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MINISTRY OF HEALTH AND SOCIAL SERVICES AND CENTRAL BUREAU OF STATISTICS DEMOGRAPHIC AND HEALTH SURVEY 2000
MAN'S QUESTIONNAIRE

10 September 2000

IDENTIFICATION
NAME AND CODE OF REGION * ______
NAME OF VILLAGE/TOWN/CITY ______
DHS CLUSTER NUMBER ______
HOUSEHOLD NUMBER _______
NAME OF HOUSEHOLD HEAD_______
NAME AND LINE NUMBER OF MAN ______

INTERVIEWER VISITS

INTERVIEW 1
DATE ____
INTERVIEWER'S NAME ____
RESULT** ____
NEXT VISIT: DATE ___ TIME ____

INTERVIEW 2
DATE ____
INTERVIEWER'S NAME ____
RESULT** ____
NEXT VISIT: DATE ___ TIME ___

INTERVIEW 3
DATE ____
INTERVIEWER'S NAME ____
RESULT** ____

FINAL VISIT
DAY ___
MONTH ___
YEAR 20__
INT. CODE ___
RESULT ___

TOTAL NO. OF VISITS ___

** RESULT CODES:
1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) ____

LANGUAGE

LANGUAGE OF QUESTIONNAIRE: ENGLISH
LANGUAGE OF INTERVIEW *** _____
HOME LANGUAGE OF RESPONDENT*** ____
WAS A TRANSLATOR USED? (YES=1, NO=2)______

*** LANGUAGE CODES:
1 AFRIKAANS
2 DAMARA/NAMA
3 ENGLISH
4 HEREO
5 KWANGALI
6 LOZI
7 OSHIWAMBO
8 OTHER

SUPERVISOR
NAME ____
DATE _____

FIELD EDITOR
NAME ____
DATE ____

OFFICE EDITOR
____

KEYED BY
____

Region codes: CAPRIVI=01; ERONGO=02; HARDAP=03; KARAS=04; KHOMAS=05; KUNENE=06; OHANGWENA=07; KAVANGO=08; OMAHEKE=09; OMUSATI=10; OSHANA=11; OSHIKOTO=12; OTJOZONDJUPA=13.

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

Hello. My name is and I am working with the Ministry of Health and Social Services. We are conducting a national survey about the health of women, men and children. We would very much appreciate your participation in this survey. I would like to ask you about your health. This information will help the government to plan health services. The survey usually takes
between 10 and 20 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

At this time, do you want to ask me anything about the survey? May I begin the interview now?

Signature of interviewer: _______ Date: _____

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

101 RECORD THE TIME.

HOUR ____
MINUTES ____

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

CITY 1
TOWN 2
COUNTRYSIDE 3

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

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

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

CITY 1
TOWN 2
COUNTRYSIDE 3

105. In what month and year were you born?

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

106. How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

AGE IN COMPLETED YEARS ____

107. Have you ever attended school?

YES 1
NO 2 (GO TO 111)

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

PRIMARY 1
SECONDARY 2
HIGHER 3

109. What is the highest grade you completed at that level?

GRADE ___

110. CHECK 108:

PRIMARY (GO TO 111)
SECONDARY OR HIGHER (GO TO 112)

111. Now I would like you to read out loud as much of this sentence as you can.
SHOW CARD TO RESPONDENT.

CANNOT READ AT ALL 1- (GO TO 113)
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) ___________ 4

112. 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

113. 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

114. 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

115. What is your religion?

ROMAN CATHOLIC 1
PROTESTANT 2
NO RELIGION 3
OTHER (SPECIFY) ____ 6

116. What is the main language spoken in your home?

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

117. Are you currently working?

YES 1 (GO TO 120)
NO 2

118. Have you done any work in the last 12 months?

YES 1 (GO TO 120)
NO 2

119. What have you been doing most of the time during the last 12 months?

GOING TO SCHOOL/STUDYING 1 (GO TO 127)
LOOKING FOR WORK 2 (GO TO 127)
INACTIVE 3 (GO TO 127)
COULD NOT WORK/HANDICAPPED 4 (GO TO 127)
OTHER (SPECIFY) ____ 6 (GO TO 127)

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

______

121 CHECK 120:

WORKS IN AGRICULTURE (GO TO 122)
DOES NOT WORK IN AGRICULTURE (GO TO 123)

122. 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

123. 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

124. 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

125. 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 (GO TO 127)
NOT PAID 4 (GO TO 127)

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

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

127. Now I would like to ask about any children you have had. I am interested only in the children that are biologically yours. Have you fathered any children?

