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2014 KENYA DEMOGRAPHIC AND HEALTH SURVEY MAN'S QUESTIONNAIRE

IDENTIFICATION

COUNTY ________

DISTRICT ________

LOCATION/TOWN _________

SUBLOCATION __________

NASSEP CLUSTER NUMBER _____

KDHS CLUSTER NUMBER _____

NAME OF HOUSEHOLD HEAD ___________

NAME AND LINE NUMBER OF MAN _________

CHECK 101B IN HOUSEHOLD QUESTIONNAIRE: IS MAN SELECTED FOR SECTION 10?

YES 1
NO 2

INTERVIEWER VISITS

FIRST INTERVIEW
DATE _____
INTERVIEWER'S NAME ________
RESULT* _______

SECOND INTERVIEW
DATE _____
INTERVIEWER'S NAME ________
RESULT* _______

THIRD INTERVIEW
DATE _____
INTERVIEWER'S NAME ________
RESULT* _______

NEXT VISIT
DATE _____
TIME _____

FINAL VISIT
DAY _____
MONTH ______
YEAR ______
INTERVIEW NUMBER _______
RESULT* _____

*RESULT CODES:

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

LANGUAGE OF QUESTIONNAIRE: 17 ENGLISH

LANGUAGE OF INTERVIEW _____

01 BORANA
02 EMBU
03 KALENJIN
04 KAMBA
05 KIKUYU
06 KISII
07 LUHYA
08 MARAGOLI
09 LUO
10 MAASAI
11 MERU
12 MIJIKENDA
13 POKOT
14 SOMALI
15 SWAHILI
16 TURKANA
17 ENGLISH
18 OTHER

TRANSLATOR USED

YES 1
NO 2

SUPERVISOR NAME _________

FIELD EDITOR NAME __________

OFFICE EDITOR __________

KEYED BY _______

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

Hello. My name is _______________. I am working with the Kenya National Bureau of Statistics. We are conducting a survey about health all over Kenya. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 20 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.

In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.

Do you have any questions?
May I begin the interview now?

SIGNATURE OF INTERVIEWER _________________
DATE _______

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)

RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

101) RECORD THE TIME.

HOUR ____
MINUTES ____

101A) 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, Kisumu, in a town, in the countryside, or outside of Kenya?

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

101B) How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE?

IF LESS THAN ONE YEAR, RECORD '00' YEARS

YEARS ____
ALWAYS ___ 96 (GO TO 101D)
VISITOR ___ 96 (GO TO 101D)

101C) Just before you moved here, did you live in Nairobi, Mombasa, Kisumu, in a town, in the countryside, or outside of Kenya?

NAIROBI/MOMBASA/KISUMU 1
TOWN 2
COUNTRYSIDE 2
OUTSIDE OF KENYA 4

101D) What is your nationality?

KENYAN 01 (GO TO 102)
TANZANIAN 02
UGANDAN 03
SOMALI 04
ETHIOPIAN 05
SUDANESE 06

OTHER (SPECIFY) _________ 96

101E) What was the main reason for moving to Kenya?

JOIN FAMILY LIVING IN KENYA 01
MARRIAGE 02
WORK 03
SCHOOL 04
ESCAPE INSECURITY/WAR 05
ESCAPE ENVIRONMENTAL DISASTER (E.G. FLOOD, DROUGHT, ETC.) 06
OTHER (SPECIFY) _______ 96

102) In what month and year were you born?

MONTH ____
DON'T KNOW MONTH 98
YEAR ______
DON'T KNOW YEAR 9998

103) How old were you at your last birthday?
COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT.

AGE IN COMPLETED YEARS ____

104) Have you ever attended school?

YES 1
NO 2 (GO TO 108)

105) 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

106) What is the highest (standard/form/year) you completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

STANDARD/FORM/YEAR ____

107) CHECK 105:

PRIMARY/POST-PRIMARY/VOCATIONAL (GO TO 108)
SECONDARY OR HIGHER (GO TO 110)

108) Now I would like you to read this sentence to me.

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

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

109) CHECK 108:

CODE '2', '3', OR '4' CIRCLED (GO TO 110)
CODE '1' OR '5' CIRCLED (GO TO 111)

110) Do you read a newspaper or magazine at least once a week, less than once a week, or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

111) Do you listen to the radio at least once a week, less than once a week, or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

112) Do you watch television at least once a week, less than once a week, or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

113) What is your religion?

ROMAN CATHOLIC 1
PROTESTANT/OTHER CHRISTIAN 2
MUSLIM 3
NO RELIGION 4

OTHER (SPECIFY) _______ 6

114) What is your ethnic group/tribe?

