MAN'S QUESTIONNAIRE
MINISTRY OF HEALTH AND SPORTS
IDENTIFICATION
STATE/REGION___
DISTRICT__
TOWNSHIP__
WARD/VILLAGE TRACT___
CLUSTER NUMBER__
HOUSEHOLD NUMBER___
LINE NUMBER OF MAN___
FIRST VISIT
DATE___
INTERVIEWER'S NAME____
RESULT___
NEXT VISIT:
DATE___
TIME___
SECOND VISIT
DATE___
INTERVIEWER'S NAME____
RESULT___
NEXT VISIT:
DATE___
TIME___
THIRD VISIT
DATE___
INTERVIEWER'S NAME____
RESULT___
FINAL VISIT
DAY__
MONTH__
YEAR____
INT. NO.___
RESULT___
TOTAL NUMBER OF VISITS__
*RESULT CODES:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER_____(SPECIFY) 7
ENGLISH 2
OTHER_____ 6
ENGLISH 2
OTHER_____ 6
NO 2
FIELD EDITOR
NAME____
KEYED BY____
SECTION 1. RESPONDENT'S BACKGROUND
INTRODUCTION AND CONSENT
INFORMED CONSENT
Mingalabar. My name is (NAME). I am working with the Ministry of Health and Sports. We are conducting a survey about health all over Myanmar. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 20 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.
In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.
Do you have any question? May I begin the interview now?
SIGNATURE OF INTERVIEWER____
DATE:_____
RESPONDENT AGREES TO BE INTERVIEWED 1
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
MINUTES__
102) In what month and year were you born?
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.)
104) Have you ever attended school?
NO 2 (SKIP TO 108)
106) What is the highest grade you completed? (IF COMPLETED LESS THAN GRADE ONE, RECORD '00'.)
GRADE 6 OR HIGHER___(SKIP 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?
ABLE TO READ ONLY PARTS OF THE SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE_____(SPECIFY LANGUAGE) 4
BLIND/VISUALLY IMPAIRED 5
CODE '1' OR '5' CIRCLED___(SKIP TO 111)
110) Do you read a newspaper or magazine, at least once a week, less than once a week, or not at all?
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?
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?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
115A) Have you changed your usual place of residence compared with this time last year?
NO 2
115B) Please tell me where you were living one year ago (state/region)?
OTHER COUNTRY 00 (SKIP TO 201)
115C) Was it an urban or rural area?
RURAL 2
115D) How many times have you moved residence in the past 5 years?
NOT MOVED IN 5 YEARS 00 (SKIP TO 201)
115E) Can you tell me the other locations (state/region) you have lived in the past 5 years? PLEASE PROVIDE THE 3 MOST RECENT LOCATIONS.
STATE/REGION___
b. LOCATION___
STATE/REGION___
c. LOCATION___
STATE/REGION___
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?
NO 2 (SKIP TO 206)
DON'T KNOW 8 (SKIP TO 206)
202) Do you have any sons or daughters that you have fathered who are now living with you?
NO 2 (SKIP TO 204)
203) How many sons live with you? And how many daughters live with you? IF NONE, RECORD '00'.
DAUGHTERS AT HOME__
204) Do you have any sons or daughters that you have fathered who are alive but do not live with you?
NO 2 (SKIP 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'.
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?
NO 2 (SKIP TO 208)
DON'T KNOW 8 (SKIP TO 208)
207) How many boys have died? And how many girls have died?
IF NONE, RECORD '00'.
GIRLS DEAD __
208) SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'.
HAS HAD ONLY ONE CHILD__(SKIP TO 212)
HAS NOT HAD ANY CHILDREN___(SKIP TO 301)
210) Did all of the children you have fathered have the same biological mother?
NO 2
211) In all, how many women have you fathered children with?
212) How old were you when your (first) child was born?
NO LIVING CHILDREN___(SKIP TO 301)
214) How old is your (youngest) child?
OTHER__(SKIP TO 301)
216) What is the name of your (youngest) child?
