Data Cart

Your data extract

0 variables
0 samples
View Cart

Demographic and Health Survey in Mali (EDSM-V, 2012), Men's questionnaire

Committee of Planning and Statistics/Ministry of Health
National Office of Statistics and Information
Republic of Mali

IDENTIFICATION

PLACE NAME________
CLUSTER_________
FIRST AND LAST NAME OF HEAD OF HOUSEHOLD_____________
PLOT NUMBER ________
HOUSEHOLD NUMBER__________
ADMINISTRATIVE REGION_________

URBAN/RURAL/ MILIEU

Urban 1
Rural 2

BAMAKO, OTHER CITIES, OTHER TOWNS, RURAL/MILIEU (DETAILED)

Bamako 1
Other cities 2
Other towns 3
Rural 4

MAN'S FIRST AND LAST NAME AND LINE NUMBER

Name_________
Line number________

Interviewer visits

INTERVIEWER 1
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
Date___________

Interviewer's name________
Result*__________

NEXT VISIT
(REPEAT FOR INTERVIEWER 2)
Date_______
Time________

FINAL VISIT
Day_____
Month______
Year 2012
Interviewer's name_______
Result________

TOTAL NO. OF VISITS_________

*Results codes

1Completed
2 Not at home
3 Postponed
4 Refused
5 Partly completed
6 Incapacitated
7 Other________ (SPECIFY)

LANGUAGE OF QUESTIONNAIRE: French

French 1
Bambara 2
Sonrai 3
Peulh 4

LANGUAGE OF INTERVIEW

French 01
Bambara/Malinke 02
Sonrai/Djerma 03
Peuhl/Foulfoulde 04
Senoufo 05
Marika/Soninke 06
Dogon 07
Minianka 08
Tamacheck/Bella 09
Bobo/Dafing 10
Bozo/Somono 11
Other 96

Interpreter

Yes 1
No 2

SUPERVISOR
NAME_____
DATE_______

FIELD EDITOR
NAME______
DATE______

OFFICE EDITOR_______

KEYED BY_______

Section 1. Respondent's background

INTRODUCTION AND CONSENT

Hello. My name is ___. I am working with INFO-STAT, which is executing this survey in collaboration with the Committee of Planning and Statistics of the Ministry of Health (CPS) and the National Office of Statistics and Information (INSTAT). We are conducting a survey about health in Mali. The information we collect will help the government to improve health services. Your household was selected for the survey. The questions usually take about 20 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You are not obligated to participate in the survey, but we hope you will agree to participate because your opinions are very important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.

In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.
Do you have any questions?
May I begin the interview?

Signature of interviewer________
Date________

Respondent agrees to be interviewed 1
Respondent does not agree to be interviewed 2-End

101) RECORD THE TIME

Hour_______
Minutes_____

102) In what month and year were you born?

Month____
Don't know month 98
Year________
Don't know year 9998

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

Age in completed years______

104) Have you attended school?

Yes 1
No 2- GO TO 108

105) What is the highest level of school you attended: fundamental 1 (1st cycle), fundamental 2 (2nd cycle), secondary (high school or technical school), or higher?

Fundamental (1st cycle) 1
Fundamental (2nd cycle) 2
Secondary (high school or technical school) 3
Higher 4

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

Grade/form/year________

107) CHECK 105:

Fundamental 1 (1st cycle)- (GO TO 108)
Fundamental 2 (2nd cycle) or higher- (GO TO 110)

108) Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE:
Can you read any part of the sentence to me?

Cannot read at all 1
Able to read only part of sentence 2
Abel to read whole sentence 3
No card with required language _________(SPECIFY LANGUAGE) 4
Blind/visually impaired 5

109) CHECK 108:

Code 2, 3, or 4 circled- (GO TO 110)
Code 1 or 5 circled- (GO TO 111)

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

At least once a week 1
Less than once a week 2
Not at all 3

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

At least once a week 1
Less than once a week 2
Not at all 3

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

At least once a week 1
Less than once a week 2
Not at all 3

113) COUNTRY-SPECIFIC QUESTION ON RELIGION, IF APPROPRIATE.

114) COUNTRY-SPECIFIC QUESTION ON ETHNICITY, IF APPROPRIATE.