EMBU 01
KALENJIN 02
KAMBA 03
KIKUYU 04
KISII 05
LUHYA 06
LUO 07
MAASAI 08
MERU 09
MIJIKEDA/SWAHILI 10
SOMALI 11
TAITA/TAVETA 12

OTHER (SPECIFY) _______ 96

115) In the last 12 months, how many times have you been away from home for one or more nights?

NUMBER OF TIMES ____

NONE 00 (GO TO 201)

116) In the last 12 months, have you been away from home for more than one month at a time?

YES 1
NO 2

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
DON'T KNOW (GO TO 206)

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

YES 1 (GO TO 203)
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?

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 0-2 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 (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
OTHER 2

220) When a child has diarrhoea; how much should he or she be given to drink: more than usual, about the same as usual, less than usual, or nothing 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.

Have you ever heard of (METHOD)?

01) FEMALE STERILIZATION.
PROBE: Women can have an operation to avoid having any more children.
YES 1
NO 2
02) MALE STERILIZATION.
PROBE: Men can have an operation to avoid having any more children.
YES 1
NO 2
03) IUD.
PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
04) INJECTABLES.
PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
05) IMPLANTS.
PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse, which can prevent pregnancy for one or more years.
YES 1
NO 2
06) PILL.
PROBE: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
07) MALE CONDOM.
PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) FEMALE CONDOM.
PROBE: 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.
PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
YES 1
NO 2
11) WITHDRAWAL.
PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
12) EMERGENCY CONTRACEPTION.
PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills 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) In the last few months have you:

a) Heard about family planning on the radio?
b) Seen anything about family planning on the television?
c) Read about family planning in a newspaper or magazine?

a) RADIO
YES 1
NO 2
b) TELEVISION
YES 1
NO 2
c) NEWSPAPER OR MAGAZINE
YES 1
NO 2

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

YES 1
NO 2

304) 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 when she has sexual relations?

YES 1
NO 2 (GO TO 306)
DON'T KNOW 8 (GO TO 306)

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

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) ________ 6
DON'T 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 a woman's business and a man should not have to worry about it.
b) Women who use contraception may become promiscuous.

a) CONTRACEPTION WOMEN'S BUSINESS
AGREE 1
DISAGREE 2
DON'T KNOW 8
b) WOMEN MAY BECOME PROMISCUOUS
AGREE 1
DISAGREE 2
DON'T KNOW 8

307) CHECK 301 (07): KNOWS MALE CONDOM

YES (GO TO 308)
NO (GO TO 311)

308) Do you know of a place where a person can get male condoms?

YES 1
NO 2 (GO TO 311)

309) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ______________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT DISPENSARY C
OTHER PUBLIC SECTOR (SPECIFY) _______ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY/CHEMIST F
NURSING/MATERNITY HOME G
FAITH-BASED, CHURCH, MISSION HOSPITAL/CLINIC H
FAMILY OPTIONS/FHOK CLINIC I
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ________ J
OTHER SOURCE
SHOP K
MOBILE CLINIC L
COMMUNITY-BASED DISTRIBUTOR M
COMMUNITY HEALTH WORKER/CHW N
FRIEND/RELATIVE O
DISPENSER P
OTHER (SPECIFY) __________ X

310) If you wanted to, could you yourself get a male condom?

YES 1
NO 2

311) CHECK 301 (08): KNOWS FEMALE CONDOM

YES 1 (GO TO 313)
NO 2 (GO TO 401)

312) Do you know of a place where a person can get female condoms?

YES 1
NO 2 (GO TO 401)

313) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ________________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT DISPENSARY C
OTHER PUBLIC SECTOR (SPECIFY) _________ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY/CHEMIST F
NURSING/MATERNITY HOME G
FAITH-BASED, CHURCH, MISSION HOSPITAL/CLINIC H
FAMILY OPTIONS/FHOK CLINIC I
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _______ J
OTHER SOURCE
SHOP K
MOBILE CLINIC L
COMMUNITY-BASED DISTRIBUTOR M
COMMUNITY HEALTH WORKER/CHW N
FRIEND/RELATIVE O
OTHER (SPECIFY) ______________ X

314) If you wanted to, could you yourself get a female 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 other wives or do you live with other women as if married?

YES (MORE THAN ONE) 1
NO (ONLY ONE) 2 (GO TO 407)

406) Altogether, how many wives or live-in partners do you have?

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS ______

407) CHECK 405:

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

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

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

NAME ________
LINE NUMBER _____

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

AGE ____

409) CHECK 407:

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

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

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

411) In what month and year did you start living with your (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 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 (GO TO 501)
AGE IN YEARS ___
FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE PARTNER 95

414A) CHECK 103:

AGE 15-25 ___
AGE 25-54 ___ (GO TO 415)

414B) The first time you had sexual intercourse, was a condom used?