WRITE NAME OF (YOUNGEST) CHILD________
217) When (NAME)'s mother was pregnant with (NAME), did she have any antenatal check-ups?
NO 2 (SKIP TO 219)
DON'T KNOW 8 (SKIP TO 219)
218) Were you ever present during any of those antenatal check-ups?
NOT PRESENT 2
219) Was (NAME) born in a hospital or health facility?
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?
ABOUT THE SAME 2
LESS THAN USUAL 3
NOTHING TO DRINK 4
DON'T KNOW 8
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)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
302) In the last few months have you:
NO 2
NO 2
NO 2
NO 2
NO 2
303) In the last few months, have you discussed family planning with a health worker or health professional?
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?
NO 2 (SKIP TO 306)
DON'T KNOW 8 (SKIP 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?
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.
DISAGREE 2
DON'T KNOW 8
DISAGREE 2
DON'T KNOW 8
307) CHECK 301 (07): KNOWS MALE CONDOM
NO__ (SKIP TO 311)
308) Do you know of a place where a person can get male condoms?
NO 2 (SKIP 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.
GOVT. HEALTH CENTER (RHC) B
GOVT. HEALTH POST (SUB-CENTER) C
VILLAGE HEALTH WORKER D
MOBILE CLINIC E
UHC/MCH CENTER F
OTHER PUBLIC SECTOR___(SPECIFY) G
MYANMAR RED CROSS SOCIETY I
PSI/M (SUN) J
MMA K
OTHER NGO SECTOR___(SPECIFY) L
PHARMACY N
PRIVATE DOCTOR O
MOBILE CLINIC P
FIELDWORKER Q
OTHER PRIVATE MEDICAL SECTOR___(SPECIFY) R
BETELNUT SHOP T
FRIENDS/RELATIVES U
310) If you wanted to, could you yourself get a condom?
NO 2
311) CHECK 301 (08): KNOWS FEMALE CONDOM
NO___(SKIP TO 401)
312) Do you know of a place where a person can get female condoms?
NO 2 (SKIP 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.
GOVT. HEALTH CENTER (RHC) B
GOVT. HEALTH POST (SUB-CENTER) C
VILLAGE HEALTH WORKER D
MOBILE CLINIC E
UHC/MCH CENTER F
OTHER PUBLIC SECTOR___(SPECIFY) G
MYANMAR RED CROSS SOCIETY I
PSI/M (SUN) J
MMA K
OTHER NGO SECTOR___(SPECIFY) L
PHARMACY N
PRIVATE DOCTOR O
MOBILE CLINIC P
FIELDWORKER Q
OTHER PRIVATE MEDICAL SECTOR___(SPECIFY) R
BETELNUT SHOP T
FRIENDS/RELATIVES U
314) If you wanted to, could you yourself get a female condom?
NO 2
SECTION 4. MARRIAGE AND SEXUAL ACTIVITY
401) Are you currently married?
NO, NOT IN UNION 2
402) Have you ever been married?
NO 2 (SKIP TO 413)
403) What is your marital status now: are you widowed, divorced, or separated? (SKIP TO 410)
DIVORCED 2
SEPARATED 3
404) Is your wife living with you now or is she staying elsewhere?
STAYING ELSEWHERE 2
NO (ONLY ONE) 2 (SKIP TO 407)
406) Altogether, how many wives do you have?
MORE THAN ONE WIFE___
Please tell me the name of your (wife / wives).
RECORD THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE. IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.
408) ASK 408 FOR EACH PERSON IN 407. How old was (NAME) on her last birthday?
MORE THAN ONE WIFE___ (SKIP TO 411A)
410) Have you been married only once or more than once?
MORE THAN ONCE 2 (SKIP TO 411A)
411) In what month and year did you start living with your wife?
411A) Now I would like to ask about your first wife. In what month and year did you start living with her?
DON'T KNOW MONTH 98
YEAR____ (SKIP TO 413)
DON'T KNOW YEAR 9998
412) How old were you when you first started living with her?
413) CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
414) Now I would like to ask 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?
AGE IN YEARS___
FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE 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 confident 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.
