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2009 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 ________

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

URBAN/RURAL

URBAN = 1
RURAL= 2

NAME AND LINE NUMBER OF MAN _______

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE __________
INTERVIEWER'S NAME ________
RESULT____

RESULT___

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

NEXT VISIT:
DATE ________
TIME ________

FINAL VISIT
DAY ______
MONTH ______
YEAR ______
NAME INT. NUMBER ______
RESULT _____

TOTAL NUMBER OF VISITS _______

LANGUAGE OF QUESTIONNAIRE:

ENGLISH

LANGUAGE OF INTERVIEW *** _______

1 ENGLISH
2 SESOTHO
6 OTHER (SPECIFY) ______________

HOME LANGUAGE OF RESPONDENT*** ________

1 ENGLISH
2 SESOTHO
6 OTHER (SPECIFY) ______________

WAS A TRANSLATOR USED?

YES=1
NO=2

SUPERVISOR
NAME ________
DATE _______

FIELD EDITOR
NAME ______
DATE _____

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 that asks men and women about various health issues. We would very much appreciate your participation in this survey. This information will help the government to plan health services. The survey usually takes about 20 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shared with anyone other than members of our survey team.
Participation in this survey is voluntary, and if we should come to any question you don't want to answer, just let me know and I will go on to the next question; or you can stop the interview at any time. However, we hope that you will participate in this survey since your views are important.
At this time, do you want to ask me anything about the survey?
May I begin the interview now?
Signature of interviewer: __________
Date: ________

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END INTERVIEW)

101 RECORD THE TIME.

HOUR _______
MINUTES ______

102 During the interview I would like to measure your blood pressure. This will be done three times during the interview.
This is a harmless procedure. It is used to find out if a person has high blood pressure. If it is not treated, high blood pressure may eventually cause serious damage to the heart.
The results of this blood pressure measurement will be given to you after the interview together with an explanation of the meaning of your blood pressure numbers. If your blood pressure is high, we will suggest that you consult a health facility or doctor since we cannot provide any further testing or treatment during the survey.
Do you have any questions about the blood pressure measurement so far? If you have any questions about the procedure at any time, please ask me.
You can say yes or no to having the blood pressure measurement now.
You can also decide at anytime not to participate in the blood pressure measures.
Would you allow me to proceed to take your blood pressure measurement at this time?
Signature of interviewer: _______
Date: _________

RESPONDENT AGREES 1 (GO TO 102A)
RESPONDENT DOES NOT AGREE 2 (GO TO 103)

102A Before taking your blood pressure, I would to ask a few questions about things that may affect these measurements.
Have you done any of the following within the past 30 minutes:

Eaten anything?
YES 1
NO 2
Had coffee, tea, cola or other drink that has caffeine?
YES 1
NO 2
Smoked any tobacco product?
YES 1
NO 2

102B May I begin the process of measuring your blood pressure?
BEFORE TAKING THE FIRST BLOOD PRESSURE READING, MEASURE THE CIRCUMFERENCE OF THE RESPONDENT'S ARM MIDWAY BETWEEN THE ELBOW AND THE SHOULDER.
RECORD THE MEASUREMENT IN CENTIMETERS.

ARM CIRCUMFERENCE (IN CENTIMETERS) _________

102C USE THE ARM CIRCUMFERENCE MEASUREMENT TO SELECT THE APPROPRIATE BLOOD PRESSURE MONITOR MODEL AND CUFF SIZE. CIRCLE THE CODE FOR THE MODEL AND CUFF SIZE.

MODEL 789
SMALL: 17 CM ¨C 22 CM 1
MEDIUM: 22 CM ¨C 32 CM 2
LARGE: 32 CM ¨C 42 CM 3

102D TAKE THE FIRST BLOOD PRESSURE READING.
RECORD THE SYSTOLIC AND DIASTOLIC PRESSURE. THEN PROCEED TO Q.103.
IF YOU ARE UNABLE TO MEASURE THE RESPONDENT'S BLOOD PRESSURE, RECORD THE REASON IN Q.102E.

SYSTOLIC ________
DIASTOLIC ________

102E RECORD REASON BLOOD PRESSURE NOT MEASURED.

REFUSED 9994
TECHNICAL PROBLEMS 9995
OTHER 9996

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 104
VISITOR 96 GO TO 104

103A Just before you moved here, did you live in a city, in a town, or in the countryside?

CITY 1
TOWN 2
COUNTRYSIDE 3

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

NUMBER OF TRIPS _____
NONE 00 (GO TO 106)

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

YES 1
NO 2

106 In what month and year were you born?

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

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

AGE IN COMPLETED YEARS ________

108 Have you ever attended school?

YES 1
NO 2 (GO TO 112)

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

PRIMARY 1
VOCATIONAL/TECHNICAL TRAINING AFTER PRIMARY 2
SECONDARY/HIGH 3
VOCATIONAL/TECHNICAL TRAINING AFTER SECONDARY/HIGH 4
COLLEGE 5
GRADUATE/POST GRADUATE 6

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

STND/FORM/YEAR _______

111 CHECK 109:

PRIMARY (GO TO 112)
SECONDARY OR HIGHER (GO TO 115)

112 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 4
BLIND/VISUALLY IMPAIRED 5

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

YES 1
NO 2

114 CHECK 112:

CODE '2', '3' OR '4' CIRCLED (GO TO 115)
CODE '1' OR '5' CIRCLED (GO TO 116)

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

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4 GO TO 116

115A What kind of newspaper or magazine do you read:
Lesotho newspaper/magazine, RSA newspaper/magazine or any other?
RECORD ALL MENTIONED.