YES 1
NO 2 (GO TO 301)

128. In total, how many living children do you have that you have fathered?

TOTAL LIVING CHILDREN ___

129. Have any of your children died? In total, how many children have you fathered that have died?

NUMBER THAT DIED ____

THERE IS NO SECTION 2.

SECTION 3. CONTRACEPTION

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

301. Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?

01 FEMALE STERILISATION Women can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO NEXT METHOD)
02 MALE STERILISATION Men can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO NEXT METHOD)
03 PILL Women can take a pill every day to stop them from becoming pregnant
YES 1
NO 2 (GO TO NEXT METHOD)
04 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2 (GO TO NEXT METHOD)
05 INJECTIONS Women can have an injection by a health provider which stops them from becoming pregnant for one or more months.
YES 1
NO 2 (GO TO NEXT METHOD)
06 CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
07 FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
08 DIAPHRAGM /FOAM/JELLY Women can place a sponge, suppository, diaphragm, jelly or cream in their vagina before intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
09 RHYTHM OR PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
10 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2 (GO TO NEXT METHOD)
11 EMERGENCY CONTRACEPTION Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
12 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1 (SPECIFY) ___
NO 2 (GO TO 302)

302. Have you ever used (METHOD)?

02 MALE STERILISATION Men can have an operation to avoid having any more children.
Have you ever had an operation to avoid having any more children?
YES 1
NO 2
06 CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
09 RHYTHM OR PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
DOES NOT KNOW 8
10 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2 (GO TO NEXT METHOD)

303. CHECK 301 (06) AND 302 (06):

HAS HEARD OF AND USED CONDOMS (GO TO 304)
HAS HEARD OF CONDOMS BUT HAS NEVER USED THEM (GO TO 310)
HAS NOT HEARD OF CONDOMS (GO TO 311)

304. Now I would like to talk to you about condoms. How old were you when you used a condom for the first time?

AGE AT FIRST USE ___
DOES NOT REMEMBER 98

305. Why did you use a condom that first time?
Any other reason?
CIRCLE ALL MENTIONED.

TO AVOID PREGNANCY A
TO AVOID GETTING HIV/AIDS B
TO AVOID GETTING AN STD C
TO AVOID INFECTING PARTNER D
OTHER (SPECIFY) _____ X

306. Now when you have sex, do you use a condom every time, sometimes, or not at all?

EVERY TIME 1 (GO TO 308)
SOMETIMES 2
NOT AT ALL 2 (GO TO 308)
NOT HAVING SEX 4 (GO TO 308)

307. When do you use a condom?
RECORD ALL MENTIONED.

ON PARTNER'S FERTILE DAYS A
DURING PARTNER'S MENSTRUATION B
ONLY WITH A STRANGER C
ONLY WITH A SEX WORKER D
WITH ANYONE OTHER THAN REGULAR PARTNER/WIFE E
OTHER (SPECIFY) ____ X

308. Have you ever experienced any problems with using condoms?
IF YES: What problems?
RECORD ALL MENTIONED.

YES 1
NO 2 (GO TO NEXT METHOD)

309. Where do you usually obtain condoms?

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVT. HEALTH CENTER/CLINIC 12
PHC CLINIC (MOBILE) 13
OTHER PUBLIC (SPECIFY) ____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL (SPECIFY) _____ 26
OTHER SOURCE
SHOP 31
CHURCH/SCHOOL 32
FRIENDS/RELATIVE 33
TRAD. BIRTH ATTENDANT 34
TRADITIONAL HEALER 35
OTHER (SPECIFY) ____ 96

310. I am going to read you some statements about condoms. Please tell me if you agree or disagree with each statement:

a) Condoms reduce a man's pleasure.
b) A condom is very inconvenient to use.
c) A condom can be re-used.
d) A condom protects against disease.
e) A woman has no right to tell a man to use a condom.

REDUCE PLEASURE
AGR 1
DIS 2
DK 8
INCONVENIENT
AGR 1
DIS 2
DK 8
CAN BE RE-USED
AGR 1
DIS 2
DK 8
PROTECTS AGAINST DIS
AGR 1
DIS 2
DK 8
WOMAN HAS NO RIGHT
AGR 1
DIS 2
DK 8

311. I am going to read you some statements about contraception. Please tell me if you agree or disagree with each statement:
a) Contraception is women's business and a man should not have to worry about it.
b) Women who are sterilised may become promiscuous.
c) Being sterilised for a man is the same as castration.
d) A woman is the one who gets pregnant so she should be the one to get sterilised.

