and year were you born?

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

108. Have you ever attended school?

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

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

111. CHECK 109:

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?

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

114. CHECK 112:

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?

116. Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?

117. Do you watch television almost every day, at least once a week, less than once a week or not at all?

118. What is your religion?

119. What is your ethnic group/tribe?

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?

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

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

204. Do you have any sons or daughters that you have fathered who are alive but do not live with you?

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'.

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?

207. How many boys have died? And how many girls have died?
IF NONE, RECORD '00'.

208. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL.
IF NONE, RECORD '00'.

209. CHECK 208:

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

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

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

213. CHECK 203 AND 205:

214. How old is your (youngest) child?

215. CHECK 214:

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

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

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

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

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

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?

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.

302. Have you or partner ever used (METHOD)?

302A. CHECK 302:

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

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

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

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

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

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?

304. In the last few months, have you talked about family planning with a health worker or health professional?

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?

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

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

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.

309. CHECK 301 (07) KNOWS MALE CONDOM

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

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.

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

SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

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

402. Have you ever been married or lived together with a woman as if married?

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

404. Is your wife/partner living with you now or is she staying elsewhere?

405. Do you have more than one wife or woman you live with as if married?

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

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'.

ASK 408 FOR EACH PERSON.

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

409. CHECK 407:

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

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?

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

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?

415. CHECK 107:

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

417. CHECK 107:

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

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.

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?

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

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

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'.

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.

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

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

428. Apart from [this person/these two people], have you had sexual intercourse with any other person in the last 12 months?

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.'

430. CHECK 424 (ALL COLUMNS):

431. CHECK 424 AND 422 (ALL COLUMNS):

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

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

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

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.'

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

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.

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

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

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?

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.

442. CHECK 302 (02): RESPONDENT EVER STERILIZED

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?

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.

SECTION 5. FERTILITY PREFERENCES

501. CHECK 407:

502. CHECK 302:

503. (Is your wife (partner) or are any of your wives (partners)) currently pregnant?

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?

505. CHECK 407:

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?

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

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.

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?

SECTION 6. EMPLOYMENT AND GENDER ROLES

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

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?

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

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

605. CHECK 604:

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?

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?

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

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

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

609. Are you paid in cash or kind for this work or are you not paid at all?

610. CHECK 407:

611. CHECK 609:

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?

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:

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.

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?

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

SECTION 7. HIV/AIDS

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

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

703. Can people get the AIDS virus from mosquito bites?

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

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

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

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

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

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

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

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

711. Can the virus that causes AIDS be transmitted from a mother to her baby:
During pregnancy?
During delivery?
By breastfeeding?

712. CHECK 711:

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?

713. CHECK 401:

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

714A. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

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

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?

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?

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

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

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

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

716B4. Have you ever heard of VCT?

716C. I do not want to know the results, but have you ever been tested to see if you have the AIDS virus?

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

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?

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

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.

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

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

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

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.

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

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?

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

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

719A. CHECK 414:

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

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?

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

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?

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

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

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.

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

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

719J. What did you do to avoid infecting your partner(s)? Did you:
Use medicine?
Stop having sex?
Use a condom when having sex?

SECTION 8. OTHER HEALTH ISSUES

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

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

803. Can tuberculosis be cured?

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

805. Some men are circumcised. Are you circumcised?

810. Do you currently smoke cigarettes?

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

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

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

814. Are you covered by any health insurance?

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

820. RECORD THE TIME.

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: _______________________