LESOTHO NEWSPAPER/MAGAZINE A
RSA NEWSPAPER/MAGAZINE B
OTHER X

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

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4 GO TO 117

116A 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 X

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

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4 GO TO 118

117A What kind of TV do you watch: Lesotho TV, RSA TV, or any other?
RECORD ALL MENTIONED.

LESOTHO TV A
RSA TV B
OTHER X

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

ROMAN CATHOLIC CHURCH 01
LESOTHO EVANG. CHURCH 02
METHODIST 03
ANGLICAN CHURCH 04
SEVENTH DAY ADVENTIST 05
PENTECOSTAL 06
OTHER CHRISTIAN 07
ISLAM 08
HINDU 09
NONE 10
OTHER RELIGION 96

SECTION 2. REPRODUCTION

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

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

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

YES 1
NO 2 (GO TO 204)

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

SONS AT HOME ______
DAUGHTERS AT HOME _______

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

YES 1
NO 2 (GO TO 206)

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

SONS AT HOME ______
DAUGHTERS AT HOME _______

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 many years 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 8 (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 CENTRE 1 (GO TO 221)
OTHER 2

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

COST TOO MUCH 01
FACILITY CLOSED 02
TOO FAR/NO TRANSPORTATION 03
DON'T TRUST FACILITY/POOR QUALITY SERVICE 04
NO FEMALE PROVIDER 05
NOT THE FIRST CHILD 06
CHILD'S MOTHER DID NOT THINK IT WAS NECESSARY 07
RESPONDENT DID NOT THINK IT WAS NECESSARY 08
FAMILY DID NOT THINK IT WAS NECESSARY 09
OTHER 96
DON"T KNOW 98

221 Now I want to ask you about something else. When a child has diarrhoea, how much should he or she be given to drink: more than usual, the same amount as usual, less than usual, or should he or she not be given anything to drink at all?

MORE THAN USUAL 1
ABOUT THE SAME 2
LESS THAN USUAL 3
NOTHING TO DRINK 4
DON'T KNOW 8

SECTION 3. CONTRACEPTION

301 Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy. Have you ever heard of (METHOD)?

01 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES 1
NO 2
02 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2
03 IUCD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
04 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
05 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
06 PILL Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
07 MALE CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08 FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse. vagina before sexual intercourse.
YES 1
NO 2
09 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
10 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
11 EMERGENCY CONTRACEPTION As an emergency measure after sexual intercourse, women can take special pills at any time within five days to prevent pregnancy.
YES 1
NO 2

303 In the last three months have you:

Heard about family planning on the radio?
YES 1
NO 2
Seen about family planning on the television?
YES 1
NO 2
Read about family planning in a newspaper or magazine?
YES 1
NO 2
Read about family planning on billboards, posters, pamphlets?
YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8 (GO TO 307)

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

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER 6
DON'T KNOW 8

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

YES 1
NO 2
DEPENDS 3
DON'T KNOW 8

308 I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.

a) Contraception is women's business and a man should not have to worry about it.
AGREE 1
DISAGREE 2
DON'T KNOW 8
b) Women who use contraception may become promiscuous.
AGREE 1
DISAGREE 2
DON'T KNOW 8
c) A woman is the one who gets pregnant so she should be the one to use contraception
AGREE 1
DISAGREE 2
DON'T KNOW 8
d) A woman who uses contraception might have a problem getting pregnant
AGREE 1
DISAGREE 2
DON'T KNOW 8

309 CHECK 301 (07):
KNOWS MALE CONDOM

YES (GO TO 310)
NO (GO TO 313)

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

YES 1
NO 2 (GO TO 313)

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

(NAME OF PLACE(S)) __________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
OTHER PUBLIC SECTOR C
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC D
LPPA E
PHARMACY F
PRIVATE DOCTOR G
OTHER MEDICAL SECTOR H
CHAL
CHAL HOSPITAL I
CHAL HEALTH CENTER J
CHAL HEALTH POST K
CBD L
COMMUNITY HEALTH WORKER/SUPPORT GROUPS M
OTHER SOURCE
SHOP N
CHURCH O
FRIENDS/RELATIVES P
PEER EDUCATORS Q
OTHER X

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

YES 1
NO 2

313 CHECK 301 (08):
KNOWS FEMALE CONDOM

YES (GO TO 314)
NO (GO TO 401)

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

YES 1
NO 2 (GO TO 401)

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

(NAME OF PLACE(S)) _________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
OTHER PUBLIC SECTOR C
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC D
LPPA E
PHARMACY F
PRIVATE DOCTOR G
OTHER MEDICAL SECTOR H
CHAL
CHAL HOSPITAL I
CHAL HEALTH CENTER J
CHAL HEALTH POST K
CBD L
COMMUNITY HEALTH WORKER/SUPPORT GROUPS M
OTHER SOURCE
SHOP N
CHURCH O
FRIENDS/RELATIVES P
PEER EDUCATORS Q
OTHER X

316 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 more than one wife or woman you live with as if married?

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

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

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS ________

407 CHECK 405:

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

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

RECORD THE NAME AND THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE AND LIVE-IN PARTNER.
IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.
ASK 408 FOR EACH PERSON.

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 TO 411A)

411 In what month and year did you start living with your (wife/partner)?
411A Now I would like to ask 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 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

419 When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1____
WEEKS AGO 2____
MONTHS AGO 3____
YEARS AGO 4____ (GO TO 435)

420 Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question. GO TO 422

421 When was the last time you had sexual intercourse with this person?

DAYS 1____
WEEKS 2____
MONTHS 3____

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

YES 1
NO 2 (GO TO 424)

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

YES 1
NO 2

424 What was your relationship to this (second/third) person with whom you had sexual intercourse?
IF GIRLFRIEND: Were you living together as if married?
IF YES, CIRCLE '2'. IF NO, CIRCLE '3'.