MAN SHOULDN'T WORRY
AGR 1
DIS 2
DK 8
PROMISCUOUS
AGR 1
DIS 2
DK 8
CASTRATION
AGR 1
DIS 2
DK 8
WOMAN SHOULD
AGR 1
DIS 2
DK 8

312. Do you currently smoke cigarettes or tobacco? IF YES: What type of tobacco do you smoke?

YES, CIGARETTES 1
YES, PIPE 2 (GO TO 314)
YES, OTHER TOBACCO 3 (GO TO 314)
NO 4 (GO TO 315)

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

CIGARETTES ___

314. How old were you when you first started smoking?

AGE ____

315. Have you ever drunk an alcohol-containing beverage?

YES 1
NO 2 (GO TO 501)

316. In the last month, on how many days did you drink an alcohol-containing beverage?

NUMBER OF DAYS ___
NONE/NEVER 95 (GO TO 501)

317. Have you ever gotten 'drunk' from drinking an alcohol-containing beverage?

YES 1
NO 2 (GO TO 501)

318. In the last month, how many times did you get 'drunk'?

NUMBER OF TIMES ____
NONE/NEVER 95

THERE IS NO SECTION 4.

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

501. Are you currently married or living with a woman?

YES, CURRENTLY MARRIED WITH CERTIFICATE 1 (GO TO 504)
YES, MARRIED BY CUSTOM 2 (GO TO 504)
YES, LIVING WITH A WOMAN 3 (GO TO 504)
NO, NOT IN UNION 4

502. Have you ever been married or lived with a woman?

YES FORMERLY MARRIED WITH CERTIFICATE 1 ???(GO TO 504)
YES, MARRIED BY CUSTOM 2 ??? (GO TO 504)
YES, LIVING WITH A WOMAN 3 ??? (GO TO 504)
NO NOT IN UNION 4

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

WIDOWED 1 (GO TO 507)
DIVORCED 2 (GO TO 507)
SEPARATED 3 (GO TO 507)

504. Do you have only one wife/woman, or do you have more than one woman with whom you are living as if married?

ONE WIFE 1 (GO TO 506)
TWO OR MORE WIVES 2

505. How many wives or women are you living with?

NUMBER OF WOMEN ___

506. RECORD THE NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR ALL HIS WIVES AND LIVE-IN PARTNERS. IF ANY ARE NOT LISTED IN THE HOUSEHOLD, RECORD '00'.
THE NUMBER OF LINES FILLED SHOULD EQUAL THE NUMBER OF WIVES/LIVE-IN PARTNERS HE TOLD YOU ABOUT IN 504/505.

NAME ______
LINE NO _____

507. How old were you when you first started living with a woman?

AGE ____

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

NEVER 00 (GO TO 518)
AGE IN YEARS ___
FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE/PARTNER 96

509. When was the last time you had sexual intercourse?
RECORD 'YEARS AGO' ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO.

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

510. The last time you had sexual intercourse, did you use a condom?

YES 1 (GO TO 510E)
NO 2

510A. What is the main reason you did not use a condom on that occasion?

NOT AVAILABLE/COST TOO MUCH 01
USED A FAMILY PLAN. METHOD 02
TRUSTED PARTNER 03
PARTNER TESTED NEGATIVE/NO RISK 04
RESPONDENT DOESN'T LIKE 05
PARTNER REFUSED/OBJECTED 06
PARTNER DRUNK/ON DRUGS 07
WANTED WOMAN TO GET PREGNANT 08 (GO TO 511)
OTHER (SPECIFY) ____ 96

510B. Did you or your partner use something to avoid a pregnancy?

YES 1 (GO TO 510E)
NO 2

510C What method did you or she use on that occasion?

FEMALE STERILISATION 01 (GO TO 511)
MALE STERILISATION 02 (GO TO 511)
PILL 03 (GO TO 511)
IUD 04 (GO TO 511)
INJECTIONS 05 (GO TO 511)
FEMALE CONDOM 07 (GO TO 511)
DIAPHRAGM/FOAM/JELLY 08 (GO TO 511)
RHYTHM/PERIODIC ABSTINENCE 09 (GO TO 511)
WITHDRAWAL 10 (GO TO 511)
OTHER (SPECIFY) ____ 96 (GO TO 511)

510D. What is the main reason you did not use a method to avoid pregnancy?

