LESOTHO DEMOGRAPHIC AND HEALTH SURVEY
MAN'S QUESTIONNAIRE

IDENTIFICATION
PLACE NAME ___________________
NAME OF HOUSEHOLD HEAD ______________
EA NUMBER
HOUSEHOLD NUMBER

LESOTHO ECOLOGICAL ZONE

LOWLANDS 1
FOOTHILLS 2
MOUNTAINS 3
SENQU RIVER VALLEY 4

DISTRICT
URBAN/RURAL

URBAN 1
RURAL 2

HOUSEHOLD SELECTED FOR MALE SURVEY

YES 1
NO 2

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 _____
INT. NUMBER ______
RESULT _____

TOTAL NUMBER OF VISITS _____
TOTAL PERSONS IN HOUSEHOLD ______
TOTAL ELIGIBLE WOMEN _____
TOTAL ELIGIBLE MEN _____
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE _____

*RESULT CODES:
COMPLETED 1
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) ________ 9

SUPERVISOR
NAME _______
DATE _______

FIELD EDITOR
NAME _______
DATE _______

OFFICE EDITOR ___ ___
KEYD BY ___ ___

01=BUTHA-BUTHE; 02=LERIBE; 03=BEREA; 04=MASERU; 05=MAFETENG; 06=MOHALE'S HOEK; 07=QUTHING; 08=QASHA'S NEK; 09=MOKHOTLONG; 10=THABA-TSEKA

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT
INFORMED CONSENT

Hello. My name is __________________ and I am working with the Ministry of Health and Social Welfare. We are conducting a national survey about the health of men, women and children. We would very much appreciate your participation in this survey. I would like to ask you about your health. This information will help the government to plan health services. The survey usually takes between 20 and 45 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.
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
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 GO TO END

101 RECORD THE TIME.

HOUR ___ ___
MINUTES ___ ___

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

URBAN 1
RURAL 2

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

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

104 Just before you moved here, did you live in an urban or in a rural area?

URBAN 1
RURAL 2

105 In the last 12 months, on how many separate occasions have you traveled away from this household and slept away?

NUMBER OF TRIPS AWAY ___ ___
NONE 00 GO TO 107

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

YES 1
NO 2

107 In what month and year were you born?

MONTH ___ ___
DON'T KNOW MONTH 98
YEAR ___ ___ ___ ___
DON'T KNOW YEAR 9998

108 How old were you at your last birthday?

COMPARE AND CORRECT 107 AND/OR 108 IF INCONSISTENT.
AGE IN COMPLETED YEARS ___ ___

109 Have you ever attended school?

YES 1
NO 2 GO TO 116

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
110 What is the highest level of school you attended?

PRIMARY 1
VOCAT/TECHN. TRAINING AFTER PRIMARY 2
SECONDARY/HIGH 3
VOCAT/TECHN. TRAINING AFTER SECONDARY/HIGH 4
COLLEGE 5
GRADUATE/POST GRADUATE 6

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

STND/FORM/YEAR ___ ___

112 CHECK 108:

AGE 24 OR BELOW GO TO NEXT
AGE 25 OR ABOVE GO TO 115

113 Are you currently attending school?

YES 1
NO 2 GO TO 115

114 What is the main reason you are not attending school?

GOT MARRIED 01
CARE FOR YOUNGER CHILDREN 02
FAMILY NEEDED HELP ON FARM OR IN BUSINESS 03
COULD NOT PAY SCHOOL FEES 04
NEEDED TO WORK FOR MONEY 05
GRADUATED 06
DID NOT PASS ENTRANCE EXAMS 07
DID NOT LIKE SCHOOL 08
SCHOOL NOT ACCESSIBLE/ TOO FAR 09
OTHER __________(SPECIFY) 96
DON'T KNOW 98

115 CHECK 110:

PRIMARY/VOCATION/TECHN AFTER PRIMARY GO TO NEXT
SECONDARY OR HIGHER GO TO 119

116 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

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

YES 1
NO 2

118 CHECK 116:

CODE '2', '3' OR '4' CIRCLED GO TO NEXT
CODE '1' OR '5' CIRCLED GO TO 120

119 Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4 GO TO 120

119A What kind of newspapers or magazines do you read: Lesotho newspapers/magazines, RSA newspapers/magazines, or any other?
RECORD ALL MENTIONED.

LESOTHO NEWSPAPER/MAGAZINE A
RSA NEWSPAPER/MAGAZINE B
OTHER _______________(SPECIFY) X

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

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4 GO TO 121

120A What kind of radio do you listen to: Lesotho radio, RSA radio, or any other?
RECORD ALL MENTIONED.

LESOTHO RADIO A
RSA RADIO B
OTHER _________________ (SPECIFY) X

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

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4 GO TO 122

121A What kind of TV do you watch: Lesotho TV, RSA TV, or any other?
RECORD ALL MENTIONED.

LESOTHO TV A
RSA TV B
OTHER ________________ (SPECIFY) X

122 Are you currently working?

YES 1
NO 2 GO TO 125

123 Have you done any work in the last 12 months?

YES 1
NO 2 GO TO 125

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

GOING TO SCHOOL/STUDYING 1
LOOKING FOR WORK 2
RETIRED 3
UNABLE TO WORK,
ILL/HANDICAPPED 4
HOUSEWORK/CHILDCARE 5
OTHER _______________ (SPECIFY) 6

ALL GO TO 132

125 What is your occupation, that is, what kind of work do you mainly do?
__________________ ____ ____

126 CHECK 125:

WORKS IN AGRICULTURE GO TO NEXT
DOES NOT WORK IN AGRICULTURE GO TO 128

127 Do you work mainly on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4

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

NUMBER OF MONTHS ___ ___

129 Are/were you paid in cash or kind for this work, or are you not paid at Are/were you paid in cash or kind for this work, or are you not paid at all?

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3 GO TO 132
NOT PAID 4 GO TO 132

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

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

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

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

132 What religion do you belong to?
IF CHRISTIAN: What church do you belong to?

ROMAN CATHOLIC CHURCH 01
LESOTHO EVANGELICAL CHURCH 02
METHODIST 03
ANGLICAN CHURCH 04
SEVENTH DAY ADVENTIST 05
PENTECOSTAL 06
OTHER CHRISTIAN 07
NONE 08
OTHER RELIGION _________________ (SPECIFY) 96

1 LITERACY CARD (Q. 116):

1. Parents love their children.
2. Farming is hard work.
3. Birds fly in the sky.
4. Children work hard at school.
Appendix E | 375

SECTION 2. REPRODUCTION

201 Now I would like to ask about any children you have had during your life. I am interested only in the children that are biologically yours.
Have you ever fathered any children with any woman?