WIFE 1
LIVE-IN PARTNER 2
GIRLFRIEND NOT LIVING WITH RESPONDENT 3 (GO TO 425A)
CASUAL ACQUAINTANCE 4 (GO TO 425A)
PROSTITUTE 5 (GO TO 425A)
OTHER 6 (GO TO 425A)

424A CHECK 410:

MARRIED ONLY ONCE (GO TO 424B)
MARRIED MORE THAN ONCE (GO TO 425A)

424B CHECK 414:

FIRST TIME WHEN STARTED LIVING WITH FIRST WIFE (GO TO 428)
OTHER (GO TO 425A)

425A How long ago did you first have sexual intercourse with this (second/third) person?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.

DAYS 1 _______
MONTHS 2 ______
YEARS 3 ______

425B How many times during the last 12 months did you have sexual intercourse with this person?
RECORD 95 IF 95 OR MORE

NUMBER OF TIMES _______

425C How old is this person?

AGE OF PARTNER ________
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 428)

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

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

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

YES 1 (GO BACK TO 421 IN NEXT COLUMN)
NO 2 (GO TO 429A)

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

NUMBER OF PARTNERS LAST 12 MONTHS ___________
DON'T KNOW 98

429A CHECK 422:
ALL FIRST COLUMNS

NOT ASKED (GO TO 429C)
CONDOM USED (GO TO 429B)
NO CONDOM USED (GO TO 429C)

429B 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 X
NO PROBLEM Y

429C 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
DON'T KNOW 3
b. A male condom is very inconvenient to use.
AGREE 1
DISAGREE 2
DON'T KNOW 3
c. A male condom can be reused.
AGREE 1
DISAGREE 2
DON'T KNOW 3
d. A male condom protects against sexually transmitted infection.
AGREE 1
DISAGREE 2
DON'T KNOW 3
e. Buying male condoms is embarrassing.
AGREE 1
DISAGREE 2
DON'T KNOW 3
f. A woman has no right to ask a man to use a male condom.
AGREE 1
DISAGREE 2
DON'T KNOW 3
g. A male condom has the AIDS virus
AGREE 1
DISAGREE 2
DON'T KNOW 3
h. A male condom is the best way to prevent unwanted pregnancy
AGREE 1
DISAGREE 2
DON'T KNOW 3
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
DON'T KNOW 3

430 CHECK 424 (ALL COLUMNS):

AT LEAST ONE PARTNER IS PROSTITUTE (GO TO 431)
NO PARTNERS ARE PROSTITUTES (GO TO 432)

431 CHECK 424 AND 422 (ALL COLUMNS):

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

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

YES 1 (GO TO 433)
NO 2

432A Have you ever paid anyone in exchange for having sexual intercourse?

YES 1
NO 2 (GO TO 435)

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

YES 1
NO 2 (GO TO 435)

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

YES 1
NO 2
DON'T KNOW 8

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

NUMBER OF PARTNERS IN LIFETIME _____
DON'T KNOW 98

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

NOT ASKED (GO TO 443)
CONDOM USED (GO TO 441)
NO CONDOM USED (GO TO 443)

441 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
GOVERNMENT HEALTH CENTER
OTHER PUBLIC SECTOR
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC
LPPA
PHARMACY
PRIVATE DOCTOR
OTHER PRIVATE MEDICAL SECTOR
CHAL
CHAL HOSPITAL
CHAL HEALTH CENTER
CHAL HEALTH POST
CBD
COMMUNITY HEALTH WORKER
SUPORT GROUPS
OTHER SOURCE
SHOP
CHURCH
PEER EDUCATORS
FRIEND/RELATIVE
OTHER

443 The last time you had sex did you or your partner use any method (other than a condom) to avoid or prevent a pregnancy?

YES 1
NO 2
DON'T KNOW 8 (GO TO 501)

444 What method did you or your partner use?
PROBE: Did you or your partner use any other method to prevent pregnancy?
RECORD ALL MENTIONED.

FEMALE STERILIZATION A
MALE STERILIZATION B
IUCD C
INJECTABLES D
IMPLANTS E
PILL F
FEMALE CONDOM G
RHYTHM METHOD H
WITHDRAWAL I
OTHER TRAD. METHOD X
OTHER MODERN METHOD Y

SECTION 5. FERTILITY PREFERENCES

501 CHECK 407:

ONE OR MORE WIVES/PARTNERS (GO TO 502)
QUESTION NOT ASKED (GO TO 508)

502 CHECK 444+E67:

MAN NOT STERILIZED (GO TO 503)
MAN STERILIZED (GO TO 508)

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

YES 1
NO 2
DON'T KNOW 8

504 CHECK 503:

NO WIFE/PARTNER PREGNANT OR DON'T KNOW: Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

WIFE(WIVES)/PARTNER(S) PREGNANT: Now I have some questions about the future. After the child(ren) you and your (wife(wives)/partner(s)) are expecting now, would you like to have another child, or would you prefer not to have any more children?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 508)
COUPLE CAN'T GET PREGNANT 3 (GO TO 508)
WIFE (WIVES)/PARTNER(S) STERILIZED 4 (GO TO 508)
UNDECIDED/DON'T KNOW 8 (GO TO 508)

505 CHECK 407:

ONE WIFE/PARTNER (GO TO 506)
MORE THAN ONE WIFE/PARTNER (GO TO 507)

506 CHECK 503:

WIFE/PARTNER NOT PREGNANT OR DON'T KNOW: How long would you like to wait from now before the birth of (a/another) child?