WEEKS AGO 2 ____
MONTHS 3 ___
YEARS 4 ___ (SKIP TO 430)
418) The last time you had sexual intercourse, was a condom used?
NO 2
430) In the last 12 months, did you pay anyone in exchange for having sexual intercourse?
NO 2
431) Have you ever paid anyone in exchange for having sexual intercourse?
NO 2 (SKIP TO 433A)
432) The last time you paid someone in exchange for having sexual intercourse, was a condom (male or female) used?
NO 2 (433A)
433) Was a condom used during sexual intercourse every time you paid someone in exchange for having sexual intercourse in the last 12 months?
NO 2
DON'T KNOW 8
433A) Have you ever had sex with another man?
NO 2 (SKIP TO 434)
433B) Have you had sex with another man in the past 6 months?
NO 2 (SKIP TO 434)
433C) The last time that you had sex with another man, did you use a condom?
NO 2 (SKIP TO 434)
434) 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 95 OR MORE, WRITE '95'
DON'T KNOW 98
NOT ASKED___(SKIP TO 438)
NO CONDOM USED___(SKIP 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 (male or female) used at that time?
IF BRAND NOT KNOWN, ASK TO SEE THE PACKAGE.
LUSOE 02
FEEL (FEMALE CONDOM) 03
OTHER___(SPECIFY) 96
DON'T KNOW 98
437) From where did you obtain the condom (male or female) the last time?
PROBE TO IDENTIFY TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER (RHC) 12
GOVT. HEALTH POST (SUB-CENTER) 13
VILLAGE HEALTH WORKER 14
MOBILE CLINIC 15
UHC/MCH CENTER 16
OTHER PUBLIC SECTOR___(SPECIFY) 17
MYANMAR RED CROSS SOCIETY 22
PSI/M (SUN) 23
MMA 24
OTHER NGO SECTOR____(SPECIFY) 26
PHARMACY 32
PRIVATE DOCTOR 33
MOBILE CLINIC 34
FIELDWORKER 35
OTHER PRIVATE MEDICAL SECTOR____(SPECIFY) 36
BETELNUT 42
FRIEND/RELATIVE 43
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?
NO 2 (SKIP TO 501)
DON'T KNOW 8 (SKIP 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.
MALE STERILIZATION B
IUD C
INJECTABLES D
IMPLANTS E
PILL F
FEMALE CONDOM G
DIAPHRAGM H
FOAM/JELLY I
LAM J
RHYTHM METHOD K
WITHDRAWAL L
OTHER MODERN METHOD X
OTHER TRADITIONAL METHOD Y
SECTON 5. FERTILITY PREFERENCES
501) CHECK 401:
NOT CURRENTLY MARRIED___(SKIP TO 509)
MAN STERILIZED___(SKIP TO 509)
503) Is your wife (Are any of your wives) currently pregnant?
NO 2 (SKIP TO 505)
DON'T KNOW (SKIP TO 505)
504) Now I have some questions about the future. After the (child/children) you and your (wife/wives) are expecting now, would you like to have another child, or would you prefer not to have any (more) children?
NO MORE 2 (SKIP TO 509)
UNDECIDED/DON'T KNOW 8 (SKIP 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?
NO MORE/NONE 2 (SKIP TO 509)
SAYS COUPLE CAN'T GET PREGNANT 3 (SKIP TO 509)
WIFE (WIVES) STERILIZED 4 (SKIP TO 509)
UNDECIDED/DON'T KNOW 8 (SKIP TO 509)
MORE THAN ONE WIFE___(SKIP TO 508)
507) CHECK 503:
WIFE PREGNANT OR DON'T KNOW___
How long would you like to wait from now before the birth of (a/another) child?
WIFE PREGNANT____
After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?
YEARS___ 2
SOON/NOW 993
COUPLE INFECUND 994
OTHER___(SPECIFY) 996
DON'T KNOW 998
(SKIP TO 509)
508) How long would you like to wait from now before the birth of (a/another) child?