FERTILITY-RELATED REASONS
CASUAL SEX PARTNER 11 (GO TO 511)
WOMAN IS MENOPAUSAL, HAD HYSTERECTOMY 23 (GO TO 511)
COUPLE UNABLE TO HAVE KIDS 24 (GO TO 511)
PARTNER WAS PREGNANT 25 (GO TO 511)
PARTNER RECENTLY DELIVERED AND NOT YET MENSTRUATING 26 (GO TO 511)
PARTNER WAS BREASTFEEDING 27 (GO TO 511)
WANTED HER TO GET PREGNANT 28 (GO TO 511)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 511)
WIFE/PARTNER OPPOSED 32 (GO TO 511)
OTHERS OPPOSED 33 (GO TO 511)
RELIGIOUS PROHIBITION 34 (GO TO 511)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 511)
KNOWS NO SOURCE 42 (GO TO 511)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 511)
FEAR OF SIDE EFFECTS 52 (GO TO 511)
LACK OF ACCESS/TOO FAR 53 (GO TO 511)
COST TOO MUCH 54 (GO TO 511)
INCONVENIENT TO USE 55 (GO TO 511)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 511)
OTHER (SPECIFY)____ 96 (GO TO 511)
DON'T KNOW 98 (GO TO 511)

510E. What is the main reason you used a condom on that occasion?

RESPONDENT WANTED TO PREVENT STD/HIV 1
RESPONDENT WANTED TO PREVENT PREGNANCY 2
RESPONDENT WANTED TO PREVENT BOTH STD/HIV AND PREGNANCY 3
DID NOT TRUST PARTNER/SHE HAS OTHER PARTNERS 4
PARTNER INSISTED 5
OTHER (SPECIFY) _____ 6

511. What is your relationship to the woman with whom you last had sex?
IF WOMAN IS "GIRLFRIEND" OR "FIANCEE", ASK: Was your girlfriend/fiancee living with you when you last had sex?
IF YES, RECORD '1'.
IF NO, RECORD '2'.

WIFE/LIVE-IN PARTNER 01 (GO TO 513)
WOMAN IS GIRLFRIEND/FIANCE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX WORKER 06
OTHER (SPECIFY) ____ 96

512. For how long have you had a sexual relationship with this woman?

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

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

YES 1
NO 2 (GO TO 517A)

514 The last time you had sex with another woman, did you use a condom?

YES 1 (GO TO 514E)
NO 2

514A. What is the main reason you did not use a condom on that occasion?

NOT AVAILABLE/COST TOO MUCH 01
USED A FAMILY PLAN. METHOD 02
TRUSTED PARTER 03
PARTNER TESTED NEGATIVE/NO RISK 04
RESPONDENT DOESN'T LIKE 05
PARTNER REFUSED/OBJECTED 06
PARTNER DRUNK/ON DRUGS 07
WANTED WOMAN TO GET PREGNANT 08 (GO TO 515)
OTHER (SPECIFY) ____ 96

514B. Did you or your partner use something to avoid a pregnancy?

YES 1
NO 2 (GO TO 514D)
DOES NOT KNOW/UNSURE 3 (GO TO 515)

514C. What method did you or she use on that occasion?

FEMALE STERILISATION 01 (GO TO 515)
MALE STERILISATION 02 (GO TO 515)
PILL 03 (GO TO 515)
IUD 04 (GO TO 515)
INJECTIONS 05 (GO TO 515)
FEMALE CONDOM 07 (GO TO 515)
DIAPHRAGM/FOAM/JELLY 08 (GO TO 515)
RHYTHM/PERIODIC ABSTINENCE 09 (GO TO 515)
WITHDRAWAL 10 (GO TO 515)
OTHER (SPECIFY) ____ 96 (GO TO 515)

514D. What is the main reason you did not use a method to avoid pregnancy?

FERTILITY-RELATED REASONS
CASUAL SEX PARTNER 11 (GO TO 515)
WOMAN IS MENOPAUSAL, HAD HYSTERECTOMY 23 (GO TO 515)
COUPLE UNABLE TO HAVE KIDS 24 (GO TO 515)
PARTNER WAS PREGNANT 25 (GO TO 515)
PARTNER RECENTLY DELIVERED AND NOT YET MENSTRUATING 26 (GO TO 515)
PARTNER WAS BREASTFEEDING 27 (GO TO 515)
WANTED HER TO GET PREGNANT 28 (GO TO 515)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 515)
WIFE/PARTNER OPPOSED 32 (GO TO 515)
OTHERS OPPOSED 33 (GO TO 515)
RELIGIOUS PROHIBITION 34 (GO TO 515)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 515)
KNOWS NO SOURCE 42 (GO TO 515)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 515)
FEAR OF SIDE EFFECTS 52 (GO TO 515)
LACK OF ACCESS/TOO FAR 53 (GO TO 515)
COST TOO MUCH 54 (GO TO 515)
INCONVENIENT TO USE 55 (GO TO 515)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 515)
OTHER (SPECIFY)____ 96 (GO TO 515)
DON'T KNOW 98 (GO TO 515)

514E. What is the main reason you used a condom on that occasion?