WIFE/PARTNER PREGNANT: After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

MONTHS 1____ (GO TO 508)
YEARS 2____ (GO TO 508)

SOON/NOW 993 (GO TO 508)
COUPLE CAN'T GET PREGNANT 994 (GO TO 508)
OTHER 996 (GO TO 508)
DON'T KNOW 998 (GO TO 508)

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

MONTHS 1 ______
YEARS 2 ______

SOON/NOW 993
HE/ALL HIS WIVES/PARTNERS ARE INFECUND 994
OTHER 996
DON'T KNOW 998

508 CHECK 203 AND 205:

HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?

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

NONE 00 (GO TO 601A)
NUMBER ______
OTHER 96 (GO TO 601A)

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

NUMBER OF BOYS _____
NUMBER OF GIRLS _____
NUMBER OF EITHER SEX _____
OTHER 96

SECTION 6. EMPLOYMENT AND GENDER ROLES

601A CHECK 102D:

AGREED TO MEASUREMENT (GO TO 601B)
DID NOT AGREE TO MEASUREMENT (GO TO 601)

601B May I measure your blood pressure at this time?

INTERVIEWER SIGNATURE ______
DATE _______
RESPONDENT AGREES (RECORD OUTCOME OF BLOOD PRESSURE MEASUREMENT)
RESPONDENT DOES NOT AGREE (RECORD 9994)
SYSTOLIC _______
DIASTOLIC _______
REASON BLOOD PRESSURE NOT MEASURED
REFUSED 9994
TECHNICAL PROBLEMS 9995
OTHER 9996

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

YES 1 (GO TO 604)
NO 2

602 Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, or any other such reason?

YES 1 (GO TO 604)
NO 2

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

YES 1
NO 2 (GO TO 613)

603A During the last 12 months, how many months did you work?

NUMBER OF MONTHS WORKED _______

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

OCCUPATION____________

605 CHECK 604:

WORKS IN AGRICULTURE (GO TO 606)
DOES NOT WORK IN AGRICULTURE (GO TO 607)

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

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

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

FOR FAMILY MEMBER 1
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3

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

THROUGHOUT THE YEAR 1
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3

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

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4

610 CHECK 407:

ONE OR MORE WIVES/PARTNERS (GO TO 611)
QUESTION NOT ASKED (GO TO 613)

611 CHECK 609:

CODE 1 OR 2 CIRCLED (GO TO 612)
OTHER (GO TO 613)

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

RESPONDENT 1
WIFE(WIVES)/PARTNER(S) 2
RESPONDENT AND WIFE (WIVES)/ PARTNER(S) JOINTLY 3
OTHER 6

613 In a couple, who do you think should have the greater say in each of the following decisions: the husband, the wife or both equally:

a) making major household purchases?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
b) making purchases for daily household needs?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
c) deciding about visits to the wife's family or relatives?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
d) deciding what to do with the money she earns for her work?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
e) deciding how many children to have?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
f) deciding on using contraception?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8

613A 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(WIVES)/PARTNER(S) = 2
RESPONDENT and WIFE/PARTNER JOINTLY = 3
SOMEONE ELSE = 4
OTHER = 6

613B Who usually makes decisions about making major household purchases?

RESPONDENT =1
WIFE(WIVES)/PARTNER(S) = 2
RESPONDENT and WIFE/PARTNER JOINTLY = 3
SOMEONE ELSE = 4
OTHER = 6

613C Do you personally own this or any other house?

YES 1
NO 2 (GO TO 613E)

613D Do you own this or any other house either alone or jointly with someone else?

ALONE 1
JOINTLY WITH WIFE 2
JOINTLY WITH SOMEONE 3
BOTH ALONE AND JOINTLY 4

613E Do you personally own any land?

YES 1
NO 2 (GO TO 614)

613F Do you own the land either alone or jointly with someone else?

ALONE 1
JOINTLY WITH WIFE 2
JOINTLY WITH SOMEONE 3
BOTH ALONE AND JOINTLY 4

614 I will now read you some statements about pregnancy. Please tell me if you agree or disagree with them.

a) Childbearing is a woman's concern and there is no need for the father to get involved.
AGREE 1
DISAGREE 2
DON'T KNOW 8
b) Assistance from a doctor or nurse to a woman at delivery is crucial for the mother's and child's health.
AGREE 1
DISAGREE 2
DON'T KNOW 8

615 Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

If she goes out without telling him?
YES 1
NO 2
DON'T KNOW 8
If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
If she argues with him?
YES 1
NO 2
DON'T KNOW 8
If she refuses to have sex with him?
YES 1
NO 2
DON'T KNOW 8
If she burns the food?
YES 1
NO 2
DON'T KNOW 8
If she is unfaithful and has sex with other men?
YES 1
NO 2
DON'T KNOW 8

616 Do you think that if a woman refuses to have sex with her husband when he wants her to, he has the right to…

Get angry and reprimand her?
YES 1
NO 2
DON'T KNOW/DEPENDS 8
Refuse to give her money or other means of support?
YES 1
NO 2
DON'T KNOW/DEPENDS 8
Use force and have sex with her even if she doesn't want to?
YES 1
NO 2
DON'T KNOW/DEPENDS 8
Go ahead and have sex with another woman?
YES 1
NO 2
DON'T KNOW/DEPENDS 8

SECTION 7. HIV/AIDS

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

YES 1
NO 2 (GO TO 733)

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

YES 1
NO 2
DON'T KNOW 8

703 Can people get the AIDS virus from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

During pregnancy?
YES 1
NO 2
DON'T KNOW 8
During delivery?
YES 1
NO 2
DON'T KNOW 8
By breastfeeding?
YES 1
NO 2
DON'T KNOW 8

710 CHECK 709:

AT LEAST ONE 'YES' (GO TO 711)
OTHER (GO TO 712)

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?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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 been tested to see if you have the AIDS virus?