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

Number of times
None 00- (GO TO 201)

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

Yes 1
No 2

Section 2. Reproduction

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

Yes 1
No 2- (GO TO 206)
Don't know 8- (GO TO 206)

202) Do you have any sons or daughters that you have fathered who are currently 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 still 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) SUM ANSWERS TO 203, 205, AND 207 AND ENTER TOTAL.
IF NONE, RECORD 00

Total_______

209) CHECK 208:

Has had more than one child- (GO TO 210)
Has only had one child- (GO TO 212)
Has not had any children- (GO TO 301)

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

Yes 1- (GO TO 212)
No 2

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

Number of women_______

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

Age in years__________

213) CHECK 203 AND 205:

At least one living child- (GO TO 214)
No living children- (GO TO 301)

214) How old is your (youngest) child?

Age in years_______

215) CHECK 214:

(Youngest) child is age 0-2 years- (GO TO 216)
Other- (GO TO 301)

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

(Name of (youngest) child)_____________

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

Present 1
Not present 2

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

Hospital/health facility 1
Other 2

220) When a child has diarrhea, how much should he or she be given to drink: more than usual, about the same as usual, less than usual or nothing to drink at all?

More than usual 1
About the same 2
Less than usual 3
Nothing to drink 4
Don't know 8

Section 3. Contraception

301) Now I would like to talk about family planning-the various ways or methods that a couple can use to delay or avoid a pregnancy. What methods have you already heard about?

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) IUD: 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 heath provider that stops them from becoming pregnant for one or more months.
Yes 1
No 2
05) IMPLANTS: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
Yes 1
No 2
06) PILL: Women can take a pill every day to avoid becoming pregnant
Yes 1
No 2
07) 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.
Yes 1
No 2
09A) CYCLE BEADS: Women use a necklace of colored beads to know which days they can become pregnant. On the days they can become pregnant, they use a condom or they don't have sexual intercourse.
Yes 1
No 2
09) LACTATIONAL AMENORRHEA method (LAM): Up to 6 months after childbirth, and when her menstrual period has not returned, a woman can use a method that requires that she breastfeeds each time the child wants, day and night, without giving him any other food.
Yes 1
No 2
10) RHYTHM METHOD: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
Yes 1
No 2
11) WITHDRAWAL: Men can be careful and pull out before ejaculation.
Yes 1
No 2
12) EMERGENCY CONTRACEPTION: Women can take special pills to prevent pregnancy within three days after they have unprotected sexual intercourse to prevent becoming pregnant.
Yes 1
No 2
13) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
Yes 1_________(SPECIFY)
No 2

302) In the last few months have you
Heard about family planning on the radio?
Seen anything about family planning on the television?
Read about family planning in a newspaper or magazine?

Radio
Yes 1
No 2
Television
Yes 1
No 2
Magazine
Yes 1
No 2

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

Yes 1
No 2

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

Yes 1
No 2- (GO TO 306)
Don't know 8- (GO TO 306)

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

Just before her period begins 1
During her period 2
Right after her period has ended 3
Halfway between two periods 4
Other______ (SPECIFY) 6
Don't know 8

306) I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.
a) Contraception is a woman's business and a man should not have to worry about it.
b) Women who use contraception may become promiscuous.

Contraception woman's business
Agree 1
Disagree 2
Don't know 8
Women may become promiscuous
Agree 1
Disagree 2
Don't know 8

307) CHECK 301 (07): KNOW MALE CONDOM

Yes- (GO TO 308)
No -(GO TO 311)

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

Yes 1
No 2- (GO TO 311)

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

(NAME OF PLACE(S))______________
Public sector
National hospital A
Regional hospital B
Referral Health Center (CSREF) C
Free clinic/Maternity D
Community Health Center (CSCOM) E
Other public sector_______ (SPECIFY) F
Private medical sector
Private clinic/hospital G
Private health care practice H
Treatment room I
Pharmacy J
Community based agent K
Other private medical sector__________ (SPECIFY) L
Other source
Shop M
Bar/nightclub N
Kiosk O
Traveling vendor P
Friend/acquaintance/relatives Q
Other __________ (SPECIFY) X

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

Yes 1
No 2

311) CHECK 301 (08): KNOWS FEMALE CONDOM

Yes- (GO TO 312)
No- (GO TO 401)

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

Yes 1
No 2- (GO TO 401)

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

(NAME OF PLACE(S))_________________
Public sector
National hospital A
Regional hospital B
Referral Health Center (CSREF) C
Free clinic/Maternity D
Community Health Center (CSCOM) E
Other public sector _________ (SPECIFY) F
Private sector
Private clinic/hospital G
Private health care practice H
Treatment room I
Pharmacy J
Community based agent K
Other private sector _________ (SPECIFY) L
Other source
Shop M
Bar/nightclub N
Kiosk O
Traveling vendor P
Friend/acquaintance/relatives Q
Other__________ (SPECIFY) X

314) If you wanted, could you yourself get a female condom?