RESPONDENT WANTED TO PREVENT STD/HIV 1
RESPONDENT WANTED TO PREVENT PREGNANCY 2
RESPONDENT WANTED TO PREVENT BOTH STD/HIV AND PREGNANCY 3
DID NOT TRUST PARTNER/SHE HAS OTHER PARTNERS 4
PARTNER INSISTED 5
OTHER (SPECIFY) _____ 6

515. What is your relationship to the woman with whom you last had sex?
IF WOMAN IS "GIRLFRIEND" OR "FIANCEE", ASK:
Was your girlfriend/fiancee living with you when you last had sex?
IF YES, RECORD '1'.
IF NO, RECORD '2'.

WIFE/LIVE-IN PARTNER 01 (GO TO 515B)
WOMAN IS GIRLFRIEND/FIANCE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX WORKER 06
OTHER (SPECIFY) ____ 96

515A. For how long have you had a sexual relationship with this woman?

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

515B. Other than these two women, have you had sexual intercourse with anyone else in the last 12 months?

YES 1
NO 2 (GO TO 517A)

516. The last time you had sex with this third woman, did you use a condom?

YES 1 (GO TO 516E)
NO 2

516A. What is the main reason you did not use a condom on that occasion?

NOT AVAILABLE/COST TOO MUCH 01
USED A FAMILY PLAN. METHOD 02
TRUSTED PARTER 03
PARTNER TESTED NEGATIVE/NO RISK 04
RESPONDENT DOESN'T LIKE 05
PARTNER REFUSED/OBJECTED 06
PARTNER DRUNK/ON DRUGS 07
WANTED WOMAN TO GET PREGNANT 08 (GO TO 516F)
OTHER (SPECIFY) ____ 96

516B. Did you or your partner use something to avoid a pregnancy?

YES 1
NO 2 (GO TO 516D)
DOES NOT KNOW/UNSURE 3 (GO TO 516F)

516C. What method did you or she use on that occasion?

FEMALE STERILISATION 01 (GO TO 516F)
MALE STERILISATION 02 (GO TO 516F)
PILL 03 (GO TO 516F)
IUD 04 (GO TO 516F)
INJECTIONS 05 (GO TO 516F)
FEMALE CONDOM 07 (GO TO 516F)
DIAPHRAGM/FOAM/JELLY 08 (GO TO 516F)
RHYTHM/PERIODIC ABSTINENCE 09 (GO TO 516F)
WITHDRAWAL 10 (GO TO 516F)
OTHER (SPECIFY) ____ 96 (GO TO 516F)

516D. What is the main reason you did not use a method to avoid pregnancy?

FERTILITY-RELATED REASONS
CASUAL SEX PARTNER 11 (GO TO 516F)
WOMAN IS MENOPAUSAL, HAD HYSTERECTOMY 23 (GO TO 516f)
COUPLE UNABLE TO HAVE KIDS 24 (GO TO 516F)
PARTNER WAS PREGNANT 25 (GO TO 516F)
PARTNER RECENTLY DELIVERED AND NOT YET MENSTRUATING 26 (GO TO 516F)
PARTNER WAS BREASTFEEDING 27 (GO TO 516F)
WANTED HER TO GET PREGNANT 28 (GO TO 516F)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 516F)
WIFE/PARTNER OPPOSED 32 (GO TO 516F)
OTHERS OPPOSED 33 (GO TO 516F)
RELIGIOUS PROHIBITION 34 (GO TO 516F)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 516F)
KNOWS NO SOURCE 42 (GO TO 516F)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 516F)
FEAR OF SIDE EFFECTS 52 (GO TO 516F)
LACK OF ACCESS/TOO FAR 53 (GO TO 516F)
COST TOO MUCH 54 (GO TO 516F)
INCONVENIENT TO USE 55 (GO TO 516F)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 516F)
OTHER (SPECIFY)____ 96 (GO TO 516F)
DON'T KNOW 98 (GO TO 516F)

516E. What is the main reason you used a condom on that occasion?

RESPONDENT WANTED TO PREVENT STD/HIV 1
RESPONDENT WANTED TO PREVENT PREGNANCY 2
RESPONDENT WANTED TO PREVENT BOTH STD/HIV AND PREGNANCY 3
DID NOT TRUST PARTNER/SHE HAS OTHER PARTNERS 4
PARTNER INSISTED 5
OTHER (SPECIFY) _____ 6

516F. What is your relationship to the woman with whom you last had sex?
IF WOMAN IS "GIRLFRIEND" OR "FIANCEE", ASK:
Was your girlfriend/fiancee living with you when you last had sex?
IF YES, RECORD '1'.
IF NO, RECORD '2'.