YES 1
NO 2 (GO TO 718)

714 When was the last time you were tested?

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

715 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

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

YES 1
NO 2

717 Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) __________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 720)
GOVT. HEALTH CENTER 12 (GO TO 720)
OTHER PUBLIC SECTOR 13 (GO TO 720)
PRIVATE MEDICAL SECTOR
PVT HOSPITAL/CLINIC 21 (GO TO 720)
LPPA 22 (GO TO 720)
PHARMACY 23 (GO TO 720)
PVT DOCTOR 24 (GO TO 720)
OTHER PRIVATE MEDICAL SECTOR 26 (GO TO 720)
CHAL
CHAL HOSPITAL 31 (GO TO 720)
CHAL HEALTH CENTER 32 (GO TO 720)
COMMUNITY HEALTH WORKER/SUPPORT GROUPS 41 (GO TO 720)
OTHER 96 (GO TO 720)

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

YES 1
NO 2 (GO TO 720)

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

(NAME OF PLACE(S)) __________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
OTHER PUBLIC SECTOR C
PRIVATE MEDICAL SECTOR
PVT HOSPITAL/CLINIC D
LPPA E
PHARMACY F
PVT DOCTOR G
OTHER PRIVATE MEDICAL SECTOR H
CHAL
CHAL HOSPITAL I
CHAL HEALTH CENTER J
COMMUNITY HEALTH WORKER/SUPPORT GROUPS K
OTHER X

720 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

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

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

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?

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

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?

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

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

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

724 Do you personally know someone who has been denied health services in the last 12 months because he or she has or is suspected to have the AIDS virus?

YES 1
NO 2
DON'T KNOW ANYONE WITH AIDS 3 (GO TO 729)

725 Do you personally know someone who has been denied involvement in social events, religious services, or community events in the last 12 months because he or she has or is suspected to have the AIDS virus?

YES 1
NO 2

726 Do you personally know someone who has been verbally abused or teased in the last 12 months because he or she has or is suspected to have the AIDS virus?

YES 1
NO 2

729 Do you agree or disagree with the following statement: People with the AIDS virus should be ashamed of themselves.

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

730 Do you agree or disagree with the following statement: People with the AIDS virus should be blamed for bringing the disease into the community.

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

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

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

733 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

734 CHECK 414:

HAS HAD SEXUAL INTERCOURSE (GO TO 734)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 742)

735 CHECK 733:
HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES (GO TO 736)
NO (GO TO 737)

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 through sexual contact?

YES 1
NO 2
DON'T KNOW 8

737 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

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?

YES 1
NO 2
DON'T KNOW 8

739 CHECK 736, 737, AND 738:

HAS HAD AN INFECTION (ANY 'YES') (GO TO 740)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 742)

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

YES 1
NO 2 (GO TO 742)

741 Where did you go? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) __________
PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
OTHER PUBLIC SECTOR 13
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
LPPA 22
PHARMACY 23
PRIVATE DOCTOR 24
OTHER PRIVATE MEDICAL SECTOR 26
CHAL
CHAL HOSPITAL 31
CHAL HEALTH CENTER 32
CHAL HEALTH POST 33
CBD 41
COMMUNITY HEALTH WORKER 42
SUPPORT GROUPS 43
OTHER SOURCE
SHOP 51
CHURCH 52
PEER EDUCATORS 53
FRIEND/RELATIVE 54
OTHER 96

741A When you had (PROBLEM FROM 736/737/738), did you do something to avoid infecting your sexual partner(s)?

YES 1
NO 2
PARTNER ALREADY INFECTED 3

741B When you had (PROBLEM FROM 736/737/738), did you inform your sexual aprtner(s) about it?

YES 1
SOME/NOT ALL 2
NO 3
DID NOT HAVE A PARTNER 4

741C What did you do to avoid infecting your partners? 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

742 If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in refusing to have sex with him?

YES 1
NO 2
DON'T KNOW 8

743 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

744 Is a wife justified in refusing to have sex with her husband when she is tired or not in the mood?

YES 1
NO 2
DON'T KNOW 8

745 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

801A Now I would like to ask you about something else. Since age 15, have you ever had the following symptoms:

Cough for two weeks or more?
YES 1
NO 2
Fever for two weeks or more?
YES 1
NO 2
Chest or back pain?
YES 1
NO 2
Coughing up blood?
YES 1
NO 2
Sweating at night?
YES 1
NO 2

801B CHECK 801A:

AT LEAST ONE YES' (GO TO 801C)
NOT A SINGLE YES' (GO TO 802)

801C Did you seek consultation or treatment for the symptoms?

YES 1 (GO TO 801E)
NO 2

801D What is the main reason you did not seek treatment for the symptoms?

SYMPTOMS HARMLESS 1 (GO TO 802)
COST 2 (GO TO 802)
DISTANCE 3 (GO TO 802)
EMBARASSED 4 (GO TO 802)
LONG QUEUE 5 (GO TO 802)
OTHER 6 (GO TO 802)

801E The last time you had such symptoms, where did you first go for advice or treatment?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) _________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVT. HEALTH CENTER 12
OTHER PUBLIC SECTOR 13
PRIVATE MEDICAL SECTOR
PVT HOSPITAL/CLINIC 21
PHARMACY 22
PVT DOCTOR 23
OTHER PRIVATE MEDICAL SECTOR 26
CHAL
CHAL HOSPITAL 31
CHAL HEALTH CENTER 32
COMMUNITY HEALTH WORKER/SUPPORT GROUPS 41
OTHER SOURCE
SHOP 51
CHURCH 52
FRIENDS/RELATIVES 53
TRADITIONAL HEALER 54
OTHER 96

801F How soon after the symptom(s) did you first seek consultation or treatment?