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

414C) How old was the person you first had sexual intercourse with?

AGE OF PARTNER ___

DON'T KNOW 98

415) 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.

416) 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 430)

417) When was the last time you had sexual intercourse with this person?
[DO NOT RECORD ANSWER FOR LAST PARTNER]

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

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

YES 1
NO 2 (GO TO 420)

418A) What is the main reason you used a condom on that occasion?

PREVENT STD/HIV 1
AVOID PREGNANCY 2
BOTH PREVENT STD/HIV AND PREGNANCY 3
DID NOT TRUST PARTNER/SHE MAY HAVE OTHER PARTNERS 4
PARTNER WANTED TO USE 5
OTHER (SPECIFY) _______ 6

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

YES 1
NO 2

420) What was your relationship to this 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
LIVE-IN PARTNER 2
GIRLFRIEND NOT LIVING WITH RESPONDENT 3 (GO TO 423)
CASUAL ACQUAINTANCE 4 (GO TO 423)
CLIENT/PROSTITUTE 5 (GO TO 423)
OTHER (SPECIFY) _______ 6 (GO TO 423)

421) CHECK 410:

MARRIED ONLY ONCE ___ (GO TO 422)
MARRIED MORE THAN ONCE OR BLANK ____ (GO TO 423)

422) CHECK 414:

FIRST TIME WHEN STARTED LIVING WITH FIRST WIFE (CODE 95)
FIRST TIME WHEN STARTED LIVING WITH FIRST WIFE (GO TO 424)
OTHER (GO TO 423)

423) How long ago did you first have sexual intercourse with this (second/third) person?

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

424) How many times during the last 12 months did you have sexual intercourse with this person?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF TIMES IS 95 OR MORE, WRITE '95'.

NUMBER OF TIMES ___

425) How old is this person?

AGE OF PARTNER ___
DON'T KNOW 98

426) Apart from (this person/these two people), have you had sexual intercourse with any other person in the last 12 months?
[DO NOT ANSWER FOR THIRD-TO-LAST PARTNER]

YES 1 (GO BACK TO 417 IN NEXT COLUMN)
NO 2 (GO TO 428)

427) 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 95 OR MORE, WRITE '95'.

NUMBER OF PARTNERS IN LAST 12 MONTHS ____

DON'T KNOW 98

428) CHECK 420 (ALL COLUMNS):

AT LEAST ONE PARTNER IS PROSTITUTE ___ (GO TO 429)
NO PARTNERS ARE PROSTITUTES ____ (GO TO 430)

429) CHECK 420 AND 418 (ALL COLUMNS):

OTHER ___ (GO TO 434)
CONDOM USED WITH EVERY PROSTITUTE ___ (GO TO 433)

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

YES 1 (GO TO 432)
NO 2

431) Have you ever paid anyone in exchange for having sexual intercourse?

YES 1 (GO TO 434)
NO 2 (GO TO 434)

432) The last time you paid someone in exchange for having sexual intercourse, was a condom used?

YES 1
NO 2 (GO TO 434)

433) 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
DON'T KNOW 8

434) In total, with how many people have you had sexual intercourse in your lifetime?

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

NUMBER OF PARTNERS IN LIFETIME ____
DON'T KNOW 98

435) CHECK 418, MOST RECENT PARTNER (FIRST COLUMN):

CONDOM USED ___ (GO TO 437)
NOT ASKED ___ (GO TO 438)
NO CONDOM USED ___ (GO TO 438)

437) From where did you obtain the condom the last time?

PROBE TO IDENTIFY TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ___________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT DISPENSARY 13
OTHER PUBLIC SECTOR (SPECIFY) _______ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY/CHEMIST 22
NURSING/MATERNITY HOME 23
FAITH-BASED, CHURCH, MISSION HOSPITAL/CLINIC 24
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _________ 26
OTHER SOURCE
SHOP 31
MOBILE CLINIC 32
COMMUNITY-BASED DISTRIBUTOR 33
COMMUNITY HEALTH WORKER/CHW 34
FRIEND/RELATIVE 35
OTHER (SPECIFY) _________ 96

438) 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)

439) 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
MALE STERILIZATION B
IUD C
INJECTABLES D
IMPLANTS E
PILL F
FEMALE CONDOM G
LAM J
RHYTHM METHOD K
WITHDRAWAL L
OTHER MODERN METHOD X
OTHER TRADITIONAL METHOD Y

SECTION 5. FERTILITY PREFERENCES

501) CHECK 401:

CURRENTLY MARRIED OR LIVING WITH A PARTNER ___ (GO TO 502)
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER ___ (GO TO 509)

502) CHECK 439:

MAN NOT STERILIZED OR 439 IS BLANK ___ (GO TO 503)
MAN STERILIZED ___ (GO TO 509)