Yes 1
No 2

Section 4. Marriage and sexual activity

401) Are you currently married or living 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 her 1
Staying elsewhere 2

405) Do you have other wives or do you live with other women as if married?

Yes (more than one) 1
No (only one) 2- (GO TO 407)

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

Total number of wives and live-in partners__________

407) CHECK 405:

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 LIFE-IN PARTNER.
IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD 00.

Name________
Line number ________

408) How old was (name) on her last birthday?
ASK FOR EACH PERSON

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- (GO TO 411)
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 you a question 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 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

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

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

Days ago_________ 1
Weeks ago_________ 2
Months ago__________ 3
Years ago___________ 4- (GO TO 430)

417) When was the last time you had sexual intercourse with this person (last sexual partner)?

Days ago ______1
Weeks ago________ 2
Months ago______ 3

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

Yes 1
No 2- (GO TO 420)

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

Yes 1
No 2

420) What was your relationship to this person with whom you had sexual intercourse?
IF GIRLFRIEND: Were you living together as if married?
IF YES, CIRCLE 2
IF NO, CIRCLE 3

Wife 1
Live-in partner 2
Girlfriend not living with respondent 3- (GO TO 423)
Casual acquaintance 4- (GO TO 423)
Client/Prostitute 5- (GO TO 423)
Other ________ (SPECIFY) 6- (GO TO 423)

421) CHECK 410:

Married only once- (GO TO 422)
Married more than once or 410 not asked- (GO TO 423)

422) CHECK 414:

First time when started living with first wife- (GO TO 424)
Other- (GO TO 423)

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

Days ago_______ 1
Weeks ago_______ 2
Months ago________ 3
Years ago_________4

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

Number of times

425) How old is this person?

Age of partner________
Don't know 98

426) Apart from (this person/these two people), have you had sexual intercourse with any other person in the last 12 months?

Yes 1-(GO BACK TO 417 IN NEXT COLUMN)
No 2-(GO TO 428)

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

Number of partners in last 12 months__________
Don't know 98

428) CHECK 420 (ALL COLUMNS):

At least one partner is prostitute- (GO TO 429)
No partners are prostitutes- (GO TO 430)

429) CHECK 420 AND 418 (ALL COLUMNS)

Condom used with every prostitute- (GO TO 433)
Other- (GO TO 434)

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

Yes 1- (GO TO 432)
No 2

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

Yes 1- (GO TO 434)
No 2- (GO TO 434)

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

Yes 1
No 2- (GO TO 434)

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

Yes 1
No 2
Don't Know 8

434) In total, with how many different people have you had sexual intercourse in your life?
IF NON-NUMERIC NUMBER, PROBE TO GET AN ESTIMATE
IF THE NUMBER IF MORE THAN 95, WRITE '95'

Number of partners in lifetime______
Don't know 98

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

Condom used- (GO TO 436)
Not asked- (GO TO 438)
No condom used- (GO TO 438)

436) You told me that a condom was used the last time you had sex. What is the brand name of the condom used at that time?
IF BRAND NOT KNOWN, ASK TO SEE THE PACKAGE.

Prudence 01
Protector 02
Kamassoutra 02
IPPF 03
Other _______(SPECIFY) 96
Don't know 98

437) From where did you obtain the condom the last time?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

(NAME OF PLACE)___________
Public sector
National hospital 11
Regional hospital 12
Referral Health Center (CSREF) 13
Free clinic/Maternity 14
Community Health Center (CSCOM) 15
Other public sector______ (SPECIFY) 16
Private sector
Private clinic/hospital 21
Private health care practice 22
Treatment room 23
Pharmacy 24
Community based agent 25
Other private medical sector _________ (SPECIFY) 26
Other source
Shop 31
Bar/nightclub 32
Kiosk
Traveling vendor 34
Friend/acquaintance/relatives 35
Other________ (SPECIFY) 96

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

Yes 1
No 2-GO TO 501
Don't know 8-GO TO 501

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

Female sterilization A
Male sterilization B
IUD C
Injectables D
Implants E
Pill F
Female condom G
Diaphragm H
Foam/Jelly I
Cycle beads J
LAMA K
Rhythm method L
Withdrawal M
Other modern method X
Other traditional method Y

Section 5. Fertility preferences

501) CHECK 401:

Currently married or living with a partner- (GO TO 502)
Not currently married and not living with a partner- (GO TO 509)

502) CHECK 439:

Man not sterilized- (GO TO 503)
Man sterilized- (GO TO 509)

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

Yes 1
No 2- (GO TO 505)
Don't Know 8- (GO TO 505)