DAYS 1 ____
WEEKS 2 ____
MONTHS 3 ____

DON'T KNOW 998

801G During that first visit, were you told by a doctor or a nurse health professional that you had tuberculosis?

YES 1
NO 2 (GO TO 802)

801H Were you given any medicine to treat TB?

YES 1
NO 2 (GO TO 802)

801I How long were you told to take the medicine?

NUMBER OF MONTHS ________
DON'T KNOW/DON'T REMEMBER 9998

801J Did you go anywhere else for advice or treatment after you were told that you had tuberculosis?

YES 1
NO 2 (GO TO 802)

801K Where did you go?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ___________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVT. HEALTH CENTER 12
OTHER PUBLIC SECTOR 13
PRIVATE MEDICAL SECTOR
PVT HOSPITAL/CLINIC 21
PHARMACY 22
PVT DOCTOR 23
OTHER PRIVATE MEDICAL SECTOR 26
CHAL
CHAL HOSPITAL 31
CHAL HEALTH CENTER 32
COMMUNITY HEALTH WORKER/SUPPORT GROUPS 41
OTHER SOURCE
SHOP 51
CHURCH 52
FRIENDS/RELATIVES 53
TRADITIONAL HEALER 54
OTHER 96

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

YES 1
NO 2 (GO TO 805)

802A 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 SHARING FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER X
DON'T KNOW Z

803 Can tuberculosis be cured?

YES 1
NO 2
DON'T KNOW 8

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

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

804A Would you be willing to work with someone who has been previously treated for tuberculosis?

YES 1
NO 2

804B What signs or symptoms would lead you to think that a person has tuberculosis?
PROBE: Any other ways?
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 X
NO SYMPTOMS Y
DON'T KNOW Z

804C What do you think is the cause of tuberculosis?
PROBE: Any other ways?
RECORD ALL MENTIONED.

MICROBES/GERMS/BACTERIA A
INHERITED B
LIFESTYLE C
SMOKING D
ALCOHOL DRINKING E
EXPOSURE TO COLD TEMP F
DUST/POLLUTION G
OTHER X
DON'T KNOW Z

805 Some men are circumcised. Are you circumcised?

YES 1
NO 2 (GO TO 806)

805 A How old were you when circumcision occurred?

AGE IN COMPLETED YEARS _______
DURING CHILDHOOD (YOUNGER THAN 5 YEARS) 96
DON'T KNOW 98

805B Who did the circumcision?

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

805C Where did you go to be circumcised?

HEALTH FACILITY 1
HOME OF A HEALTH WORKER 2
INITIATION SCHOOL 3
OTHER 4
DON'T KNOW 8

806 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 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 (GO TO 810)

807 Among these injections, how many were administered by a doctor, a nurse, 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.

NUMBER OF INJECTIONS _________
NONE 00 (GO TO 810)

808 The last time you had an injection given to you by a health worker, where did you go to get the injection?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE MEDICAL SECTOR, THE NAME OF THE PLACE.

(NAME OF PLACE) _________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVT. HEALTH CENTER 12
OTHER PUBLIC SECTOR 13
PRIVATE MEDICAL SECTOR
PVT HOSPITAL/CLINIC 21
PHARMACY 22
PVT DOCTOR 23
OTHER PRIVATE MEDICAL SECTOR 26
CHAL
CHAL HOSPITAL 31
CHAL HEALTH CENTER 32
OTHER 96

810 Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 813A)

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

CIGARETTES _____

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

YES 1
NO 2 (GO TO 813A)

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

PIPE A
CHEWING TOBACCO B
SNUFF C
OTHER X

813A Have you ever drunk an alcohol-containing beverage?

YES 1
NO 2 (GO TO 813F)

813B 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 00

813C Have you ever gotten drunk from drinking an alcohol-containing beverage?

YES 1
NO 2 (GO TO 813F)

813D CHECK 813B:

DRANK ALCOHOL ON AT LEAST ONE DAY (GO TO 813E)
NONE (GO TO 813F)

813E In the last 3 months, on how many occasions did you get drunk?

NUMBER OF TIMES _______
NONE 00

813F Now I want to talk about diabetes. Have you ever heard of an illness called diabetes?

YES 1
NO 2 (GO TO 813J)

813G Have you ever been told by a doctor that you have diabetes?

YES 1
NO 2 (GO TO 813J)

813H Are you taking medications for diabetes?

YES 1
NO 2

813I How do you take the medicine?

INJECTED 1
ORALLY 2

813J Now I want to talk about blood pressure. Before this survey, has your blood pressure ever been checked?

YES 1
NO 2 (GO TO 814)

813K Who took your blood pressure?

DOCTOR 1
NURSE 2
OTHER 6
DON'T KNOW 8

813L When was the last time you had your blood pressure checked?

LESS THAN 6 MONTHS AGO 1
6 - 11 MONTHS AGO 2
1 - 5 YEARS AGO 3
MORE THAN 5 YEARS AGO 4
DON'T KNOW 8

813M Have you ever been told by a doctor or a nurse that you have high blood pressure?