YES 1
NO 2
DON'T KNOW 8 GO TO 206

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

YES 1
NO 2 GO TO 204

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

SONS AT HOME ___ ___
DAUGHTERS AT HOME ___ ___

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

YES 1
NO 2 GO TO 206

205 How many sons are alive but do not live with you? And how many daughters are alive but do not live with you?
IF NONE, RECORD '00'.

SONS ELSEWHERE ___ ___
DAUGHTERS ELSEWHERE ___ ___

206 Have you ever fathered a son or a daughter who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

YES 1
NO 2 GO TO 208
DON'T KNOW 8 GO TO 208

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

BOYS DEAD ___ ___
GIRLS DEAD ___ ___

208 (In addition to the children that you have just told me about), do you have:
a) any other living sons or daughters who are biologically your children but who are not legally yours or do not have your last name?
b) any other sons or daughters who died who were biologically your children but who were not legally yours or did not have your last name?

NO TO BOTH GO TO NEXT
YES TO EITHER PROBE AND EITHER 201-207 AS NECESSARY.

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

TOTAL CHILDREN ___ ___

210 CHECK 209:

HAS HAD MORE THAN ONE CHILD GO TO NEXT
HAD HAD ONLY ONE CHILD GO TO 213
HAS OT HAD ANY CHLDREN GO TO 301

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

YES 1
NO 2 GO TO 213

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

NUMBER OF WOMEN ___ ___

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

AGE IN YEARS ___ ___

SECTION 3. CONTRACEPTION

Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.
CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED,
AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302 IF APPLICABLE.

301 Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK:

01 FEMALE STERILIZATION Women can have an operation to avoid having any more children.

YES 1
NO 2

02 MALE STERILIZATION Men can have an operation to avoid having any more children.

YES 1
NO 2 (GO TO NEXT)

03 PILL Women can take a pill every day to avoid becoming pregnant.

YES 1
NO 2

04 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.

YES 1
NO 2

05 INJECTABLES Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.

YES 1
NO 2

06 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.

YES 1
NO 2

07 MALE CONDOM Men can put a rubber sheath on their penis before sexual ntercourse.

YES 1
NO 2 (GO TO NEXT)

08 FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.

YES 1
NO 2

09 DIAPHRAGM Women can place a sheath in their vagina before sexual intercourse.

YES 1
NO 2

10 FOAM OR JELLY Women can place a suppository, jelly, or cream in their vagina before intercourse.

YES 1
NO 2 (GO TO NEXT)

11 LACTATIONAL AMENORRHEA METHOD (LAM) Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.

YES 1
NO 2

12 RHYTHM METHOD Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.

YES 1
NO 2 (GO TO NEXT)

13 WITHDRAWAL Men can be careful and pull out before climax.

YES 1
NO 2 (GO TO NEXT)

14 EMERGENCY CONTRACEPTION Women can take pills up to three days after seuxla intercourse or IUCD up to five days after sexual intercourse to avoid becoming pregnant.

YES 1
NO 2

15 LOCAL TRADITIONAL METHODS There are various methods that exist in different regions in Lesotho used to delay or avoid a pregnancy.

YES 1
NO 2

16 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?

YES 1
____________________(SPECIFY)
NO 2

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

02 MALE STERILIZATION Men can have an operation to avoid having any more children.
Have you ever had an operation to avoid having any more children?

YES 1
NO

07 MALE CONDOM Men can put a rubber sheath on their penis before sexual intercourse. Have you (or your partner) ever used (METHOD)?

YES 1
NO 2

08 FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse. Have you (or your partner) ever used (METHOD)?

YES 1
NO 2

12 RHYTHM OR PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant. Have you (or your partner) ever used (METHOD)?

YES 1
NO 2
DON'T KNOW 8

13 WITHDRAWAL Men can be careful and pull out before climax. Have you (or your partner) ever used (METHOD)?

YES 1
NO 2 GO TO NEXT

15 LOCAL TRADITIONAL METHODS There are various traditional methods that exist in different regions in Lesotho used to delay or avoid a pregnancy. Have you (or your partner) ever used (METHOD)?

YES 1
NO 2

16 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?

YES 1
____________________(SPECIFY)
NO 2

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

YES 1
NO 2
DON'T KNOW 8 GO TO 305

304 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

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

YES 1
NO 2
DEPENDS 3
DON'T KNOW 8

306 I would like to ask you about the first time that you or your partner did something or used a method to avoid pregnancy.
How many living children did you have at that time, if any?

NUMBER OF CHILDREN ___ ___
DON'T KNOW 98

307 How old were you when you first started using something to avoid impregnating someone?

AGE AT FIRST USE ___ ___

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.

AGREE 1
DISAGREE 2
DK 8

b) Women who use contraception may become promiscuous.

AGREE 1
DISAGREE 2
DK 8

c) A woman is the one who gets pregnant so she should be the one to use contraception.

AGREE 1
DISAGREE 2
DK 8

d) A woman who uses contraceptives might have a problem getting pregnant.

AGREE 1
DISAGREE 2
DK 8

309 CHECK 301(02) AND 302(02): KNOWLEDGE AND USE OF MALE STERILIZATION

HAS HEARD OF MALE STERILIZATION BUT IS NOT STERILIZED GO TO NEXT
OTHER GO TO 401

310 Once you have had all the children you want, would you yourself ever consider getting sterilized?

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

311 Why would you never consider getting sterilized?
PROBE: Any other reasons?
RECORD ALL REASONS MENTIONED.

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

SECTION 4. MARRIAGE, SEXUAL ACTIVITY AND CONTRACEPTIVE USE

401 Are you currently married or living with a partner?
NOTE TO INTERVIEWER: 'MARRIED' MEANS HAVING GOTTEN MARRIED THROUGH TRADITIONAL, CIVIL AND/OR RELIGIOUS CEREMONY.

YES, CURRENTLY MARRIED 1
YES, LIVING WITH A WOMAN 2 GO TO 404
NO, NOT IN UNION 3 GO TO 405

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

NUMBER OF WIVES ___ ___ ___

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

YES 1
NO 2 GO TO 405

404 Are you living with one (other) woman or more than one (other) woman as if married?
IF ONE LIVE-IN PARTNER, ENTER '01'.
IF MORE THAN ONE, ASK: How many women are you living with as if married?