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

YES 1
NO 2 (GO TO 505)
DON'T KNOW 8 (GO TO 505)

504) Now I have some questions about the future. After the (child/children) 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 ANOTHER CHILD 1 (GO TO 506)
NO MORE 2 (GO TO 509)
UNDECIDED/DON'T KNOW 8 (GO TO 509)

505) 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?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 509)
SAYS COUPLE CAN'T GET PREGNANT 3 (GO TO 509)
WIFE (WIVES)/PARTNER(S) STERILIZED 4 (GO TO 509)
UNDECIDED/DON'T KNOW 8 (GO TO 509)

506) CHECK 407:

ONE WIFE/PARTNER__ (GO TO 507)
MORE THAN ONE WIFE/PARTNER ___ (GO TO 508)

507) 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 509)
YEARS ___ 2 (GO TO 509)

SOON/NOW 993 (GO TO 509)
COUPLE INFECUND 994 (GO TO 509)
OTHER (SPECIFY) ______ 996 (GO TO 509)
DON'T KNOW 998 (GO TO 509)

508) 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

509) 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? PROBE FOR NUMERIC RESPONSE.

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 NUMERIC RESPONSE.

NONE 00 (GO TO 601)
NUMBER ____
OTHER (SPECIFY) _________ (GO TO 601)

510) How many of these children would you like to be boys, how many would you like to be girls, and for how many would it not matter if it's a boy or a girl?

NUMBER 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 (GO TO 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 607)

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

_________________________________________

604A) CHECK 603:

WORKS IN AGRICULTURE ___ (GO TO 604B)
DOES NOT WORK IN AGRICULTURE ___ (GO TO 605)

605) 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

606) 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

607) CHECK 401:

CURRENTLY MARRIED OR LIVING WITH A PARTNER ___ (GO TO 608)
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER ___ (GO TO 612)

608) CHECK 606:

CODE '1' OR '2' CIRCLED ___ (GO TO 609)
OTHER ___ (GO TO 610)

609) Who usually decides how the money you earn will be used: you, your (wife/partner), or you and your (wife/partner) jointly?

RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
OTHER (SPECIFY) _____ 6

610) Who usually makes decisions about health care for yourself: you, your (wife/partner), you and your (wife/partner) jointly, or someone else?

RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) ________ 6

611) Who usually makes decisions about making major household purchases?

RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) ________ 6

612) Do you own this or any other house either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4

613) Do you own any land either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4

614) 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?
b) If she neglects the children?
c) If she argues with him
d) If she refuses to have sex with him?
e) If she burns the food?

a) GOES OUT
YES 1
NO 2
DON'T KNOW 8
b) NEGLECT CHILDREN
YES 1
NO 2
DON'T KNOW 8
c) ARGUES
YES 1
NO 2
DON'T KNOW 8
d) REFUSES SEX
YES 1
NO 2
DON'T KNOW 8
e) BURNS FOOD
YES 1
NO 2
DON'T KNOW 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 723)

702) Can people reduce their chance of getting the AIDS virus by having 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

705A) 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

706) Can people get the AIDS virus because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

707) Is it possible for a healthy-looking person to have the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

708) Can the virus that causes AIDS be transmitted from a mother to her baby:

a) During pregnancy?
b) During delivery?
c) By breastfeeding?

a) DURING PREGNANCY
YES 1
NO 2
DON'T KNOW 8
b) DURING DELIVERY
YES 1
NO 2
DON'T KNOW 8
c) BREASTFEEDING
YES 1
NO 2
DON'T KNOW 8

709) CHECK 708:

AT LEAST ONE 'YES' ___ (GO TO 710)
OTHER ___ (GO TO 711)

710) 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

711) CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY MEASURE TO ENSURE PRIVACY.

712) I don't 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 716)

713) How many months ago was your most recent HIV test?

MONTHS AGO ____
TWO OR MORE YEARS 95

714) I don't want to know the results, but did you get the results of the test?

YES 1
NO 2

715) Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ____________________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 717A)
GOVERNMENT HEALTH CENTER/CLINIC 12 (GO TO 717A)
GOVERNMENT DISPENSARY 13 (GO TO 717A)
OTHER PUBLIC SECTOR (SPECIFY) ________ 18 (GO TO 717A)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (GO TO 717A)
MISSIONARY/CHURCH/HOSPITAL CLINIC 22 (GO TO 717A)
FAMILY OPTIONS/FHOK CLINIC 23 (GO TO 717A)
VCT CENTRE 24 (GO TO 717A)
NURSING/MATERNITY HOMES 25 (GO TO 717A)
BLOOD TRANSFUSION SERVICES 26 (GO TO 717A)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ________ 27 (GO TO 717A)
OTHER SOURCE
HOME 31 (GO TO 717A)
CORRECTIONAL FACILITY 32 (GO TO 717A)
OTHER (SPECIFY) ____________ 96 (GO TO 717A)

