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MYANMAR DEMOGRAPHIC AND HEALTH SURVEY 2015-16
MAN'S QUESTIONNAIRE

MINISTRY OF HEALTH AND SPORTS

IDENTIFICATION

STATE/REGION___

DISTRICT__

TOWNSHIP__

WARD/VILLAGE TRACT___

CLUSTER NUMBER__

HOUSEHOLD NUMBER___

LINE NUMBER OF MAN___

INTERVIEWER VISITS

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:

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

LANGUAGE OF INTERVIEW

MYANMAR 1
ENGLISH 2
OTHER_____ 6

NATIVE LANGUAGE OF RESPONDENT

MYANMAR 1
ENGLISH 2
OTHER_____ 6

TRANSLATER USED?

YES 1
NO 2

SUPERVISOR
NAME____

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)

101) RECORD THE TIME

HOURS__
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 ever attended school?

YES 1
NO 2 (SKIP TO 108)

106) What is the highest grade you completed? (IF COMPLETED LESS THAN GRADE ONE, RECORD '00'.)

GRADE__

107) CHECK 106:

GRADE 5 OR LOWER___(CONTINUE TO 108)
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?

CANNOT READ AT ALL 1
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

109) CHECK 108:

CODE '2', '3' OR '4' CIRCLED___(CONTINUE TO 110)
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?

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

115A) Have you changed your usual place of residence compared with this time last year?

YES 1
NO 2

115B) Please tell me where you were living one year ago (state/region)?

STATE/REGION____
OTHER COUNTRY 00 (SKIP TO 201)

115C) Was it an urban or rural area?

URBAN 1
RURAL 2

115D) How many times have you moved residence in the past 5 years?

NUMBER OF TIMES___
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.

a. LOCATION____
STATE/REGION___
b. LOCATION___
STATE/REGION___
c. LOCATION___
STATE/REGION___

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 (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?

YES 1
NO 2 (SKIP 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 (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'.

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 (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’.

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__(CONTINUE TO 210)
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?

YES 1 (SKIP 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___(CONTINUE TO 214)
NO LIVING CHILDREN___(SKIP TO 301)

214) How old is your (youngest) child?

AGE IN YEARS__

215) CHECK 214:

(YOUNGEST) CHILD IS AGE 0-2 YEARS__(CONTINUE TO 216)
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?

YES 1
NO 2 (SKIP TO 219)
DON'T KNOW 8 (SKIP 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 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.
Have you ever heard of (METHOD)?

METHOD 1 Female Sterilization. PROBE: Women can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 2 Male Sterilization. PROBE: Men can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 3 IUD. PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
METHOD 4 Injectables. PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
METHOD 5 Implants. PROBE: 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
METHOD 6 Pill. PROBE: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
METHOD 7 Condom. PROBE: Men can put a rubber sheath on their penis before intercourse.
YES 1
NO 2
METHOD 8 Female condom. PROBE: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
METHOD 9 Lactational Amenorrhea Method (LAM)
YES 1
NO 2
METHOD 10 Rhythm Method. PROBE: 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
METHOD 11 Withdrawal. PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
METHOD 12 Emergency Contraception. PROBE: As an emergency measure, within three/five days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
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?
YES 1
NO 2
Seen anything about family planning on the television?
YES 1
NO 2
Read anything about family planning in a newspaper or magazine?
YES 1
NO 2
Seen or read about family planning in internet?
YES 1
NO 2
Read about family planning in billboard?
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 (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?

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.
AGREE 1
DISAGREE 2
DON'T KNOW 8
b) Women who use contraception may become promiscuous.
AGREE 1
DISAGREE 2
DON'T KNOW 8

307) CHECK 301 (07): KNOWS MALE CONDOM

YES__(CONTINUE TO 308)
NO__ (SKIP TO 311)

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

YES 1
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.

_______(NAME OF PLACE(S))
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
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
NON-GOVERNMENT SECTOR
MARIE STOPES H
MYANMAR RED CROSS SOCIETY I
PSI/M (SUN) J
MMA K
OTHER NGO SECTOR___(SPECIFY) L
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC M
PHARMACY N
PRIVATE DOCTOR O
MOBILE CLINIC P
FIELDWORKER Q
OTHER PRIVATE MEDICAL SECTOR___(SPECIFY) R
OTHER SOURCE
SHOP S
BETELNUT SHOP T
FRIENDS/RELATIVES U
OTHER_____(SPECIFY) X

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

YES 1
NO 2

311) CHECK 301 (08): KNOWS FEMALE CONDOM

YES__(CONTINUE TO 312)
NO___(SKIP TO 401)

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

YES 1
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.