NUMBER OF LIVE-IN PARTNERS ___ ___

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

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

ALL GO TO 409

406 Do you currently have any regular sexual partners, occasional sexual partners, or do you have no sexual partner at all?

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

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

YES, FORMERLY MARRIED ONLY 1
YES, LIVED WITH A WOMAN ONLY 2 GO TO 411
YES, BOTH 3
NO 4 GO TO 416

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

WIDOWED 1
DIVORCED 2
SEPARATED 3
COHABITING 4

ALL GO TO 411

409 WRITE THE LINE NUMBERS FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE/PARTNER REPORTED IN QUESTIONS 402 AND 404 ONLY. IF A WIFE/PARTNER IS NOT LISTED IN THE HOUSEHOLD
SCHEDULE, ENTER '00' IN THE LINE NUMBER BOXES. THE NUMBER OF LINES FILLED IN MUST BE EQUAL TO THE NUMBER OF WIVES AND PARTNERS. (IF RESPONDENT HAS MORE THAN FIVE WIVES/PARTNERS
USE ADDITIONAL QUESTIONNAIRE(S).
CHECK: 402 AND 404
SUM OF 402 AND 404 = 1
Please tell me the name of your wife/partner.
SUM OF 402 AND 404 > 1
Please tell me the name of each wife/partner that you live with, starting with the one you lived with first.
WIFE/PARTNER NUMBER/ LINE NUMBER IN HOUSEHOLD QUESTIONNAIRE
1 ____________________________________________________ ___ ___
2 ____________________________________________________ ___ ___
3 ____________________________________________________ ___ ___
4 ____________________________________________________ ___ ___
5 ____________________________________________________ ___ ___
6_____________________________________________________ ___ ___
7 ____________________________________________________ ___ ___
8 ____________________________________________________ ___ ___
9 ____________________________________________________ ___ ___
10____________________________________________________ ___ ___

410 CHECK 409:

ONLY ONE WIFE/PARNTER GO TO NEXT
MORE THAN ONE WIFE/PARNTER GO TO 412

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

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

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

YES 1
NO 2 GO TO 414

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

NUMBER OF WOMEN ___ ___

414 CHECK 409 AND 411:
ONLY ONE WIFE/PARNTER AND 411=1
In what month and year did you start living with your wife/partner?

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

MONTH ___ ___
DON'T KNOW MONTH 98
YEAR ___ ___ ___ ___ GO TO 418
DON'T KNOW YEAR 9998

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

AGE ___ ___

416 Now I need to ask you some questions about sexual activity in order to gain a better understanding of some health issues.
How old were you when you first had sexual intercourse with a woman (if ever)?

NEVER 00 GO TO 416
AGE IN YEARS ___ ___
FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE/PARTNER 95

416A CHECK 108:

15-24 YEARS OLD GO TO NEXT
25-59 YEARS OLD GO TO 417

416B The first time you had sexual intercourse, was a male or female condom used?

YES, MALE CONDOM 1
YES, FEMALE CONDOM 2
NO 3

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

DAYS AGO 1___ ___
WEEKS AGO 2___ ___
MONTHS AGO 3___ ___
YEARS AGO 4 ___ ___ GO TO 445

418 The last time you had sexual intercourse, did you or your partner use any contraception/protection?

YES 1
NO 2 GO TO 420
DON'T KNOW/UNSURE 8 GO TO 423A

419 What method of contraception/protection was used the last time you had sex?
IF MORE THAN ONE METHOD USED, RECORD THE HIGHEST METHOD ON THE LIST.

FEMALE STERILIZATION 01
MALE STERILIZATION 02
PILL 03
IUCD 04
INJECTABLES 05
IMPLANTS 06
MALE CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMEN. METHOD 11
PERIODIC ABSTINENCE 12
WITHDRAWAL 13
LOCAL TRADITIONAL METHOD 14
OTHER ________________(SPECIFY) 96

ALL GO TO 421

420 What is the reason a method was not used? Any other reasons?
RECORD ALL MENTIONED.

CASUAL SEX PARTNER SO DOES NOT CARE A
CONTRACEPTION WOMEN'S BUSINESS B
FERTILITY-RELATED REASONS

WIFE/PARTNER MENOPAUSAL/HAD HYSTERECTOMY C
COUPLE SUBFECUND/INFECUND D
WIFE/PARTNER WAS PREGNANT E
WIFE/PARTNER WAS POSTPARTUM AMENORRHEIC F
WIFE/PARTNER WAS BREASTFEEDING G
WANTED (MORE) CHILDREN H

OPPOSITION TO USE

RESPONDENT OPPOSED I
WIFE/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L

LACK OF KNOWLEDGE

KNOWS NO METHOD M
KNOWS NO SOURCE N

METHOD-RELATED REASONS

HEALTH CONCERNS O
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COST TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T

OTHER _______________ (SPECIFY) X
DON'T KNOW Z

ALL GO TO 423A

421 CHECK 419:

MALE OR FEMALE CONDOM USED GO TO NEXT
OTHER METHOD USED ALL GO TO 423

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

RESPONDENT WANTED TO PREVENT STD/HIV 01
RESPONDENT WANTED TO PREVENT PREGNANCY 02
RESPONDENT WANTED TO PREVENT BOTH STD/HIV AND PREGNANCY 03
DID NOT TRUST PARTNER/FELT PARTNER HAD OTHER PARTNERS 04
PARTNER REQUESTED/INSISTED 05
OTHER ___________________ (SPECIFY) 96
DON'T KNOW 98

ALL GO TO 423A

423 What is main reason you did not use a condom that time?

NOT AVAILABLE 01
COST TOO MUCH 02
USED FAMILY PLANNING METHOD 03
CONDOMS TRANSMIT HIV 04
CONDOMS HAVE WORMS 05
TRUSTED PARTNER 06
PARTNER WAS NEGATIVE/NO RISK 07
RESPONDENT DOESN'T LIKE 08
PARTNER REFUSED/OBJECTED 09
PARTNER DRUNK/ON DRUGS 10
RESPONDENT DRUNK/ON DRUGS 11
PARTNER WANTED TO GET PREGNANT 12
OTHER _______________ (SPECIFY) 96

423A The last time you had sexual intercourse with this person, did you or this person drink alcohol?

YES 1
NO 2 GO TO 424

423B Were you or your partner drunk at that time?
IF YES: Who was drunk?