WIFE/LIVE-IN PARTNER 01 (GO TO 517)
WOMAN IS GIRLFRIEND/FIANCE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERICIAL SEX WORKER 06
OTHER (SPECIFY) ___ 96

516G. For how long have you had a sexual relationship with this woman?

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

517. In total, with how many different women have you had sex in the last 12 months?

NUMBER OF PARTNERS ____

517A. Have you ever paid for sex?

YES 1
NO 2 (GO TO 517D)

517B. How long ago was the last time you paid for sex?

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

517C. The last time you paid for sex, did you use a condom?

YES 1
NO 2

517D. CHECK 309:

SOURCE NOT CIRCLED (GO TO 518)
SOURCE CIRCLED (GO TO 521)

518. Do you know of a place where one can get condoms?

YES 1
NO 2 (GO TO 520)

519. Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
Any other place?
RECORD ALL MENTIONED.

(NAME OF PLACE) ______
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER/CLINIC B
PHC CLINIC (MOBILE) C
COMMUN. HEALTH WORKER D
OTHER PUBLIC (SPECIFY) ____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
OTHER PRIVATE MEDICAL (SPECIFY) _____ L
OTHER SOURCE
SHOP M
CHURCH/SCHOOL N
FRIENDS/RELATIVE O
TRAD. BIRTH ATTENDANT P
TRADITIONAL HEALER Q
OTHER (SPECIFY) ____ X

520. If you wanted to, could you yourself get a condom?

YES 1
NO 2
DON'T KNOW/UNSURE 8

521. In the last few months have you heard about condoms:
On the radio?
On the television?
In a newspaper or magazine?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2

SECTION 6. FERTILITY PREFERENCES

601. 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 603)
UNDECIDED/DON'T KNOW 8 (GO TO 603)

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

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

603. CHECK 510, 510B, 514, 514B, 516, 516B:

'NO/BLANK' IN ANY OF THE QUESTIONS (GO TO 604)
'YES' IN ANY OF THE QUESTIONS (GO TO 607)

604. Do you think you will use a method to delay or avoid pregnancy at any time in the future?

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

605. Which method would you prefer to use?

FEMALE STERILISATION 01 (GO TO 607)
MALE STERILISATION 02 (GO TO 607)
PILL 03 (GO TO 607)
IUD 04 (GO TO 607)
INJECTIONS 05 (GO TO 607)
FEMALE CONDOM 07 (GO TO 607)
DIAPHRAGM/FOAM/JELLY 08 (GO TO 607)
RHYTHM/PERIODIC ABSTINENCE 09 (GO TO 607)
WITHDRAWAL 10 (GO TO 607)
OTHER (SPECIFY) ____ 96 (GO TO 607)

606. What is the main reason that you think you will not use a method at any time in the future?

FERTILITY-RELATED REASONS
INFREQUENT SEX/NO SEX 22
WIFE/PARTNER IS MENOPAUSAL, HAD HYSTERECTOMY 23
COUPLE UNABLE TO HAVE KIDS 24
WANTS AS MANY CHILDREN AS POSSIBLE 26
OPPOSITION TO USE
RESPONDENT OPPOSED 31
WIFE/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY)____ 96
DON'T KNOW 98

607. CHECK 128:
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.

NUMBER ___
OTHER (SPECIFY) ___ 96 (GO TO 609)

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

NUMBER
BOYS ___
GIRLS ___
EITHER ___

OTHER (SPECIFY) ____ 96

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

APPROVE 1
DISAPPROVE 2
DON'T KNOW/UNSURE 3

610. In the last few months, have you discussed the practice of family planning with your friends, neighbors, or relatives?

YES 1
NO 2 (GO TO 612)

611. With whom?
Anyone else?
RECORD ALL MENTIONED.

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

612. CHECK 501:

YES, CURRENTLY MARRIED (GO TO 613)
YES, LIVING WITH A MAN (GO TO 613)
NO, NOT IN UNION (GO TO 616)

613. Now I want to ask you about your wife's/partner's views on family planning.
Do you think that your wife/partner approves or disapproves of couples using a method to avoid pregnancy?
IF MORE THAN ONE WIFE, ASK ABOUT THE FIRST LISTED IN Q.506.

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

614. How often have you talked to your wife/partner about family planning in the past year?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

615. Do you think your wife/partner wants the same number of children that you want, or does she want more or fewer than you want?

SAME NUMBER 1
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8

616. 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 neglects the children?
If she argues with him?
If she refuses to have sex with him?