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

YES 1
NO 2 (GO TO 717A)

717) Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) _____________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER/CLINIC B
GOVERNMENT DISPENSARY C
OTHER PUBLIC SECTOR (SPECIFY) _______ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
MISSIONARY/CHURCH HOSPITAL/CLINIC F
FAMILY OPTIONS/FHOK CLINIC G
VCT CENTRE H
NURSING/MATERNITY HOMES I
BLOOD TRANSFUSION SERVICES J
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) __________ K
OTHER (SPECIFY) ______________ X

717A) CHECK 401:

CURRENTLY MARRIED OR LIVING WITH A PARTNER ___ (GO TO 717B)
NOT CURRENTLY MARRIED AN NOT LIVING WITH A PARTNER ___ (GO TO 718)

717B) Have you ever talked with your wife/partner about ways to prevent getting the virus that causes AIDS?

YES 1
NO 2
DON'T KNOW 8

718) 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

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

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

720) If a member of your family got infected with the AIDS, would you be willing to care for her or him in your household?

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

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

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

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

SHOULD BE ALLOWED 1
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8

722) Should children age 12-14 be taught about using a condom to avoid getting AIDS?

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

723) 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 724)

723A) If a man has 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/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
DOES NOT KNOW Z

723B) If a woman has a sexually transmitted disease, what symptoms might she have? Any others?

RECORD ALL MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE/DRIPPING B
FOUL SMELL/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 L
OTHER (SPECIFY) _________ W
OTHER (SPECIFY) _________ X
NO SYMPTOMS Y
DOES NOT KNOW Z

724) CHECK 414:

HAS HAD SEXUAL INTERCOURSE ___ (GO TO 725)
HAS NOT HAD SEXUAL INTERCOURSE ____ (GO TO 732)

725) CHECK 723: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES ___ (GO TO 726)
NO ___ (GO TO 732)

726) Now I would like to ask you some questions about your health in last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?

YES 1
NO 2
DON'T KNOW 8

727) 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

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

YES 1
NO 2
DON'T KNOW 8

729) CHECK 726, 727, AND 728:

HAS HAD AN INFECTION (ANY 'YES') ____ (GO TO 730)
HAS NOT HAND INFECTION OR DOES NOT KNOW ____ (GO TO 732)

730) The last time you had (PROBLEM FROM 726/727/728), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 731A)

731) Where did you go? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) __________________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTRE/CLINIC B
GOVERNMENT DISPENSARY C
OTHER PUBLIC SECTOR (SPECIFY) _______ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR E
MISSIONARY/CHURCH HOSPITAL/CLINIC F
FAMILY OPTIONS/FHOK CLINIC G
VCT CENTRE H
NURSING/MATERNITY HOMES I
BLOOD TRANSFUSION SERVICES J
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _______ K
OTHER SOURCE
SHOP/PHARMACY M
TRADITIONAL HEALER N
FRIENDS/RELATIVES O
OTHER (SPECIFY) ___________ X

731A) When you had (PROBLEMS(S) FROM 726/727/728), did you inform the persons with whom you were having sex?

YES, INFORMED ALL PARTNERS 1
INFORMED SOME, NOT ALL 2
NO, INFORMED NONE 3
DID NOT HAVE A PARTNER 4 (GO TO 732)

731B) When (PROBLEMS(S) FROM 726/727/728), did you do anything to avoid infecting your sexual partner(s)?

YES 1
NO 2 (GO TO 732)

731C) What did you do to avoid infecting your partner(s)? Did you:

a) Use medicine?
b) Stop sex?
c) Use a condom when having sex?

a) USE MEDICINE
YES 1
NO 2
b) STOP HAVING SEX
YES 1
NO 2
c) USE CONDOM
YES 1
NO 2

732) If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?

YES 1
NO 2
DON'T KNOW 8

733) Is a wife justified in refusing to have sex with her husband when she knows her husband has sex with women other than his wives?

YES 1
NO 2
DON'T KNOW 8

SECTION 8. OTHER HEALTH ISSUES

801) Some men are circumcised, that is, the foreskin is completely removed from the penis. Are you circumcised?

YES 1
NO 2 (GO TO 805)
DON'T KNOW 8 (GO TO 805)

802) How old were you when you got circumcised?

AGE IN COMPETED YEARS ___
DURING CHILDHOOD (LESS THAN 5 YEARS) 95

DON'T KNOW 98

803) Who did the circumcision?