RESPONDENT ONLY 1
PARTNER ONLY 2
BOTH RESPONDENT AND PARTNER 3
NEITHER 4

424 What is your relationship to this woman?
IF WOMAN IS "GIRLFRIEND" OR "FIANCÉE", ASK:
Was your girlfriend/fiancé living with you when you last had sex with her?
IF YES, CIRCLE '01'.
IF NO, CIRCLE '02'.

WIFE/COHABITING PARTNER 01 ALL GO TO 426
WOMAN IS GIRLFRIEND/FIANCÉE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
WOMAN IS PROSTITUTE 06
OTHER ____________ (SPECIFY) 96

425 For how long (have you had/did you have) sexual relations with this woman?
IF ONLY HAD SEXUAL RELATIONS WITH THIS WOMAN ONCE, RECORD '01' DAYS.

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

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

YES 1
NO 2 GO TO 445

427 The last time you had sexual intercourse with this second woman, did you or your partner use any contraception/protection ?

YES 1
NO 2 GO TO 429
DON'T KNOW/UNSURE 8 GO TO 432A

428 What method of contraception/protection was used the last time you had sex?
IF MORE THAN ONE METHOD USED, RECORD THE HIGHEST METHOD ON THE LIST.

429 What is the reason a method was not used? Any other reasons?
RECORD ALL MENTIONED.

CASUAL SEX PARTNER SO DOES NOT CARE A
CONTRACEPTION WOMEN'S BUSINESS B
FERTILITY-RELATED REASONS

WIFE/PARTNER MENOPAUSAL/HAD HYSTERECTOMY C
COUPLE SUBFECUND/INFECUND D
WIFE/PARTNER WAS PREGNANT E
WIFE/PARTNER WAS POSTPARTUM AMENORRHEIC F
WIFE/PARTNER WAS BREASTFEEDING G
WANTED (MORE) CHILDREN H

OPPOSITION TO USE

RESPONDENT OPPOSED I
WIFE/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L

LACK OF KNOWLEDGE

KNOWS NO METHOD M
KNOWS NO SOURCE N

METHOD-RELATED REASONS

HEALTH CONCERNS O
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COST TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T

OTHER (SPECIFY) _________ X
DON'T KNOW Z

ALL GO TO 432A

430 CHECK 428:

MALE OR FEMALE CONDOM USED GO TO NEXT
OTHER METHOD USED GO TO 432

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

ALL GO TO 432A

432 What is the main reason you did not use a condom that time?

432A The last time you had sexual intercourse with this second person, did you or this person drink alcohol?

YES 1
NO 2 GO TO 433

432B Were you or your partner drunk at that time?
IF YES: Who was drunk?

RESPONDENT ONLY 1
PARTNER ONLY 2
BOTH RESPONDENT AND PARTNER 3
NEITHER 4

433 What is your relationship to this woman?
IF WOMAN IS "GIRLFRIEND" OR "FIANCÉE", ASK:
Was your girlfriend/fiancé living with you when you last had sex with her?
IF YES, CIRCLE '01'.
IF NO, CIRCLE '02'.

WIFE/COHABITING PARTNER 01 GO TO 435
WOMAN IS GIRLFRIEND/FIANCÉE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
WOMAN IS PROSTITUTE 06
OTHER ________(SPECIFY) 96

434 For how long (have you had/did you have) sexual relations with this woman?
IF ONLY HAD SEXUAL RELATIONS WITH THIS WOMAN ONCE, RECORD '01' DAYS.

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

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

YES 1
NO 2 GO TO 445

436 The last time you had sexual intercourse with this third woman, did you or your partner use any contraception/ protection?

YES 1
NO 2 GO TO 438
DON'T KNOW/UNSURE 8 GO TO 441A

437 What method of contraception/protection was used the last time you had sex?
IF MORE THAN ONE METHOD USED, RECORD THE HIGHEST METHOD ON THE LIST.

ALL GO TO 439

438 What is the reason a method was not used? Any other reasons?
RECORD ALL MENTIONED.

CASUAL SEX PARTNER SO DOES NOT CARE A
CONTRACEPTION WOMEN'S BUSINESS B
FERTILITY-RELATED REASONS

WIFE/PARTNER MENOPAUSAL/HAD HYSTERECTOMY C
COUPLE SUBFECUND/INFECUND D
WIFE/PARTNER WAS PREGNANT E
WIFE/PARTNER WAS POSTPARTUM AMENORRHEIC F
WIFE/PARTNER WAS BREASTFEEDING G
WANTED (MORE) CHILDREN H

OPPOSITION TO USE

RESPONDENT OPPOSED I
WIFE/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L

LACK OF KNOWLEDGE

KNOWS NO METHOD M
KNOWS NO SOURCE N

METHOD-RELATED REASONS

HEALTH CONCERNS O
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COST TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T

OTHER _____________ (SPECIFY) X
DON'T KNOW Z

ALL GO TO 441A

439 CHECK 437:

MALE OR FEMALE CONDOM USED GO TO NEXT
OTHER METHOD USED GO TO 441

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

ALL GO TO 441A

441 What is the main reason you did not use a condom that time?

441A The last time you had sexual intercourse with this third person, did you or this person drink alcohol?

YES 1
NO 2 GO TO 442

441B Were you or your partner drunk at that time?

RESPONDENT ONLY 1
PARTNER ONLY 2
BOTH RESPONDENT AND PARTNER 3
NEITHER 4

442 What is your relationship to this woman?
IF WOMAN IS "GIRLFRIEND" OR "FIANCÉE", ASK:
Was your girlfriend/fiancé living with you when you last had sex with her?
IF YES, CIRCLE '01'.
IF NO, CIRCLE '02'.

WIFE/COHABITING PARTNER 01 GO TO 444
WOMAN IS GIRLFRIEND/FIANCÉE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
WOMAN IS PROSTITUTE 06
OTHER ___________(SPECIFY) 96

443 For how long (have you had/did you have) sexual relations with this woman?
IF ONLY HAD SEXUAL RELATIONS WITH THIS WOMAN ONCE, RECORD '01' DAYS.

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

444 In total, how many different women have you had sexual intercourse with in the last 12 months?
IF NON-NUMERIC, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'.

NUMBER OF PARTNERS ___ ___
DON'T KNOW 98

445 In total, how many different women have you had sexual intercourse with in your lifetime?
IF NON-NUMERIC, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'.