NEGLECTS CHILDREN
YES 1
NO 2
DK 8
ARGUES WITH HIM
YES 1
NO 2
DK 8
REFUSES SEX
YES 1
NO 2
DK 8

617. Husbands and wives do not always agree on everything. Please tell me if you think a wife isjustified in refusing to have sex with her husband when:
She is tired or not in the mood?
She has recently given birth?
She knows her husband has sex with other women?
She knows her husband has a sexually transmitted disease?

TIRED/MOOD
YES 1
NO 2
DK 8
RECENT BIRTH
YES 1
NO 2
DK 8
OTHER WOMEN
YES 1
NO 2
DK 8
HAS DISEASE
YES 1
NO 2
DK 8

618. Do you think that if a wife refuses to have sex with her husband when he wants her to, he has the right to:
Get angry and yell at her?
Refuse to give her money or other means of financial support?
Force her to have sex with him even if she doesn't want to?
Have sex with another woman?

GET ANGRY AND YELL
YES 1
NO 2
DK 8
REFUSE TO SUPPORT
YES 1
NO 2
DK 8
FORCE HER TO HAVE SEX
YES 1
NO 2
DK 8
HAVE ANOTHER WOMAN
YES 1
NO 2
DK 8

THERE IS NO SECTION 7.

SECTION 8. AIDS AND OTHER SEXUALLY-TRANSMITTED DISEASES

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

YES 1
NO 2 (GO TO 815)

801A. Where have you heard about AIDS?
RECORD ALL MENTIONED.

RADIO A
TELEVISION B
NEWSPAPERS/MAGAZINES C
DOCTOR, NURSE, HEALTH STAFF D
FRIENDS/RELATIVES E
OTHER (SPECIFY) ____ X
DON'T KNOW Z

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

YES 1
NO 2 (GO TO 808)
DON' T KNOW 8 (GO TO 808)

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

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

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

YES 1
NO 2
DON'T KNOW 8

805. Can a person get the AIDS virus from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

807. Can people protect themselves from getting the AIDS virus by not sharing food with a person who has AIDS?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

809. Can the virus that causes AIDS be transmitted from a mother to a child?

YES 1
NO 2 (GO TO 510A)
DON'T KNOW 8 (GO TO 510A)

810. When can the virus that causes AIDS be transmitted from a mother to a child? Can it be transmitted...

During pregnancy?
During delivery?
During breastfeeding?

DURING PREGNANCY
YES 1
NO 2
DK 8
DURING DELIVERY
YES 1
NO 2
DK 8
DURING BREASTFEEDING
YES 1
NO 2
DK 8

810A. Do you think your chances of getting AIDS are small, moderate, great, or no risk at all?

SMALL 1
MODERATE 2 (GO TO 810C)
GREAT 3 (GO TO 810C)
NO RISK AT ALL 4
DON'T KNOW 8 (GO TO 810D)

810B. Why do you think that you have (NO RISK/A SMALL CHANCE) of getting AIDS?
Any other reasons?
RECORD ALL MENTIONED.

NOT HAVING SEX THESE DAYS A (GO TO 810D)
USE CONDOMS B (GO TO 810D)
HAS ONLY 1 PARTNER C (GO TO 810D)
HAS LIMITED NUMBER OF PARTNERS D (GO TO 810D)
OTHER (SPECIFY) ____ E (GO TO 810D)
DON' TKNOW X (GO TO 810D)

810C. Why do you think that you have a (MODERATE/GREAT) chance of getting AIDS?
Any other reasons?
RECORD ALL MENTIONED.

DO NOT USE CONDOMS A
MULTIPLE PARTNERS B
PARTNER HAS MANY PARTNERS C
HAD TRANSFUSION/INJECTIONS D
OTHER (SPECIFY) _____ E
DON'T KNOW X

810E. How have you changed your behaviour since you heard about AIDS?
Any other ways?
RECORD ALL MENTIONED.

STOPPED HAVING SEX A
STARTED USING CONDOMS B
STAYED WITH ONLY 1 PARTNER C
REDUCED NUMBER OF PARTNERS D
STOPPED SEX WITH PROSTITUTES E
OTHER (SPECIFY) ____ F
DON'T KNOW X

810F. If a teacher has the AIDS virus but is not sick, should he or she be allowed to continue teaching in school?

YES 1
NO 2
DON'T KNOW 8

810G. If you knew that a shopkeeper or food seller had AIDS or the virus that causes it, would you buy food from him or her?

YES 1
NO 2
DON'T KNOW 8

811. CHECK 501:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 812)
NOT CURRENTLY MARRIED/NOT LIVING WITH A MAN (GO TO 812A)

812. Have you ever talked about ways to prevent getting the virus that causes AIDS with (your husband/the man you are living with)?