TRADITIONAL PRACTITIONER/FAMILY/FRIEND 1
HEALTH WORKER/PROFESSIONAL 2
OTHER 3
DON'T KNOW 8

804) Where was it done?

HEALTH FACILITY 1
HOME OF A HEALTH WORKER/PROFESSIONAL 2
CIRCUMCISION DONE AT HOME 3
RITUAL SITE 4
OTHER HOME/PLACE 5
DON'T KNOW 8

805) Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?

IF YES: How many injections have you had?

IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ____
NONE 00 (GO TO 807A)

806) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?

IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ____
NONE 00 (GO TO 807A)

807A) The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

YES 1
NO 2
DON'T KNOW 8

807B) Have you ever been told by a doctor or health worker that you have raised blood pressure or hypertension?

YES 1
NO 2

807B) Have you ever been told by a doctor or health worker that you have raised blood sugar or diabetes?

YES 1
NO 2

807C) In the past 12 months, have you been involved in a road traffic accident as a driver, passenger, pedestrian, or cyclist?

YES 1
NO 2

807D) In the past 12 months, were you injured accidentally, not related to a traffic accident?

YES 1
NO 2 (GO TO 807F)

807E) How did the injury happen?

PROBE: Any other ways?
RECORD ALL MENTIONED.

FALL A
BURN B
POISONING C
CUT D
NEAR-DROWNING E
ANIMAL BITE F
SHOOTING G
OTHER (SPECIFY) _______ X

807F) Have you ever heard of an illness called tuberculosis or TB?

YES 1
NO 2 (GO TO 808)

807G) 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

808) Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 810)

809) In the last 24 hours, how many cigarettes did you smoke?

NUMBER OF CIGARETTES ____

810) Do you currently smoke or use any (other) type of tobacco?

YES 1
NO 2 (GO TO 811A)

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

PIPE A
CHEWING TOBACCO B
SNUFF C
WATER PIPE/SHISHA D
OTHER (SPECIFY) _________ X

811A) Do you drink alcohol?

YES 1
NO 2 (811C)

811B) During the last two weeks, on how many days did you have at least one alcoholic drink?

NUMBER OF DAYS ______

811C) Are you involved in exercise that causes an increase in your heart rate for at least 10 minutes continuously?

a) At work?
b) During other physical activities?

a) AT WORK
YES 1
NO 2
b) OTHER PHYSICAL ACTIVITIES
YES 1
NO 2

811D) Now I would like to ask you about men's health. Have you ever heard of prostate cancer?

YES 1
NO 2 (GO TO 811I)

811E) Has a doctor or health care professional ever examined you to detect or test for prostate cancer?

YES 1
NO 2 (811I)

811F) Did this prostate exam happen within the last 5 years?

YES 1
NO 2

811G) Did the doctor or health care professional who examined you tell you that you have a problem with your prostate?

YES 1
NO 2 (811I)

811H) Were you treated or referred for treatment for the prostate problem?

YES 1
NO 2

811I) Sometimes a woman can have a problem of constant leakage of urine or stool from her vagina during the day and night. This problem usually occurs after a difficult childbirth, but may also occur after asexual assault or after pelvic surgery.

Have you ever heard or this problem?

YES 1
NO 2

812) Are you covered by any health insurance?

YES 1
NO 2 (GO TO 901)

813) What type of health insurance are you covered by? RECORD ALL MENTIONED.

MUTUAL HEALTH ORGANIZATION/COMMUNITY-BASED HEALTH INSURANCE A
HEALTH INSURANCE THROUGH EMPLOYER B
NATIONAL HEALTH INSURANCE SCHEME C
PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
PRE-PAYMENT SCHEME E
OTHER (SPECIFY) _________ X

SECTION 9. FEMALE GENITAL CUTTING

901) Have you ever heard of female circumcision?

YES 1 (GO TO 902A)
NO 2

902) In some countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard about this practice?

YES 1
NO 2 (GO TO 1001)

902A) Do you believe that female circumcision is required by your community?

YES 1
NO 2
DON'T KNOW 8

903) Do you believe that female circumcision is required by your religion?

YES 1
NO 2
NO RELIGION 3
DON'T KNOW 8

904) Do you think that female circumcision should be continued, or should it be stopped?

CONTINUED 1
STOPPED 2
DEPENDS 3
DON'T KNOW 8

SECTION 10. DOMESTIC VIOLENCE

1001) CHECK COVER PAGE: IS MAN SELECTED FOR SECTION 10?

MAN SELECTED FOR THIS SECTION ___ (GO TO 1001A)
MAN NOT SELECTED OR HH QUESTION 101B IS BLANK ___ (GO TO 1033)

1001A) CHECK FOR PRESENCE OF OTHERS: DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

PRIVACY OBTAINED __ 1: READ TO THE RESPONDENT : Now I would like to ask you some questions about some other important aspects of a man's life. You many find some of these questions very personal. However, your answers are crucial for helping to understand the condition of men in Kenya. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in your household will know that you were asked these questions.