NUMBER OF PARTNERS ___ ___
DON'T KNOW 98

446 If you needed or wanted to, could you yourself get a male condom easily?

EASILY 1
SOMEWHAT DIFFICULT 2
VERY DIFFICULT/IMPOSSIBLE 3
DON'T KNOW/UNSURE 8

447 CHECK 302(07), 416B, 419, 428, 437 EVER USED A MALE OR FEMALE CONDOM?

HAS USED CONDOM GO TO NEXT
NEVER USED A CONDOM GO TO 449

448 How old were you when you used a male/female condom for the first time?

AGE AT FIRST USE ___ ___
DON'T REMEMBER 98

449 Have you ever paid for sex?

YES 1
NO 2 GO TO 452

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

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

451 The last time that you paid for sex, was a male or female condom used on that occasion?

YES, MALE CONDOM 1
YES, FEMALE CONDOM 2
NO 3

452 Do you know of a place where a person can get male or female condoms?

YES 1
NO 2 GO TO 454

453 Where is that? Any other place?
RECORD ALL MENTIONED.

PUBLIC SECTOR

GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
FAMILY PLANNING CLINIC C
OTHER PUBLIC _____________(SPECIFY) D

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
OTHER PRIVATE MEDICAL _____________(SPECIFY) H

CHAL

CHAL HOSPITAL I
CHAL HEALTH CENTER J

CBD K
COMMUNITY HEALTH WORKER L
SUPPORT GROUPS M
OTHER SOURCE

SHOP N
CHURCH O
PEER EDUCATORS P
FRIENDS/RELATIVES Q

OTHER (SPECIFY) ______________ X

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

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

455 I will now read you some statements about male condom use. Please tell me if you agree or disagree with each.
a) Male condoms diminish a man's sexual pleasure.

AGREE 1
DISAGREE 2
DK 8

b) A male condom is very inconvenient to use.

AGREE 1
DISAGREE 2
DK 8

c) A male condom can be reused.

AGREE 1
DISAGREE 2
DK 8

d) A male condom protects against sexually transmitted infection.

AGREE 1
DISAGREE 2
DK 8

e) Buying male condoms is embarrassing.

AGREE 1
DISAGREE 2
DK 8

f) A woman has no right to ask a man to use a male condom.

AGREE 1
DISAGREE 2
DK 8

g) A male condom has the AIDS virus

AGREE 1
DISAGREE 2
DK 8

h) A male condom is the best way to prevent unwanted pregnancy

AGREE 1
DISAGREE 2
DK 8

i) People who use the male condom are not faithful since they might have the AIDS virus or other sexually transmitted infections.

AGREE 1
DISAGREE 2
DK 8

SECTION 5. FERTILITY PREFERENCES

501 CHECK 409:

HAS ONE WIFE/PARTNER GO TO NEXT
HAS MORE THAN ONE/WIFE PARTNER GO TO ENXT
QUESTION SKIPPED GO TO 505

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

YES 1
NO 2
UNSURE 3

503 CHECK 502:
YES, WIFE/WIVES/ PARTNER(S) PREGNANT (CODE '1')
Now I have some questions about the future. After the child(ren) you wife/wives/partner(s) is/are expecting now, would you like to have another child or would you prefer not to have any more children at all?

NO WIFE/PARTNER PREGNANT OR UNSURE (CODE '2' OR '3')
Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children at all?

HAVE A/ANOTHER CHILD 1
NO MORE/NONE 2 GO TO 505
WIFE/WIVES INFECUND/STERILIZED 3 GO TO 505
UNDECIDED/DON'T KNOW 8 GO TO 505

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

MONTHS 1 ___ ___
YEARS 2 ___ ___
SOON/NOW 993
AFTER MARRIAGE 995
OTHER ___________(SPECIFY) 996
DON'T KNOW 998

505 CHECK 203 AND 205:
HAS LIVING CHILDREN
If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole that be?

NO LIVING CHILDREN
If you could choose exactly the number of children to have in your whole life, how many would life, how many would that be?
PROBE FOR A NUMERIC RESPONSE.

NONE 00 GO TO 507
NUMBER ___ ___
OTHER _________(SPECIFY) 96 GO TO 507

506 How many of these children would you like to be boys, how many would you like to be girls, and for how many would the sex not matter?

NUMBER
BOYS ___ ___
GIRS ___ ___
ETHER ___ ___
OTHER ________________ (SPECIFY) 96

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

APPROVE 1
DISAPPROVE 2
DON'T KNOW/UNSURE 8

508 In the last few months have you heard about family planning:
On the radio?

YES 1
NO 2

On the television?

YES 1
NO 2

In a newspaper or magazine?

YES 1
NO 2

509 In the last 3 months, have you discussed the practice of family planning with your friends, neighbors, or relatives?

YES 1
NO 2 GO TO 511

510 With whom? Anyone else?
RECORD ALL PERSONS MENTIONED.

WIFE/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
SON G
MOTHER-IN-LAW H
FRIENDS/NEIGHBORS I
TEACHERS J
CHIEFS K
FATHER-IN-LAW L
OTHER _____________ (SPECIFY) X

511 In the last 3 months, have you discussed the practice of family planning with a health worker or health professional?

YES 1
NO 2

SECTION 6. PARTICIPATION IN HEALTH CARE

601 CHECK 209:

HAS HAD ONE OR MORE CHILDREN GO TO NEXT
HAS NOT HAD ANY CHILDREN GO TO 617

602 Please tell me the name and sex of your child (who was born most recently).
________________________ (NAME OF CHILD)

BOY 1
GIRL 2

603 In what month and year was (NAME OF CHILD) born?

MONTH ___ ___
YEAR ___ ___ ___ ___

604 Is (NAME OF CHILD) still living?

YES 1 GO TO 606
NO 2
DON'T KNOW 8 GO TO 606

605 How old was (NAME OF CHILD) when he/she died?
IF '1 YEAR', PROBE:
How many months old was (NAME)?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1 ___ ___
MONTHS 2 ___ ___
YEARS 3 ___ ___
DON'T KNOW 998

606 What is the name of (NAME OF CHILD)'s mother?
WRITE THE CHILD'S MOTHER'S NAME AND HER LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE.
IF THE MOTHER IS NOT LISTED IN THE HOUSEHOLD SCHEDULE RECORD '00'
NAME OF CHILD'S MOTHER
________________________