_______(NAME OF PLACE(S))
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
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
NON-GOVERNMENT SECTOR
MARIE STOPES H
MYANMAR RED CROSS SOCIETY I
PSI/M (SUN) J
MMA K
OTHER NGO SECTOR___(SPECIFY) L
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC M
PHARMACY N
PRIVATE DOCTOR O
MOBILE CLINIC P
FIELDWORKER Q
OTHER PRIVATE MEDICAL SECTOR___(SPECIFY) R
OTHER SOURCE
SHOP S
BETELNUT SHOP T
FRIENDS/RELATIVES U
OTHER_____(SPECIFY) X

314) 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?

YES, CURRENTLY MARRIED 1 (SKIP TO 404)
NO, NOT IN UNION 2

402) Have you ever been married?

YES, FORMERLY MARRIED 1
NO 2 (SKIP TO 413)

403) What is your marital status now: are you widowed, divorced, or separated? (SKIP TO 410)

WIDOWED 1
DIVORCED 2
SEPARATED 3

404) Is your wife living with you now or is she staying elsewhere?

LIVING WITH HIM 1
STAYING ELSEWHERE 2

405) Do you have other wives?

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

406) Altogether, how many wives do you have?

TOTAL NUMBER OF WIVES___

407) CHECK 405:

ONE WIFE___
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'.

LINE NUMBER___

408) ASK 408 FOR EACH PERSON IN 407. How old was (NAME) on her last birthday?

AGE___

409) CHECK 407:

ONE WIFE___(CONTINUE TO 410)
MORE THAN ONE WIFE___ (SKIP TO 411A)

410) Have you been married only once or more than once?

ONLY ONCE 1
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?

MONTH___
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?

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 (SKIP TO 501)
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.

DAYS AGO 1 ____
WEEKS AGO 2 ____
MONTHS 3 ___
YEARS 4 ___ (SKIP TO 430)

418) The last time you had sexual intercourse, was a condom used?

YES 1
NO 2

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

YES 1 (SKIP TO 432)
NO 2

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

YES 1 (SKIP TO 433A)
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?

YES 1
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?

YES 1
NO 2
DON'T KNOW 8

433A) Have you ever had sex with another man?

YES 1
NO 2 (SKIP TO 434)

433B) Have you had sex with another man in the past 6 months?

YES 1
NO 2 (SKIP TO 434)

433C) The last time that you had sex with another man, did you use a condom?

YES 1
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'

NUMBER OF PARTNERS IN LIFETIME___
DON'T KNOW 98

435) CHECK 418:

CONCOM (MALE OR FEMALE) USED ___(CONTINUE TO 436)
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.

AHPHAW 01
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.

________(NAME OF PLACE)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
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
NON-GOVERNMENT SECTOR
MARIE STOPES 21
MYANMAR RED CROSS SOCIETY 22
PSI/M (SUN) 23
MMA 24
OTHER NGO SECTOR____(SPECIFY) 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
MOBILE CLINIC 34
FIELDWORKER 35
OTHER PRIVATE MEDICAL SECTOR____(SPECIFY) 36
OTHER SOURCE
SHOP 41
BETELNUT 42
FRIEND/RELATIVE 43
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 (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.

FEMALE STERILIZATION A
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:

CURRENTLY MARRIED___(CONTINUE TO 502)
NOT CURRENTLY MARRIED___(SKIP TO 509)

502) CHECK 439:

MAN NOT STERILIZED__(CONTINUE TO 503)
MAN STERILIZED___(SKIP TO 509)

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

YES 1
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?

HAVE ANOTHER CHILD 1 (SKIP TO 506)
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?

HAVE (A/ANOTHER) CHILD 1 (CONTINUE TO 506)
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)

506) CHECK 407:

ONE WIFE___(CONTINUE TO 507)
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?

MONTHS____ 1
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?

MONTHS____ 1
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.

NONE 00 (SKIP TO 601)
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_____(BOYS)
NUMBER____(GIRLS)
NUMBER____(EITHER)
OTHER____(SPECIFY) 96


SECTION 6. EMPLOYMENT AND GENDER ROLES

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

YES 1 (SKIP 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 (SKIP TO 604)
NO 2

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

YES 1
NO 2 (SKIP TO 607)

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

OCCUPATION_________

605) 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

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

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

607) CHECK 401:

CURRENTLY MARRIED ___(CONTINUE TO 608)
NOT CURRENTLY MARRIED____(SKIP TO 612)

608) CHECK 606:

CODE 1 OR 2 CIRCLED____(CONTINUE TO 609)
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?

RESPONDENT 1
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?