YES 1
NO 2 (GO TO 814)

813N To lower your blood pressure, are you now:

a. taking prescribed medicine?
YES 1
NO 2
N/A 3
b. controlling your weight or losing weight?
YES 1
NO 2
N/A 3
c. cutting down on salt in your diet?
YES 1
NO 2
N/A 3
d. exercising?
YES 1
NO 2
N/A 3
e. cutting down on alcohol consumption?
YES 1
NO 2
N/A 3
f. stopping smoking?
YES 1
NO 2
N/A 3
g. taking traditional medicine/herbs
YES 1
NO 2
N/A 3

814 Are you covered by any health insurance?

YES 1
NO 2 (GO TO 816)

815 What type of health insurance?
RECORD ALL MENTIONED.

MUTUAL HEALTH ORGANIZATION/COMMUNITY BASED HEALTH INSURANCE A
HEALTH INSURANCE THROUGH EMPLOYER B
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE C
OTHER X

816 CHECK 214:

(YOUNGEST) CHILD IS AGE 0-17 (GO TO 817)
OTHER (GO TO 818)

817 Now I would like to ask you about your own child(ren) who (is/are) under the age of 18.
Have you made arrangements for someone to care for (him/her/them) in the event that you fall sick or are unable to care for (him/her/them)?

YES 1
NO 2
UNSURE 8

818 (Besides your own child/children), are you the primary caregiver for any children under the age of 18?

YES 1
NO 2 (GO TO 901)

819 Have you made arrangements for someone to care for (this child/these children) in the event that you fall sick or are unable to care for (him/her/them)?

YES 1
NO 2
UNSURE 8

9. PARTICIPATION IN HEALTH CARE

901 CHECK 209:

HAS HAD ONE OR MORE CHILDREN (GO TO 902)
HAS NOT HAD ANY CHILDREN (GO TO 913)

902 Please tell me the name and sex of your child (who was born most recently.

(NAME OF CHILD) _______
BOY 1
GIRL 2

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

MONTH ________
YEAR _______

904 Is (NAME OF CHILD) still living?

YES 1 (GO TO 906)
NO 2
DON'T KNOW 8 (GO TO 908)

905 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

906 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 HOUSEHOLD QUESTIONNAIRE ____

907 CHECK 903:

LAST CHILD BORN IN 2004 OR LATER (GO TO 908)
LAST CHILD BORN IN 2003 OR EARLIER (GO TO 913)

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

CURRENT SPOUSE 1
FORMER SPOUSE 2
CURRENT LIVE-IN PARTNER 3
FORMER LIVE-IN PARTNER 4
REGULAR SEXUAL PARTNER 5
WOMAN IS GIRLFRIEND/FIANCEE 6
OCCASIONAL SEXUAL PARTNER 7
FRIEND/ACQUAINTANCE 8

909 ASK QUESTIONS 910-912 FIRST FOR PREGNANCY, THEN FOR DELIVERY, AND THEN FOR THE SIX WEEKS AFTER DELIVERY. ALL QUESTIONS REFER TO THE LAST BIRTH.

910 Now, think back to the time when (NAME OF CHILD'S MOTHER) was pregnant with (NAME OF CHILD).

PREGNANCY

910A: 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 (GO TO 912)
DON'T KNOW 8 GO TO 910B IN NEXT COLUMN

DELIVERY

910B: Did a doctor or any health care provider assist with the delivery of (NAME OF CHILD)?

YES 1
NO 2 (GO TO 912)
DON'T KNOW 8 (GO TO 910C IN NEXT COLUMN)

SIX WEEKS AFTER DELIVER

910C: 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?

1 YES 1
2 NO 2 (GO TO 912)
8 DON'T KNOW 8 (GO TO 913)

911 Who mainly provided the money or goods or services to pay for this care?

PREGNANCY

FREE 01
INSURANCE 02
RESPONDENT 03
CHILD'S MOTHER 04
RESPONDENT AND CHILD'S MOTHER 05
RESPONDENT'S FAMILY 06
CHILD'S MOTHER'S FAMILY 07
OTHER 08

GO TO 910B IN NEXT COLUMN

DELIVERY

FREE 01
INSURANCE 02
RESPONDENT 03
CHILD'S MOTHER 04
RESPONDENT AND CHILD'S MOTHER 05
RESPONDENT'S FAMILY 06
CHILD'S MOTHER'S FAMILY 07
OTHER 08

GO TO 910C IN NEXT COLUMN

SIX WEEKS AFTER DELIVERY

FREE 01
INSURANCE 02
RESPONDENT 03
CHILD'S MOTHER 04
RESPONDENT AND CHILD'S MOTHER 05
RESPONDENT'S FAMILY 06
CHILD'S MOTHER'S FAMILY 07
OTHER 08

GO TO 913

912 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 08

GO TO 910B 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 08

GO TO 910C IN NEXT COLUMN

SIX WEEKS AFTER DEELIVERY

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 08

913 CHECK 601B:

AGREED TO MEASUREMENT (GO TO 914)
DID NOT AGREE TO MEASUREMENT (GO TO 915)

914 May I measure your blood pressure at this time?

INTERVIEWER SIGNATURE _______
DATE _______
RESPONDENT AGREES (RECORD OUTCOME OF BLOOD PRESSURE MEASUREMENT)
RESPONDENT DOES NOT AGREE (RECORD 9994)
SYSTOLIC _______
DIASTOLIC _______
REASON BLOOD PRESSURE NOT MEASURED
REFUSED 9994
TECHNICAL PROBLEMS 9995
OTHER 9996

915 RECORD THE TIME.

HOUR _____
MINUTES _______

SECTION 10. AVERAGING BLOOD PRESSURE MEASURES

1001 CHECK Q601B AND Q914:

SYSTOLIC AND DIASTOLIC BLOOD PRESSURE RECORDED IN BOTH Q601B AND Q914 (GO TO 1002)
SYSTOLIC AND DIASTOLIC BLOOD MEASURES NOT PRESSURE RECORDED IN BOTH IN BOTH Q601B AND Q914 (GO TO 1007)