PRIVACY NOT POSSIBLE __ 2 (GO TO 1032)

1002) CHECK 401 AND 402:

CURRENTLY MARRIED/LIVING WITH A WOMAN ___ (GO TO 1003)

FORMERLY MARRIED/LIVED WITH A WOMAN (READ IN PAST TENSE AND USE 'LAST' WITH WIFE/PARTNER) ____ (GO TO 1003)

NEVER MARRIED/NEVER LIVED WITH A WOMAN ___ (GO TO 1016)

1003) First, I am going to ask you about some situations which happen to some men. Please tell me if these apply to your relationship with your (last) (wife/partner)?

a) She (is/was) jealous or angry if you (talk/talked) to other women?
b) She frequently (accuses/accused) you of being unfaithful?
c) She (does/did) not permit you to meet your male friends?
d) She (tries/tried) to limit your contact with family?
e) She (insists/insisted) on knowing where you (are/were) at all times?

a) JEALOUS
YES 1
NO 2
DON'T KNOW 8
b) ACCUSES
YES 1
NO 2
DON'T KNOW 8
c) NOT MEET FRIENDS
YES 1
NO 2
DON'T KNOW 8
d) NO FAMILY
YES 1
NO 2
DON'T KNOW 8
e) WHERE YOU ARE
YES 1
NO 2
DON'T KNOW 8

1004) Now I need to ask some more questions about your relationship with you (last) (wife/partner).

1004A) Did your (last) (wife/partner) ever:

a) Say or do something to humiliate you in front of others?
YES 1 (GO TO 1004B-a)
NO 2 (GO TO 1004A-b)
b) Threaten to hurt or harm you or someone you care about?
YES 1 (GO TO 1004B-b)
NO 2 (GO TO 1004A-c)
c) Insult you or make you feel bad about yourself?
YES 1 (GO TO 1004B-c)
NO 2

1004B) How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) Say something to humiliate you in front of others?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) Threaten to hurt or harm you or someone you care about?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) Insult you or make you feel bad about yourself?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

1005A) Did your (last) (wife/partner) ever do any of the following things to you:

a) Push you, shake you, or throw something at you?
YES 1 (GO TO 1005B-a)
NO 2 (GO TO 1005A-b)
b) Slap you?
YES 1 (GO TO 1005B-b)
NO 2 (GO TO 1005A-c)
c) Twist your arm or pull your hair?
YES 1 (GO TO 1005B-c)
NO 2 (GO TO 1005A-d)
d) Punch you with her fist or with something that could hurt you?
YES 1 (GO TO 1005B-d)
NO 2 (GO TO 1005A-e)
e) Kick you, drag you, or beat you up?
YES 1 (GO TO 1005B-e)
NO 2 (GO TO 1005A-f)
f) Try to choke you or bum you on purpose?
YES 1 (GO TO 1005B-f)
NO 2 (GO TO 1005A-g)
g) Threaten or attack you with a knife, gun, or other weapon?
YES 1 (GO TO 1005B-g)
NO 2 (GO TO 1005A-h)
h) Physically force you to have sexual intercourse with her when you did not want to?
YES 1 (GO TO 1005B-h)
NO 2 (GO TO 1005A-i)
i) Physically force you to perform any other sexual acts you did not want to?
YES 1 (GO TO 1005B-i)
NO 2 (GO TO 1005A-j)
j) Force you with threats or in any other way to perform sexual acts you did not want to?
YES 1 (GO TO 1005B-j)
NO 2

1005B) How often did this happen during the last 12 months; often, only sometimes, or not at all?

a) Push you, shake you, or throw something at you?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
b) Slap you?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
c) Twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
d) Punch you with her fist or with something that could hurt you?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
e) Kick you, drag you, or beat you up?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
f) Try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
g) Threaten or attack you with a knife, gun, or other weapon?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
h) Physically force you to have sexual intercourse with her when you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
i) Physically force you to perform any other sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
j) Force you with threats or in any other way to perform sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3

1006) CHECK 1005A (a-j):

AT LEAST ONE 'YES' ___ (GO TO 1007)
NOT A SINGLE 'YES' ___ (GO TO 1009)

1007) How long after you first (got married/started living together) with your (last) (wife/partner) did (this/any of these things) first happen?

IF LESS THAN ONE YEAR, RECORD '00'.

NUMBER OF YEARS ____
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95

1008) Did the following ever happen as a result of what your (last) (wife/partner) did to you:

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

1009) Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) (wife/partner) at times when she was not already beating or physically hurting you?