LINE NUMBER IN HHD QRE. ___ ___

607 CHECK 603:

(LAST) CHILD BORN IN 1999 OR LATER GO TO NEXT
(LAST) CHILD BORN IN 1998 OR EARLIER GO TO 617

608 CHECK 606:

LINE NUMBER IS '00' GO TO NEXT
OTHER LINE NUMBER GO TO 610

609 What is your relationship with (NAME OF CHILD'S MOTHER)?

CURRENT SPOUSE 01
FORMER SPOUSE 02
CURRENT LIVE-INPARTNER 03
FORMER LIVE-IN PARTNER 04
REGULAR SEXUALPARTNER 05
WOMAN IS GIRLFRIEND/FIANCÉE 06
OCCASIONAL SEXUAL PARTNER 07
FRIEND/ACQUAINTANCE 08
OTHER __________ (SPECIFY) 96

FOR THE SIX WEEKS AFTER DELIVERY. ALL QUESTIONS REFER TO THE LAST BIRTH.
610 Now, think back to the time when (NAME OF CHILD'S MOTHER) was pregnant with (NAME OF CHILD).
PREGNANCY DELIVERY
610A: Did (NAME OF CHILD'S MOTHER) receive any antenatal care from a doctor or any health care provider when she was pregnant with (NAME OF CHILD)?

YES 1
NO 2 (SKIP TO 612)
DK 8 (GO TO 610B IN NEXT COLUMN)

SIX WEEKS AFTER
610B: Did a doctor or any health care provider assist with the delivery of (NAME OF CHILD)?

YES 1
NO 2(SKIP TO 612)
DK 8 (GO TO 610C IN NEXT COLUMN)

DELIVERY
610C: Did (NAME OF CHILD'S MOTHER) receive any care for herself from a doctor or any health care provider during the six weeks after this delivery?

YES 1
NO 2 (SKIP TO 612)
DK 8 (SKIP TO 613)

611 Who mainly provided the money or goods or services to pay for this care?
PREGNANCY DELIVERY

FREE 01
INSURANCE 02
RESPONDENT 03
CHILD'S MOTHER 04
RESPONDENT AND CHILD'S MOTHER 05o
RESPONDENT'S FAMILY 06
CHILD'S MOTHER'S FAMILY 07
OTHER __________(SPECIFY) 96

ALL GO TO 610B IN NEXT COLUMN

DELIVERY

FREE 01
INSURANCE 02
RESPONDENT 03
CHILD'S MOTHER 04
RESPONDENT AND CHILD'S MOTHER 05o
RESPONDENT'S FAMILY 06
CHILD'S MOTHER'S FAMILY 07
OTHER __________(SPECIFY) 96

ALL GO TO 610B IN NEXT COLUMN

SIX WEEKS AFTER DELIVERY

FREE 01
INSURANCE 02
RESPONDENT 03
CHILD'S MOTHER 04
RESPONDENT AND CHILD'S MOTHER 05o
RESPONDENT'S FAMILY 06
CHILD'S MOTHER'S FAMILY 07
OTHER __________(SPECIFY) 96

ALL GO TO 610B IN NEXT COLUMN

612 What was the main reason (NAME OF CHILD'S MOTHER) did not receive any advice or care from a doctor or other health care provider during (pregnancy/ delivery/the six weeks after delivery)?
PREGNANCY

NOT NECESSARY 01
NOT CUSTOMARY 02
RESPONDENT DIDN'T ALLOW 03
TOO COSTLY 04
TOO FAR/NO TRANSPORT 05
POOR SERVICE 06
LACK OF KNOWLEDGE 07
OTHER _________(SPECIFY) 96

ALL GO TO 610B IN NEXT COLUMN

DELIVERY

NOT NECESSARY 01
NOT CUSTOMARY 02
RESPONDENT DIDN'T ALLOW 03
TOO COSTLY 04
TOO FAR/NO TRANSPORT 05
POOR SERVICE 06
LACK OF KNOWLEDGE 07
OTHER _________(SPECIFY) 96

ALL GO TO 610B IN NEXT COLUMN

SIX WEEKS AFTER DELIVERY

NOT NECESSARY 01
NOT CUSTOMARY 02
RESPONDENT DIDN'T ALLOW 03
TOO COSTLY 04
TOO FAR/NO TRANSPORT 05
POOR SERVICE 06
LACK OF KNOWLEDGE 07
OTHER _________(SPECIFY) 96

ALL GO TO 610B IN NEXT COLUMN

613 At any time while (NAME OF CHILD'S MOTHER) was pregnant with (NAME OF CHILD), did you yourself talk with a doctor or any other health care provider about the health of the mother or of the pregnancy?

YES 1
NO 2

614 CHECK 602 AND 604:
NAME OF (LAST) CHILD _____________________

(LAST) CHILD LIVING GO TO NEXT
(LAST) CHILD NOT LIVING OR DON'T KNOW GO TO 617

615 Does (NAME OF CHILD) live with you in your household?

YES 1
NO 2 GO TO 617

616 In your household who usually decides what to do if (NAME OF CHILD) is ill?
RECORD ALL PERSONS MENTIONED.

RESPONDENT A
CHILD'S MOTHER B
WIFE/PARTNER WHO IS NOT CHILD'S MOTHER C
FEMALE RELATIVE D
MALE RELATIVE E
OTHER ______________ (SPECIFY) X
CHILD HAS NEVER BEEN ILL Y

617 Now, I want to talk to you about pregnancy and the health of children.
Sometimes a pregnancy can have complications that lead to miscarriage or even death. What are some of the signs and symptoms that indicate that a pregnancy may be in danger?
PROBE: Any other signs or symptoms?
RECORD ALL SIGNS AND SYMPTOMS MENTIONED.

VAGINAL BLEEDING A
HIGH FEVER B
ABDOMINAL PAIN C
SWELLING OF HANDS AND FEET D
DIFFICULT LABOR FOR MORE THAN 12 HRS E
CONVULSIONS F
OTHER ____________ (SPECIFY) X
DON'T KNOW ANY SIGNS OR SYMPTOMS Z

618 When a child has diarrhea, should he/she be given less to drink than usual, about the same amount, or more than usual?

LESS 1
ABOUT THE SAME 2
MORE 3
DON'T KNOW 8

619 Have you ever heard of a special product called [MOTSOAKO] you can get for the treatment of diarrhea?

YES 1
NO 2

620 Now, please tell me about yourself. Do you currently smoke cigarettes or tobacco?
IF YES: What type of tobacco do you smoke?
RECORD ALL TYPES MENTIONED.