YEARS____ 2
SOON/NOW 993
HE/ALL HIS WIVES ARE INFECUND 994
OTHER____(SPECIFY) 996
DON'T KNOW 998
509) CHECK 203 AND 205:
HAS LIVING CHILDREN___
If you could go back to the time you did not have any children and 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.
NUMBER___
OTHER____(SPECIFY) 96 (SKIP 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____(GIRLS)
NUMBER____(EITHER)
OTHER____(SPECIFY) 96
SECTION 6. EMPLOYMENT AND GENDER ROLES
601) Have you done any work in the last seven days?
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?
NO 2
603) Have you any done any work in the last 12 months?
NO 2 (SKIP TO 607)
604) What is your occupation, that is, what kind of work do you mainly do?
605) Do you usually work throughout the year, or do you work seasonally, or only once in a while?
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 AND KIND 2
IN KIND ONLY 3
NOT PAID 4
NOT CURRENTLY MARRIED____(SKIP TO 612)
OTHER___(SKIP TO 610)
609) Who usually decides how the money you earn will be used: you, your wife, or you and your wife jointly?
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
OTHER___(SPECIFY) 6
610) Who usually makes decisions about health care for yourself: you, your wife, you and your wife jointly, or someone else?
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
SOMEONE ELSE 4
OTHER___(SPECIFY) 6
611) Who usually makes decision about making major household purchases?
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
SOMEONE ELSE 4
OTHER___(SPECIFY) 6
612) Who usually makes decisions regarding the wellbeing of children?
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
SOMEONE ELSE 4
OTHER___(SPECIFY) 6
613) Do you own this or any other house either alone or jointly with someone else?
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:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
701) Now I would like to talk about something else. Have you ever heard of an illness called AIDS?
NO 2 (SKIP TO 723)
702) Can people reduce their chance of getting HIV by having just one uninfected sex partner who has no other sex partners?
NO 2
DON'T KNOW 8
703) Can people get HIV from mosquito bites?
NO 2
DON'T KNOW 8
704) Can people reduce their chance of getting HIV by using a condom every time they have sex?
NO 2
DON'T KNOW 8
705) Can people get HIV by sharing food with a person who has AIDS?
NO 2
DON'T KNOW 8
706) Can people get HIV because of witchcraft or other supernatural means?
NO 2
DON'T KNOW 8
707) Is it possible for a healthy-looking person to have HIV?
NO 2
DON'T KNOW 8
708) Can HIV be transmitted from a mother to her baby:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
OTHER___(SKIP TO 711)
710) Are there any special drugs that a doctor or a nurse can give to a woman infected with HIV to reduce the risk of transmission to the baby?
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 HIV?
NO 2 (SKIP TO 716)
713) How many months ago was your most recent HIV test?
TWO OR MORE YEARS 95
714) I don't want to know the results, but did you get the results of the test?
NO 2
715) Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
(SKIP TO 718 REGARDLESS OF RESPONSE)
GOVT. HEALTH CENTER (RHC) 12
GOVT. HEALTH POST (SUB-CENTER) 13
STAND-ALONE VCT CENTER 14
FAMILY PLANNING CLINIC 15
MOBILE CLINIC 16
FIELDWORKER 17
SCHOOL BASED CLINIC 18
OTHER PUBLIC SECTOR_____(SPECIFY) 19
MYANMAR RED CROSS SOCIETY 22
PSI/M (SUN) 23
MMA 24
OTHER NGO SECTOR____(SPECIFY) 26
STAND-ALONE VCT CENTER 32
PHARMACY 33
MOBILE CLINIC 34
DIAGNOSTIC LABORATORY 35
OTHER PRIVATE MEDICAL SECTOR____(SPECIFY) 36
CORRECTIONAL FACILITY 42
716) Do you know of a place where people can go to get tested for HIV?