YES 1
NO 2 (GO TO 1011)

1010) In the last 12 months, how often have you done this to your (last) (wife/partner): often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1011) Does (did) your (last) (wife/partner) drink alcohol?

YES 1
NO 2 (GO TO 1013)

1012) How often does (did) she get drunk: often, only sometimes, or never?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1013) Are (Were) you afraid of your (last) (wife/partner): most of the time, sometimes, or never?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1014) CHECK 410:

MARRIED MORE THAN ONCE OR 410 IS BLANK ___ (GO TO 1015)
MARRIED ONLY ONCE ___ (GO TO 1016)

1015A) So far we have been talking about the behavior of your (current/last) (wife/partner). Now I want to ask you about the behavior of any previous (wife/partner).

a) Did any previous (wife/partner) ever hit, slap, kick, or do anything else to hurt you physically?
YES 1 (GO TO 1015B-a)
NO 2 (GO TO 1015A-b)
b) Did any previous (wife/partner) physically force you to have intercourse or perform any other sexual acts against your will?
YES 1 (GO TO 1015B-b)
NO 2

1015B) How long ago did this last happen?

a) Did any previous (wife/partner) ever hit, slap, kick, or do anything else to hurt you physically?
0-11 MONTHS AGO 1
12+ MONTHS AGO 2
DON'T REMEMBER 3
b) Did any previous (wife/partner) physically force you to have intercourse or perform any other sexual acts against your will?
0-11 MONTHS AGO 1
12+ MONTHS AGO 2
DON'T REMEMBER 3

1016) CHECK 401 AND 402:

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

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

YES 1
NO 2 (GO TO 1022)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1022)

1017) Who has hurt you in this way? Anyone else?
RECORD ALL MENTIONED.

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

1018) In the last 12 months, how often has (this person/have these persons) physically hurt you: often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1022) CHECK 401 AND 402:

EVER MARRIED/EVER LIVED WITH A WOMAN ___ (GO TO 1022A)
NEVER MARRIED/NEVER LIVED WITH A WOMAN ___ (GO TO 1022B)

1022A) Now I want to ask you about things that may have been done to you by someone other than (your/any) (wife/partner).

At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

YES 1 (GO TO 1023)
NO 2 (GO TO 1024A)
REFUSED TO ANSWER/NO ANSWER (GO TO 1024A)

1022B) At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

YES 1
NO 2 (GO TO 1026)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1026)

1023) Who has the person who was forcing you the very first time this happened?

CURRENT WIFE/PARTNER 01
FORMER WIFE/PARTNER 02
CURRENT/FORMER GIRLFRIEND 03
FATHER/STEP-FATHER 04
BROTHERS/STEP-BROTHER 05

1024) CHECK 1005A (h-j) and 1015A(b)

AT LEAST ONE 'YES' ___ (GO TO 1025)
NOT A SINGLE 'YES' ___ (GO TO 1026)

1025) CHECK 401 AND 402:

EVER MARRIED/EVER LIVED WITH A WOMAN: How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts by anyone, including (your/any) wife/partner?

AGE IN COMPLETED YEARS ____
DON'T KNOW 98

NEVER MARRIED/NEVER LIVED WITH A WOMAN: How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?

AGE IN COMPLETED YEARS ____
DON'T KNOW 98

1026) CHECK 1005A (a-j), 1015A (a,b), 1016, 1022A, AND 1022B:

AT LEAST ONE 'YES' ___ (GO TO 1027)
NOT A SINGLE 'YES' ___ (GO TO 1030)

1027) Thinking about what yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

YES 1
NO 2 (GO TO 1029)

1028) From whom have you sought help? Anyone else?
RECORD ALL MENTIONED.

OWN FAMILY A (GO TO 1030)
WIFE'S/PARTNER'S FAMILY B (GO TO 1030)
CURRENT/FORMER WIFE/PARTNER C (GO TO 1030)
CURRENT/FORMER GIRLFRIEND D (GO TO 1030)
FRIEND E (GO TO 1030)
NEIGHBOR F (GO TO 1030)
RELIGIOUS LEADER G (GO TO 1030)
DOCTOR/MEDICAL PERSONNEL H (GO TO 1030)
POLICE I (GO TO 1030)
LAWYER J (GO TO 1030)
SOCIAL SERVICE ORGANIZATION K (GO TO 1030)

OTHER (SPECIFY) _______ X (GO TO 1030)

1029) Have you ever told anyone about this?

YES 1
NO 2

1030) As far as you know, did your father ever beat your mother?

YES 1
NO 2
DON'T KNOW 8

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

1031) DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

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

1032) INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE

________________________________________________________________________

1033) RECORD THE TIME.

HOUR ___
MINUTES ___