1002 RECORD AND CALCULATE THE AVERAGE OF THE SYSTOLIC AND DIASTOLIC BLOOD PRESSURE FROM Q455 AND Q914.

1003 BLOOD PRESSURE MEASUREMENTS FROM Q601B

SYSTOLIC _______
DIASTOLIC _______

1004 BLOOD PRESSURE MEASUREMENTS FROM Q1116

SYSTOLIC _______
DIASTOLIC _______

1005 RECORD THE SUM OF THE SYSTOLIC AND DIASTOLIC MEASURES.

SUM SYSTOLIC _______
SUM DIASTOLIC _______

1006 CALCULATE THE AVERAGE SYSTOLIC AND DIASTOLIC PRESSURES BY THE SUM IN Q1005 BY 2.

AVERAGE SYSTOLIC _______ (GO TO 1011)
AVERAGE DIASTOLIC _______ (GO TO 1011)

1007 CHECK Q914:

SYSTOLIC AND DIASTOLIC BLOOD PRESSURE NOT RECORDED IN Q914 (GO TO 1008)
BOTH SYSTOLIC AND DIASTOLIC BLOOD PRESSURE RECORDED IN Q914 (GO TO 1010)

1008 CHECK Q601B:

SYSTOLIC AND DIASTOLIC BLOOD PRESSURE NOT RECORDED IN Q601B (GO TO 1009)
BOTH SYSTOLIC AND DIASTOLIC BLOOD PRESSURE RECORDED IN Q601B (GO TO 1010)

1009 CHECK Q102D:

SYSTOLIC AND DIASTOLIC BLOOD PRESSURE RECORDED IN Q102D (GO TO 1010)
BOTH SYSTOLIC AND DIASTOLIC BLOOD PRESSURE NOT RECORDED IN Q102D (GO TO 1013)

1010 RECORD THE SYSTOLIC AND DIASTOLIC PRESSURE.

SYSTOLIC _______
DIASTOLIC _______

1011 USE THE TABLE BELOW TO DETERMINE THE CORRECT CODE TO RECORD ON THE BLOOD PRESSURE REPORT AND REFERRAL FORM.
CIRCLE THE ROW IN WHICH THE VALUE FOR THE SYSTOLIC BLOOD PRESSURE FROM Q1006 OR Q1010 IS FOUND.
THEN CIRCLE THE COLUMN IN WHICH THE VALUE FOR THE DIASTOLIC BLOOD FROM Q1006 OR Q1010 IS FOUND.
THE VALUE WHERE THE ROW AND COLUMN YOU HAVE CIRCLED INTERSECT IN THE TABLE WILL BE USED IN COMPLETING Q1012.

AVERAGE DIASTOLIC PRESSURE
less than 84 85-89 90-99 100-109 110-119 greater than 120
AVERAGE SYSTOLIC
PRESSURE
less than 130 1 2 3 4 5 6
130-139 2 2 3 4 5 6
140-159 3 3 3 4 5 6
160-179 4 4 4 4 5 6
180-209 5 5 5 5 5 6
greater than 210 6 6 6 6 6 6

1012 RECORD THE NUMBER YOU CIRCLED IN Q1211 IN THE CHART BELOW. THEN USE THE INSTRUCTIONS TO THE RIGHT OF THAT NUMBER TO COMPLETE A BLOOD PRESSURE REPORT AND REFERRAL FORM FOR THE RESPONDENT. GIVE THE FORM TO THE RESPONDENT AND ANSWER ANY QUESTIONS HE/SHE MAY HAVE.

RESPONDENT'S BLOOD PRESSURE CATEGORY
1 NORMAL
CONSULT HEALTH PROVIDER TO CHECK BLOOD PRESSURE WITHIN:
1 24 MONTHS

RESPONDENT'S BLOOD PRESSURE CATEGORY
2 AT THE HIGH END OF THE NORMAL RANGE
CONSULT HEALTH PROVIDER TO CHECK BLOOD PRESSURE WITHIN:
2 12 MONTHS

RESPONDENT'S BLOOD PRESSURE CATEGORY
3 ABOVE NORMAL RANGE
CONSULT HEALTH PROVIDER TO CHECK BLOOD PRESSURE WITHIN:
3 2 MONTHS

RESPONDENT'S BLOOD PRESSURE CATEGORY
4 MODERATELY HIGH
CONSULT HEALTH PROVIDER TO CHECK BLOOD PRESSURE WITHIN:
4 1 MONTH

RESPONDENT'S BLOOD PRESSURE CATEGORY
5 VERY HIGH
CONSULT HEALTH PROVIDER TO CHECK BLOOD PRESSURE WITHIN:
5 7 DAYS

RESPONDENT'S BLOOD PRESSURE CATEGORY
6 EXTREMELY HIGH
CONSULT HEALTH PROVIDER TO CHECK BLOOD PRESSURE WITHIN:
6 TODAY

1013 CHECK THAT THE HOUSEHOLD HAS RECEIVED A BROCHURE ON BLOOD PRESSURE.
THANK THE RESPONDENT AND ADVISE THAT THE RESPONDENT OR OTHER MEMBERS OF THE HOUSEHOLD MAY BE ASKED TO PARTICIPATE AGAIN IN INTERVIEWS OR OTHER SURVEY ACTIVITIES IN THE FUTURE.
Thank you for taking the time to answer these questions.
We may return to interview you or other members of your household again or to ask you to participate in other survey activities in the future. We hope that you will agree at that time.