NO 2 (SKIP TO 718)
717) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER (RHC) B
GOVT. HEALTH POST (SUB-CENTER) C
STAND-ALONE VCT CENTER D
FAMILY PLANNING CLINIC E
MOBILE CLINIC F
FIELDWORKER G
OTHER PUBLIC SECTOR_____(SPECIFY) H
MYANMAR RED CROSS SOCIETY J
PSI/M (SUN) K
MMA L
OTHER NGO SECTOR____(SPECIFY) M
STAND-ALONE VCT CENTER O
PHARMACY P
MOBILE CLINIC Q
DIAGNOSTIC LABORATORY R
OTHER PRIVATE MEDICAL SECTOR____(SPECIFY) S
718) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?
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?
NO 2
DON'T KNOW/NOT SUREDEPENDS 8
720) If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?
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 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?
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?
NO 2
HAS NOT HAD SEXUAL INTERCOURSE___(SKIP TO 732)
725) CHECK 723: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?
NO___(SKIP 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?
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?
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?
NO 2
DON'T KNOW 8
HAS NOT HAD AN INFECTION OR DOES NOT KNOW___(SKIP TO 732)
730) The last time you had (PROBLEM FROM 726/727/728), did you seek any kind of advice or treatment?
NO 2 (SKIP TO 732)
731) Where did you go? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER (RHC) B
GOVT. HEALTH POST (SUB-CENTER) C
STAND-ALONE VCT CENTER D
FAMILY PLANNING CLINIC E
MOBILE CLINIC F
FIELDWORKER G
OTHER PUBLIC SECTOR____(SPECIFY) H
MYANMAR RED CROSS SOCIETY J
PSI/M (SUN) K
MMA L
OTHER NGO SECTOR____(SPECIFY) M
STAND-ALONE VCT CENTER O
PHARMACY P
MOBILE CLINIC Q
FIELDWORKER R
OTHER PRIVATE MEDICAL SECTOR___(SPECIFY) S
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?
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 other women?
NO 2
DON'T KNOW 8
SECTION 8. OTHER HEALTH ISSUES
801) Some men are circumcised, that is, the foreskin is completely removed from the penis. Are you circumcised?
NO 2 (SKIP TO 805)
DON'T KNOW 8 (SKIP TO 805)
802) How old were you when you got circumcised?
DURING CHILDHOOD (LESS THAN 5 YEARS) 95
DON'T KNOW KNOW 98
803) Who did the circumcision?
HEALTH WORKER/PROFESSIONAL 2
OTHER 3
DON'T KNOW 8
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.
NONE 00 (SKIP TO 808)
806) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?
IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NON 00 (SKIP TO 808)
807) The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?
NO 2
DON'T KNOW 8
808) Do you currently smoke cigarettes?
NO 2 (SKIP TO 810)
809) In the last 24 hours, how many cigarettes did you smoke?
810) Do you currently smoke or use any (other) type of 11?
NO 2 (SKIP TO 811A)
811) What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.
CHEWING TOBACCO B
SNUFF C
OTHER___(SPECIFY) X
811A) Do you currently chew betel nuts?
NO 2 (SKIP TO 811C)
811B) In the last 24 hours, how many pieces did you chew?
811C) Have you ever heard of an illness called tuberculosis or TB
NO 2 (SKIP TO 812)
811D) How does tuberculosis spread from one person to another?
PROBE: Any other ways?
[CIRCLE ALL MENTIONED]
BY SHARING UTENSILS B
BY TOUCHING A PERSON WITH TB C
THROUGH SHARING FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER___(SPECIFY) X
DON'T KNOW Z
811E) Can tuberculosis be cured?
NO 2 (SKIP TO 811G)
DON'T KNOW 8 (SKIP TO 811G)
811F) What is the duration of treatment of TB now a days?
[IF MORE THAN 7 MONTHS, RECORD 7]
DON'T KNOW 8
811G) Have you ever been told by a doctor or nurse or LHV that you have/had tuberculosis?
NO 2
DON'T KNOW 8
812) Are you covered by any health insurance?
NO 2 (SKIP TO 814)
813) What type of health insurance are you covered by?
RECORD ALL MENTIONED.
HEALTH INSURANCE THROUGH EMPLOYER B
SOCIAL SECURITY C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
OTHER___(SPECIFY) X
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:_____