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

Have another child 1- (GO TO 506)
No more 2- (GO TO 509)
Undecided/don't know 8- (GO TO 509)

505) Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

Have (a/another) child 1
No more/none 2-GO TO 509
Says couple can't get pregnant 3-GO TO 509
Wife (wives)/partner(s) sterilized 4-GO TO 509
Undecided/don't know 8-GO TO 509

506) CHECK 407:

One wife/partner- (GO TO 508)
More than one wife/partner --(GO TO 508)

507) CHECK 503:

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

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

Months______ 1- (GO TO 509)
Years________ 2- (GO TO 509)
Soon/now 993- (GO TO 509)
Couple infertile994- (GO TO 509)
Other_______ (SPECIFY) 996- (GO TO 509)
Don't know 998- (GO TO 509)

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

Months___________ 1
Years__________ 2
Soon/now 993
He/all his wives/partners are infertile 994
Other_________ (SPECIFY) 996
Don't know 998

509) CHECK 203 AND 205:

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

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 601
Number________
Other__________ (SPECIFY) 96- (GO TO 601)

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

Number of Boys ___________
Number of Girls______
Number of Either_______
Other __________(SPECIFY) 96

Section 6. Employment and gender roles

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

Yes 1- (GO TO 604)
No 2

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, maternity leave, or any other such reason?

Yes 1- (GO TO 604)
No 2

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

Yes 1
No 2- (GO TO 607)

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

Occupation____________

605) Do you usually work all year, seasonally, or do you only work once in a while?

All year 1
Seasonally/part of the year 2
Once in a while 3

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

Cash only 1
Cash and kind 2
In kind only 3
Not paid 4

607) CHECK 401:

Currently married or living with a partner- (GO TO 608)
Not currently married and not living with a partner- (GO TO 612)

608) CHECK 606:

Code 1 or 2 circled- (GO TO 609)
Other --(GO TO 610)

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

Respondent 1
Wife/partner 2
Respondent and wife/partner together 3
Other_________ (SPECIFY) 6

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

Respondent 1
Wife/partner 2
Respondent and wife/partner together 3
Someone else 4
Other_________ (SPECIFY) 6

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

Respondent 1
Wife/partner 2
Respondent and wife/partner jointly 3
Someone else 4
Other_______ (SPECIFY) 6

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

Alone only 1
Jointly only 2
Both alone and jointly 3
Does not own 4

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

Alone only 1
Jointly only 2
Both alone and jointly 3
Does not own 4

614) In your opinion, is a husband justified in hitting or beating his wife in the following situations:
If she goes out without telling him?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she burns the food?

Leaves without telling him
Yes 1
No 2
Don't Know 8
Neglects the children
Yes 1
No 2
Don't Know 8
Argues
Yes 1
No 2
Don't Know 8
Refuses sex
Yes 1
No 2
Don't Know 8
Burns food
Yes 1
No 2
Don't Know 8

Section 7. HIV/AIDS

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

Yes 1
No 2- (GO TO 723)

702) Can people reduce their chance of getting the AIDS virus by having 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 get the AIDS virus because of witchcraft or other supernatural means?

Yes
No 2
Don't know 8

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

Yes 1
No 2
Don't know 8

708) Can the virus that causes AIDS be transmitted from a mother to a child?
During pregnancy?
During delivery?
By breastfeeding?

Pregnancy
Yes 1
No 2
Don't Know 8
Delivery
Yes 1
No 2
Don't Know 8
Breast Feeding
Yes 1
No 2
Don't Know 8

709) CHECK 708:

At least one yes- (GO TO 710)
Other- (GO TO 711)

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

Yes 1
No 2
Don't Know 8

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

712) I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?

Yes 1
No 2- (GO TO 716)

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

Months ago_____________
Two or more years 95

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

Yes 1
No 2

715) Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

(NAME OF PLACE)_______________________
Public sector
National hospital 11
Regional hospital 12
Referral Health Center (CSREF) 13
Free clinic/Maternity 14
Community Health Center (CSCOM) 15
Public volunteer testing center 16
School based clinic 17
Other public sector_________ (SPECIFY) 18
Private sector
Private clinic/hospital 21
Private health care practice 22
Treatment room 23
Independent volunteer testing center 24
Pharmacy 25
Community based agent 26
School based clinic 27
Other private medical sector____________ (SPECIFY) 28
Other source
Home (respondent's home) 31
Correctional facility 32
Military camp 33
Other______________ (specify) 96

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

Yes 1
No 2- (GO TO 718)