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

621 CHECK 620:

CODE 'A' CIRCLED GO TO NEXT
CODE 'A' NOT CIRCLED GO TO 623

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

CIGARETTES ___ ___

623 Have you ever drunk an alcohol-containing beverage?

YES 1
NO 2 GO TO 628A

624 In the last 3 months, on how many days did you drink an alcohol-containing beverage?
IF EVERY DAY, RECORD '90'.

NUMBER OF DAYS ___ ___
NONE 95

625 Have you ever gotten drunk from drinking an alcohol-containing beverage?

YES 1
NO 2 GO TO 628A

626 CHECK 624:

DRANK ALCOHOL ON AT LEAST ONE DAY GO TO NEXT
NONE GO TO 628A

627 In the last 3 months, on how many occasions did you get drunk?

NUMBER OF TIMES ___ ____ ___
NONE 95

628A Have you had an injection for any reason in the last three months?
IF YES: How many injections did you have?
IF DAILY INJECTIONS FOR 3 MONTHS, ASK: Are you diabetic?
IF YES, CIRLCE CODE '95'.
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS AND NOT DIABETIC, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ___ ___
DIABETIC 95 GO TO 628C
NONE 00 GO TO 629A

628B Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health workers?
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.

NUMBER OF INJECTIONS ___ ___
NONE 00

628C The last time you had an injection, did [You/The person who gave you the injection] take the syringe and the needle from a new, unopened package?

YES 1
NO 2
DON'T KNOW 8

629A Do you have a Health Card/Bukana?

YES 1
NO 2 GO TO 701

629B Have you ever used another person's Health Card/Bukana?

YES 1
NO 2

SECTION 7. HIV AND AIDS, OTHER SEXUALLY TRANSMITTED INFECTIONS, AND TUBERCULOSIS

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 734

702 Can people reduce their chances of getting the AIDS virus by having just one sex partner who is not infected and who has no other partners?

YES 1
NO 2
DON'T KNOW 8

703 Can a person get the AIDS virus from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

704 Can a person get the AIDS virus from kissing another person?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

707 Can people get the AIDS virus by using the same eating utensils as a person who has AIDS?

YES 1
NO 2
DON'T KNOW . 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 GO TO 712
DON'T KNOW 8 GO TO 712

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

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS INTRAVENOUSLY H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING RAZORS/BLADES K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM TRADITIONAL PRACTITIONER N
OTHER __________ (SPECIFY) W
OTHER (SPECIFY) ____________ X
DON'T KNOW Z

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

YES 1
NO 2
DON'T KNOW 8

713 Do you know someone personally who has the virus that causes AIDS or someone who died from AIDS?

YES 1
NO 2

714 Can the virus that causes AIDS be transmitted from a mother to her baby:
During pregnancy?

YES 1
NO 2
DK 8

During delivery?

YES 1
NO 2
DK 8

By breastfeeding?

YES 1
NO 2
DK 8

715 Are there any special medications that a doctor or a nurse can give to a pregnant woman infected with the AIDS virus can take to reduce the risk of transmission to the baby?

YES 1
NO 2
DON'T KNOW 8

716 Is there any special medication that people infected with the AIDS virus can get from a doctor or a nurse?

YES 1
NO 2
DON'T KNOW 8

717 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 721

718 When was the last time you were tested?

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

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

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

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

YES 1 GO TO 723A
NO 2 GO TO 723A

721 Would you want to be tested for the AIDS virus?

YES 1
NO 2
DON'T KNOW/UNSURE 8

722 Do you know a place where you could go to get an AIDS test?

YES 1
NO 2 GO TO 724

723 Where can you go for the test?
RECORD ONLY FIRST RESPONSE GIVEN.

723A Where did you go for the test?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
_________________________________________ (NAME OF PLACE)

PUBLIC SECTOR

GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
OTHER PUBLIC ______________ (SPECIFY) 16

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL ___________( SPECIFY) 26

CHAL

CHAL HOSPITAL 31
CHAL HEALTH CENTER 32

CBD 41
COMMUNITY HEALTH WORKER 42
SUPPORT GROUPS 43
OTHER SOURCE

SHOP 51
CHURCH 52
FRIENDS/RELATIVES 53

OTHER ______________ (SPECIFY) 96

724 CHECK 401:

YES, CURRENTLY MARRIED/LIVING WITH A WOMAN GO TO NEXT
NO, NOT IN UNION GO TO 726

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

YES 1
NO 2

726 In your opinion, is it acceptable or unacceptable for AIDS to be discussed:
On the radio?

ACCEPTABLE 1
NOT ACCEPTABLE 2

On the TV?

ACCEPTABLE 1
NOT ACCEPTABLE 2

In newspapers?

ACCEPTABLE 1
NOT ACCEPTABLE 2

727 Would you buy fresh vegetables from a vendor who has the AIDS virus?

YES 1
NO 2
DK/NOT SURE 8

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

YES 1
NO 2
DK/NOT SURE 8

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

YES 1
NO 2
DK/NOT SURE 8

730A If a female teacher has the AIDS virus, should she be allowed to continue teaching in the school?

CAN CONTINUE 1
SHOULD NOT CONTINUE 2
DK/NOT SURE 8

730B If a male teacher has the AIDS virus, should she be allowed to continue teaching in the school?

CAN CONTINUE 1
SHOULD NOT CONTINUE 2
DK/NOT SURE 8

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

YES 1
NO 2
DK/NOT SURE 8

732 Have you ever been taught how to use a condom?

YES 1
NO 2 GO TO 734

733 Where/who taught you how to use a condom? Anywhere/anybody else?
RECORD ALL MENTIONED.

PUBLIC SECTOR

GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
FAMILY PLANNING CLINIC C
OTHER PUBLIC ____________(SPECIFY) D

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
OTHER PRIVATE MEDICAL ________ (SPECIFY) H

CHAL

CHAL HOSPITAL I
CHAL HEALTH CENTER J

CBD K
COMMUNITY HEALTH WORKER L
SUPPORT GROUPS M
OTHER SOURCE

MEDIA N
PEER EDUCATORS O
SHOP P
CHURCH Q
FRIENDS/RELATIVES R

OTHER ____________(SPECIFY) X

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

YES 1
NO 2 GO TO 737

735 If a man has a sexually transmitted infection, what symptoms might he have? Any others?
RECORD ALL SYMPTOMS MENTIONED.

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

736 If a woman has a sexually transmitted infection, what symptoms might she have? Any others?
RECORD ALL SYMPTOMS MENTIONED.