YES 1
NO 2

812A. In your opinion, is it acceptable or unacceptable for AIDS to be discussed:

on the radio?
on the TV?
In newspapers?

ON THE RADIO
ACCEPTABLE 1
NOT ACCEPTABLE 2
ON THE TV
ACCEPTABLE 1
NOT ACCEPTABLE 2
IN NEWSPAPERS
ACCEPTABLE 1
NOT ACCEPTABLE 2

813. If a person learns that he/she is infected with the virus that causes AIDS, should the person be allowed to keep this fact private or should this information be available to the community?

CAN BE KEPT PRIVATE 1
AVAILABLE TO COMMUNITY 2
DK/NOT SURE 8

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

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

814A. Should children aged 12-14 be taught about using a condom to avoid AIDS?

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

814B. We are interested to know how much demand there is in your community for HIV testing and counselling. I do not 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 814E)

814C. When you went to get tested, did the staff at the health facility talk to you about the consequences of getting the results?

YES 1
NO 2

814D. I do not want you to tell me the results of the test, but have you been told the results?

YES 1 (GO TO 814H)
NO 2 (GO TO 814H)

814E. Would you want to be tested for the AIDS virus?

YES 1
NO 2
DON'T KNOW/UNSURE 8

814F. Do you know a place where you could go to get an AIDS test?

YES 1
NO 2 (GO TO 814I)

814G. Where can you go for the test?

814H. Where did you go for the test?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THEAPPROPRIATE CODE.

(NAME OF PLACE)___
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVT. HEALTH CENTER/CLINIC 12
OTHER PUBLIC (SPECIFY) ____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL (SPECIFY) _____ 26
OTHER SOURCE
BLOOD TRANSFUSION SERVICE 31
OTHER (SPECIFY) ____ 96

814I. Do you know someone personally who has the virus that causes AIDS or someone who died from AIDS?

YES 1
NO 2 (GO TO 815)

814J. How well do (did) you know this person?
IF MORE THAN 1 PERSON, ASK ABOUT THE CLOSEST PERSON.

CLOSE RELATIVE (PARENT, SIBLING) 1
CLOSE FRIEND 2
DISTANT RELATIVE (COUSIN, UNCLE) 3
ACQUAINTANCE/COLLEAGUE 4

815. Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

YES 1
NO 2 (GO TO 827)

816. If a man has a sexually transmitted disease, what symptoms might he have?
Any others?
RECORD ALL MENTIONED.

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

817. CHECK 508:

HAS HAD SEXUAL INTERCOURSE (GO TO 818)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 827)

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

YES 1
NO 2
DON'T KNOW 8

819. Sometimes, men experience a discharge from their penis. During the last 12 months, have you had a discharge from your penis?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

821. CHECK 818, 819, 820:

'YES' IN ANY OF THE Qs. 818, 819, 820 (GO TO 822)
'NO/DK' IN ALL THREE Qs. 818, 819, 820 (GO TO 827)

822. The last time you had (INFECTION FROM 818/819/820), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 824)

823. The last time you had (INFECTION FROM 818/819/820) did you do any
of the following? Did you....

Seek advice from a health worker in a clinic or hospital?
Seek advice or medicine from a traditional healer?
Seek advice or buy medicines in a shop or pharmacy?
Ask for advice from friends or relatives?

CLINIC/HOSPITAL
YES 1
NO 2
TRADITIONAL HEALER
YES 1
NO 2
SHOP/PHARMACY
YES 1
NO 2
FRIENDS/RELATIVES
YES 1
NO 2

824. When you had (INFECTION FROM 818/819/820), did you inform the persons with whom you have been having sex?

YES 1
NO 2
SOME/NOT ALL 3

825. When you had (INFECTION FROM 818/819/820) did you do something to avoid infecting your sexual partner(s)?

YES 1
NO 2 (GO TO 827)
PARTNER ALREADY INFECTED 23 (GO TO 827)

826. What did you do to avoid infecting your partner? Did you....
Stop having sex?
Use a condom when having sex?
Take medicine?

STOP SEX
YES 1
NO 2
USE CONDOMS
YES 1
NO 2
TAKE MEDICINE
YES 1
NO 2

827. RECORD THE TIME.

HOURS ____
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 THE SUPERVISOR:________________ DATE: _____________________
EDITOR'S OBSERVATIONS

NAME OF EDITOR:_______________________ DATE: _________________________

SENTENCES FOR LITERACY TEST (Q. 111)

NOTE: These should be translated into all the languages that respondents might be literate in.

1. The child is reading a book.
2. The rains came late this year.
3. Parents must care for their children.
4. Farming is hard work.