717) Where is that?
Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

(NAME OF PLACE)________________
Public sector
National hospital 11
Regional hospital 12
Referral Health Center (CSREF) 13
Free clinic/Maternity 14
Community Health Center (CSCOM) 15
Public volunteer testing center 16
School based clinic 17
Other public sector____________ (SPECIFY) 18
Private sector
Private clinic/hospital 21
Private health care practice 22
Treatment room 23
Independent volunteer testing center 24
Pharmacy 25
Community based agent 26
School based clinic 27
Other private medical sector_____________(SPECIFY) 28
Other source
Home (respondent's home) 31
Correctional facility 32
Military camp 33
Other____________ (SPECIFY) 96

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

Yes 1
No 2
Don't know 8

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

Yes, remain a secret 1
No 2
Don't Know/not sure/depends 8

720) If a member of your family 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
Don't Know/Not sure/Depends 8

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

Should be allowed 1
Should not be allowed 2
Don't Know/Not sure/Depends 8

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

Yes 1
No 2
Don't Know/Not sure/Depends 8

723) CHECK 701:

HEARD ABOUT AIDS- Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

NOT HEARD ABOUT AIDS- Have you heard about infections that can be transmitted through sexual contact?

Yes 1
No 2

724) CHECK 414:

Has had sexual intercourse- (GO TO 725)
Has not had sexual intercourse- (GO TO 732)

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

Yes- (GO TO 726)
No- (GO TO 727)

726) 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

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

Yes 1
No 2
Don't know 8

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

Yes 1
No 2
Don't know 8

729) CHECK 726, 727, AND 728:

Has had an infection (any yes)- (GO TO 730)
Has not had an infection or does not know -- (GO TO 732)

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

Yes 1
No 2- (GO TO 732)

731) Where did you go?
Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

(NAME OF PLACE(S))______________
Public sector
National hospital A
Regional hospital B
Referral Health Center (CSREF) C
Free clinic/Maternity D
Community Health Center (CSCOM) E
Public volunteer testing center F
School based clinic G
Other public sector____________ (SPECIFY) H
Private sector
Private clinic/hospital I
Private health care practice J
Treatment room K
Independent volunteer testing center L
Pharmacy M
Community based agent N
School based clinic O
Other private medical sector______________ (SPECIFY) P
Other source
Home (respondent's home) Q
Military camp R
Other_____________ (SPECIFY) X

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

Yes 1
No 2
Don't know 8

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

Yes 1
No 2
Don't know 8

Section 8. Other health issues

801A) Have you ever heard of female circumcision?

Yes 1- (GO TO 801C)
No 2

801B) In a number of countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard of this practice?

Yes 1
No 2 -- (GO TO 801)

801C) Do you believe that this practice is required by your religion?

Yes 1
No 2
No religion 3
Don't know 8

801D) Do you think that this practice should be continued, or should it be discontinued?

Continued 1
Discontinued 2
Depends 3
Don't know 8

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

Yes 1
No 2- (GO TO 805)
Don't know 8- (GO TO 805)

802) How old were you when you got circumcised?

Age in completed years
During childhood (less than 5 years) 96
Don't know 98

803) Who did the circumcision?

Traditional practitioner/family/friend 1
Health worker/professional 2
Other 3
Don't know 8

804) Where was it done?

Health facility 1
Home of a health worker/professional 2
Circumcision done at home 3
Ritual site 4
Other home/place 5
Don't know 8

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

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

Number of injections_____________
None 00- (GO TO 808)

806) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or another healthcare worker?

IF THE NUMBER OF INJECTIONS IS OVER 90 OR IF THERE WERE DAILY INJECTIONS IN THE LAST 3 MONTHS OR LONGER, RECORD 90.
IF THE RESPONSE IS NOT NUMERIC, PROBE TO OBTAIN AN ESTIMATE.

Number of injections____________
None-00- (GO TO 808)

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

Yes 1
No 2
Don't know 8

808) Do you currently smoke cigarettes?

Yes 1
No 2- (GO TO 810)

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

Number of cigarettes____________

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

Pipe A
Chewing tobacco B
Snuff C
Other ______________(SPECIFY) X

812) Are you covered by any health insurance?

Yes 1
No 2- (GO TO 814)

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

Mutual health organization/community-based health insurance A
Health insurance through employer B
Social security C
Other privately purchased commercial health insurance D
Other_________ (SPECIFY) X

818) RECORD THE TIME

Hour______________
Minutes____________

Interviewer's observations

TO BE FILLED IN AFTER COMPLETING INTERVIEW

Comments about respondent: _________________

Comments on specific questions:________________

Any other comments:___________

Supervisor's observations______________
Name of supervisor___________
Date______________

Editor's observations______________
Name of editor_______________
Date_______________