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

737 CHECK 416:

HAS HAD SEXUAL INTERCOURSE GO TO NEXT
HAS NOT HAD SEXUAL INTERCOURSE GO TO 748

738 CHECK 734:

KNOWS STIP TO NEXT
DOES NOT KNOW STIP TO 740

739 Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a sexually-transmitted infection?

YES 1
NO 2
DON'T KNOW 8

740 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

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

YES 1
NO 2
DON'T KNOW 8

742 CHECK 739/740/741:

HAS HAD AN INFECTION GO TO NEXT
HAS NOT HAD AN INFECTION OR DOES NOT KNOW GO TO 748

743 The last time you had (PROBLEM FROM 739/740/741), did you seek any kind of advice or treatment?

YES 1
NO 2 GO TO 745

744 Where did you go? Anywhere else?
RECORD ALL MENTIONED.

PUBLIC SECTOR

GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
FAMILY PLANNING CLINIC C
OTHER PUBLIC _____________(SPECIFY) D

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
OTHER PRIVATE MEDICAL ____________ (SPECIFY) H

CHAL

CHAL HOSPITAL I
CHAL HEALTH CENTER J

CBD K
COMMUNITY HEALTH WORKER L
SUPPORT GROUPS M
OTHER SOURCE

SHOP N
CHURCH O
FRIENDS/RELATIVES P
TRADITIONAL HEALER Q

OTHER ________________ (SPECIFY) X

745 When you had (PROBLEM FROM 739/740/741), did you do something to avoid infecting your sexual partner(s)?

YES 1
NO 2
PARTNER ALREADY INFECTED 3 GO TO 748

746 When you had (PROBLEM FROM 739/740/741), did you inform your sexual partner(s) about it?

YES 1
SOME/NOT ALL 2
NO 3
DID NOT HAVE PARTNER 4 GO TO 748

747 What did you do to avoid infecting your partner(s)? Did you
Use medicine?

YES 1
NO 2

Stop having sex?

YES 1
NO 2

Use a condom when having sex?

YES 1
NO 2

748 Now I would like to ask you about something else. Some men in Lesotho are circumcised. Are you circumcised?

YES 1
NO 2

749 Now I would like to ask you about something else. Since age 15, have you ever had the following symptoms:
a. Cough for two weeks or more?

YES 1
NO 2

b. Fever for two weeks or more?

YES 1
NO 2

c. Chest or back pain?

YES 1
NO 2

d. Coughing up blood?

YES 1
NO 2

e. Sweating at night?

YES 1
NO 2

750 CHECK 749:

AT LEAST ONE 'YES' (ANY SYMPTOMS) GO TO NEXT
NOT A SINGLE 'YES' GO TO 758

751 Did you seek consultation or treatment for the symptom(s)?

YES 1 GO TO 753
NO 2

752 What is the main reason you did not seek consultation or treatment for the symptom(s)?

SYMPTOMS HARMLESS 1
COST 2
DISTANCE 3
EMBARRASSED 4
OTHER _______________(SPECIFY) 6

ALL GO TO 758

753 The last time you had such symptoms, where did you first go for advice or treatment?

PUBLIC SECTOR

GOVERNMENT HOSPITAL 11
GOVT. HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
OTHER PUBLIC ___________(SPECIFY) 14

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL __________(SPECIFY) 24

CHAL

CHAL HOSPITAL 31
CHAL HEALTH CENTER 32

CBD 41
COMMUNITY HEALTH WORKER 42
SUPPORT GROUPS 43
TRADITIONAL HEALER 51
OTHER ______________(SPECIFY) 96

754 How soon after the symptom(s) did you first seek consultation or treatment?

DAYS 1 ___ ___
WEEKS 2 ___ ___
MONTHS 3 ___ ___
DON'T KNOW 998

755 During that first visit, were you told by a doctor or another health professional that you had tuberculosis?

YES 1
NO 2 GO TO 758

756 Did you go anywhere else for advice or treatment after you were told that you had tuberculosis?

YES 1
NO 2 GO TO 759

757 Where did you go?

PUBLIC SECTOR

GOVERNMENT HOSPITAL 11
GOVT. HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
OTHER PUBLIC ____________(SPECIFY) 14

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL (SPECIFY) _______ 24

CHAL

CHAL HOSPITAL 31
CHAL HEALTH CENTER 32

CBD 41
COMMUNITY HEALTH WORKER 42
SUPPORT GROUPS 43
TRADITIONAL HEALER 51
OTHER ________________(SPECIFY) 96

ALL GO TO 759

758 Have you ever heard of an illness called tuberculosis?

YES 1
NO 2 GO TO 801

759 Do you think tuberculosis can be cured?

YES 1
NO 2

760 Would you be willing to work with someone who has been previously treated for tuberculosis?

YES 1
NO 2
DK/NOT SURE 8

761 What signs or symptoms would lead you to think that a person has tuberculosis?
PROBE: Any others?
RECORD ALL MENTIONED.

COUGHING A
COUGHING WITH SPUTUM B
COUGHING FOR SEVERAL WEEKS C
FEVER D
BLOOD IN SPUTUM E
LOSS OF APPETITE F
NIGHT SWEATING G
PAIN IN CHEST OR BACK H
TIREDNESS/FATIGUE I
WEIGHT LOSS J
OTHER ______________(SPECIFY) X
NO SYMPTOMS Y
DON'T KNOW Z

762 What do you think is the cause of tuberculosis?
PROBE: Anything else?
RECORD ALL METIONED

MICROBES/GERMS/BACTERIA A
INHERITED B
LIFESTYLE C
SMOKING D
ALCOHOL DRINKING E
EXPOSURE TO COLD TEMPERAT. F
DUST/POLLUTION G
OTHER ____________(SPECIFY) X
OTHER ______________(SPECIFY) Y
DON'T KNOW Z

SECTION 8. ATTITUDES TOWARDS GENDER ROLES

801 In a couple, who do you think should have the greater say in each of the following decisions: the husband, the wife or both equally:
a) making large household purchases?

HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8

b) making small daily household purchases?

HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8

c) deciding when to visit family, friends or relatives?

HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8

d) deciding what to do with the money she earns for her work?

HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8

e) deciding how many children to have and when to have them?

HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8

f) deciding on family planning

HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8

802 Sometimes a husband is annoyed or angered by things that his wife/partner does. In your opinion, is a husband justified in hitting or beating his wife in the following situations
a) If she goes out without telling him?