GOVERNMENT OF LIBERIA

LIBERIA INSTITUTE FOR STATISTICS AND GEO-INFORMATION SERVICES

IDENTIFICATION

NAME OF COUNTY____

NAME OF DISTRICT____

NAME OF CLAN/TOWNSHIP____

NAME OF CITY/TOWN/VILLAGE____

LDHS CLUSTER NUMBER_____

LDHS STRUCTURE NUMBER_____

HOUSEHOLD NUMBER_____

URBAN:

NAME OF HOUSEHOLD HEAD____

NAME AND LINE NUMBER OF MAN____

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE___
INTERVIEWER'S NAME____

RESULT*

NEXT VISIT:
DATE___
TIME___

FINAL VISIT
DAY____
MONTH____
YEAR 200____
INTERVIEWER NUMBER____
RESULT*

TOTAL NUMBER OF VISITS

SUPERVISOR
NAME____
DATE____

FIELD EDITOR
NAME____
DATE____

OFFICE EDITOR____

KEYED BY____

SECTION 1. RESPONDENT'S BACKGROUND

Hello. My name is _____ and I am working with the Liberia Institute for Statistics and Geo-Information Services (LISGIS). We are conducting a National Demographic and Health Survey that asks women and men 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 interview usually takes about 45 minutes. The information you provide will be kept strictly confidential and will not be shown to other persons.

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

Do you want to ask me anything about the survey? May I begin the interview now?

101) RECORD THE TIME AT START OF INTERVIEW:

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

103) Just before you moved here, did you live in a city, in a town, or in a village?

103A) During the war, did you leave your house? IF YES: Where did you go?
CIRCLE ALL MENTIONED.

104) In the last 12 months, how many times did you travel away from your home and slept away?

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

106) In what month and year were you born?

107) How old are you?
COMPARE AND CORRECT 106 AND/OR 107 IF INCONSISTENT.

108) Have you ever been to school?

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

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

111) CHECK 109:

112) Can you read this sentence to me?

SHOW SENTENCES TO RESPONDENT.

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

SENTENCES FOR READING (Q. 112):

113) Have you ever been to any program besides primary school that teaches you to read and write?

114) CHECK 112:

115) Do you read newspapers or magazines? How many times a week do you read them: almost every day, at least once a week, less than once a week or not at all?

116) Do you listen to the radio? How many times a week do you listen: almost every day, at least once a week, less than once a week or not at all?

117) Do you watch TV or videos? How many times a week do you watch TV: almost every day, at least once a week, less than once a week or not at all?

118) What is your religion?

119) What dialect do you speak (besides English)?

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 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 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 many years old is your (youngest) child?

215) CHECK 214:

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

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

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

219) When a child has a running stomach, how much should he or she be given 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 or birth control.

Which family planning 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 ever used (METHOD)?

303) In the last few months, have you:

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

306) When do you think a woman can get pregnant: just before her period begins, during her period, just after her period ends, or halfway between two periods?

307) Do you think that a woman who is giving titi to her baby can get pregnant?

308) Please tell me if you agree or disagree.

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 get yourself 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 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 woman business in order to gain a better understanding of some important life issues.

How old were you when you did woman business for the first time?

415) CHECK 107:

416) Do you plan to wait until you get married to do woman business?

417) CHECK 107:

418) The first time you did woman business, did you use a condom?

419) When was the last time you did woman business?

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 I ask 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 did woman business with this person?
[EXCLUDE LAST SEXUAL PARTNER]

422) The last time you did woman business (with this second/third person), did you use a condom?

423) Did you use a condom every time you did woman business with this person in the last 12 months?

424) What was your relationship to this (second/third) person with whom you did woman business?

IF GIRLFRIEND: Were you living together as if married?
IF YES, CIRCLE '02'. IF NO, CIRCLE '03'.

425) How long (have you done/did you do) woman business with her?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.

426) The last time you did woman business 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], did you do woman business with any other person in the last 12 months?
[EXCLUDE THIRD TO LAST PARTNER]

429) In the last 12 months, how many women have you done woman business with?
PROBE TO GET AN ESTIMATE.
[ASK ONLY FOR THIRD TO LAST SEXUAL PARTNER]

IF MORE THAN 96, WRITE '96'.

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 doing woman business?

433) The last time you paid someone in exchange for doing woman business, did you use a condom?

434) Did you use a condom every time you paid someone in exchange for doing woman business in the last 12 months?

435) In your whole life, how many woman have you done woman business with?
PROBE TO GET AN ESTIMATE.

IF MORE THAN 96, WRITE '96'.

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

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

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

441) From where did you obtain 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 PLACE.

442) CHECK 302 (02): RESPONDENT EVER STERILIZED

443) The last time you did woman business did you or your partner use any family planning method (other than a condom)?

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)/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?

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?

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?

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?

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 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.

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:

616) Do you think that if a woman refuses to do men business 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 chances 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 do woman business?

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

706) Can people reduce their chances of getting the AIDS virus by not doing woman business at all?

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

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

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

710) CHECK 709:

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

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

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

713) I don't want to know the results, but have you ever gone for an AIDS test?

714) When was the last time you were tested?

715) The last time you had the test, did you ask for the test, was if offered to you and you accepted, or was it required?

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

717) Where was the test done?

PROBE TO IDENTIFY THE 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.

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

719) Where is that? Any other place?

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

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

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

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

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

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

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

732) Should children age 12-14 be taught to wait until they get married to do woman business in order to avoid getting AIDS?

733) CHECK 701:

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

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

734) CHECK 414:

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

736) Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got from doing woman business?

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

738) 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?

739) CHECK 736, 737, AND 738:

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

741) Where did you go? Any other place?

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

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

742) Husbands and wives do not always agree in everything. If a wife knows her husband has a disease that she can get from doing men business, is she justified in refusing to do men business with him?

743) If a wife knows her husband has a disease that she can get from doing men business, is she justified in asking that they use a condom when they have sex?

744) Is a wife justified in refusing to do men business with her husband when she is tired or not in the mood?

745) Is a wife justified in refusing to do men business with her husband when she knows her husband has sex with other women?

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?

806) Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?

IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.

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

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

IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.

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

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

PROBE TO IDENTIFY THE 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.

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

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) CHECK 107:

815) Are you currently attending school?

816) Who is helping to pay for most of your school expenses?

817) Do you drink liquor?

820) RECORD THE TIME.

INTERVIEWER'S OBSERVATIONS

TO BE FILLED OUT AFTER COMPLETING INTERVIEW.

COMMENTS ABOUT RESPONDENT_____
COMMENTS ON SPECIFIC QUESTIONS_____
ANY OTHER COMMENTS_____

SUPERVISOR'S OBSERVATIONS_____
NAME____
DATE____

EDITOR'S OBSERVATIONS_____
NAME ____
DATE____