RESPONDENT 1
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
SOMEONE ELSE 4
OTHER___(SPECIFY) 6

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

RESPONDENT 1
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
SOMEONE ELSE 4
OTHER___(SPECIFY) 6

612) Who usually makes decisions regarding the wellbeing of children?

RESPONDENT 1
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?

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?
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 refuses to use contraception?
YES 1
NO 2
DON'T KNOW 8
If she is involved in too much social activities?
YES 1
NO 2
DON'T KNOW 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 (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?

YES 1
NO 2
DON'T KNOW 8

703) Can people get HIV from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

704) Can people reduce their chance of getting HIV by using a condom every time they have sex?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

706) Can people get HIV because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

707) Is it possible for a healthy-looking person to have HIV?

YES 1
NO 2
DON'T KNOW 8

708) Can HIV 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

709) CHECK 708:

AT LEAST ONE 'YES'___(CONTINUE TO 710)
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?

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 HIV?

YES 1
NO 2 (SKIP TO 716)

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

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.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
(SKIP TO 718 REGARDLESS OF RESPONSE)

________(NAME OF PLACE)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
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
NGO
MARIE STOPES 21
MYANMAR RED CROSS SOCIETY 22
PSI/M (SUN) 23
MMA 24
OTHER NGO SECTOR____(SPECIFY) 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 31
STAND-ALONE VCT CENTER 32
PHARMACY 33
MOBILE CLINIC 34
DIAGNOSTIC LABORATORY 35
OTHER PRIVATE MEDICAL SECTOR____(SPECIFY) 36
OTHER SOURCE
HOME 41
CORRECTIONAL FACILITY 42
OTHER____(SPECIFY) 96

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

YES 1
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.

____(NAME OF PLACE)
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
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
NGO
MARIE STOPES I
MYANMAR RED CROSS SOCIETY J
PSI/M (SUN) K
MMA L
OTHER NGO SECTOR____(SPECIFY) M
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR N
STAND-ALONE VCT CENTER O
PHARMACY P
MOBILE CLINIC Q
DIAGNOSTIC LABORATORY R
OTHER PRIVATE MEDICAL SECTOR____(SPECIFY) S
OTHER____(SPECIFY) X

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 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?

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 INTERCOUSE___(CONTINUE TO 725)
HAS NOT HAD SEXUAL INTERCOURSE___(SKIP TO 732)

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

YES__(CONTINUE TO 726)
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?

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')___(CONTINUE TO 730)
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?

YES 1
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.

_____(NAME OF PLACE(S))
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
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
NGO
MARIE STOPES I
MYANMAR RED CROSS SOCIETY J
PSI/M (SUN) K
MMA L
OTHER NGO SECTOR____(SPECIFY) M
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR N
STAND-ALONE VCT CENTER O
PHARMACY P
MOBILE CLINIC Q
FIELDWORKER R
OTHER PRIVATE MEDICAL SECTOR___(SPECIFY) S
OTHER SOURCE
SHOP T
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 other women?

YES 1
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?

YES 1
NO 2 (SKIP TO 805)
DON'T KNOW 8 (SKIP TO 805)

802) How old were you when you got circumcised?

AGE IN COMPLETED YEARS____
DURING CHILDHOOD (LESS THAN 5 YEARS) 95
DON'T KNOW 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 FACULTY 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 (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.

NUMBER OF INJECTIONS___
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?

YES 1
NO 2
DON'T KNOW 8

808) Do you currently smoke cigarettes?

YES 1
NO 2 (SKIP TO 810)

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

NUMBER OF CIGARETTES__

810) Do you currently smoke or use any (other) type of 11?

YES 1
NO 2 (SKIP TO 811A)

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

PIPE/CIGAR/CHEROOT A
CHEWING TOBACCO B
SNUFF C
OTHER___(SPECIFY) X

811A) Do you currently chew betel nuts?

YES 1
NO 2 (SKIP TO 811C)

811B) In the last 24 hours, how many pieces did you chew?

NUMBER OF PIECES___

811C) Have you ever heard of an illness called tuberculosis or TB

YES 1
NO 2 (SKIP TO 812)

811D) How does tuberculosis spread from one person to another?
PROBE: Any other ways?
[CIRCLE ALL MENTIONED]

THROUGH THE AIR WHEN COUGHING OR SNEEZING A
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?

YES 1
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]

MONTHS__
DON'T KNOW 8

811G) Have you ever been told by a doctor or nurse or LHV that you have/had tuberculosis?

YES 1
NO 2
DON'T KNOW 8

812) Are you covered by any health insurance?

YES 1
NO 2 (SKIP 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


814) 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:_____