MINISTRY OF HEALTH AND SOCIAL SERVICES 2006 NAMIBIA DEMOGRAPHIC AND HEALTH SURVEY MAN'S QUESTIONNAIRE - ENGLISH
NAME AND CODE OF REGION* ______________
NAME OF VILLAGE/TOWN/CITY _____________
DHS CLUSTER NUMBER _____
URBAN/RURAL
RURAL 2
LARGE CITY/SMALL CITY/TOWN/RURAL
SMALL CITY 2
TOWN 3
RURAL 4
HOUSEHOLD NUMBER __________
NAME AND LINE NUMBER OF MAN ___________
INTERVIEWER VISITS
FIRST VISIT:
DATE ____
INTERVIEWER'S NAME ____
RESULT ** _____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7
NEXT VISIT: DATE ____ TIME ___
SECOND VISIT:
DATE ____
INTERVIEWER'S NAME ____
RESULT** ____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7
NEXT VISIT: DATE ____ TIME ___
THIRD VISIT:
DATE ____
INTERVIEWER'S NAME ____
RESULT** ____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7
FINAL VISIT:
DAY ___
MONTH ___
YEAR 200__
INT. NUMBER ___
RESULT** ___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7
LANGUAGE OF QUESTIONNAIRE: ENGLISH 3
LANGUAGE OF INTERVIEW*** ___
DAMARA/NAMA 2
ENGLISH 3
OTJIHERERO 4
RUKWANGALI 5
SILOZI 6
OSHIWAMBO 7
OTHER 8
RESPONDENT'S LANGUAGE*** ___
DAMARA/NAMA 2
ENGLISH 3
OTJIHERERO 4
RUKWANGALI 5
SILOZI 6
OSHIWAMBO 7
OTHER 8
TRANSLATOR USED
SOMETIMES 2
ALL THE TIME 3
DAMARA/NAMA 2
ENGLISH 3
OTJIHERERO 4
RUKWANGALI 5
SILOZI 6
OSHIWAMBO 7
OTHER 8
SUPERVISOR
NAME _____
DATE _____
FIELD EDITOR
NAME ____
DATE ____
OFFICE EDITOR ____
KEYED BY ___
ERONGO 02
HARDAP 03
KARAS 04
KHOMAS 05
KUNENE 06
CHANGWENA 07
KAVANGO 08
OMAHEKE 09
OMUSATI 10
OSHANA 11
OSHIKOTO 12
OTJOZONDJUPA 13
SECTION 1. RESPONDENT'S BACKGROUND
INTRODUCTION AND CONSENT
INFORMED CONSENT
Hello. My name is _______________________________________ and I am working with the Ministry of Health and Social Services. We are conducting a national survey that asks women and men about various health issues. We would very much appreciate your participation in this survey. This information will help the government to plan health services. The survey usually takes between 30 and 60 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.
Participation in this survey is voluntary, and if we should come to any question you don't want to answer, just let me know and I will go on to the next question; or you can stop the interview at any time. However, we hope that you will participate in this survey since your views are important.
At this time, do you want to ask me anything about the survey?
May I begin the interview now?
Signature of interviewer:____ Date:___
RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
MINUTES ____
102. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)? IF LESS THAN ONE YEAR, RECORD '00' YEARS.
ALWAYS 95 (GO TO 104)
VISITOR 96 (GO TO 104)
103. Just before you moved here, did you live in a city, in a town, or in the countryside?
TOWN 2
COUNTRYSIDE 3
104. In the last 12 months, on how many separate occasions have you traveled away from your home community and slept away?
NONE 00 (GO TO 106)
105. In the last 12 months, have you been away from your home community for more than one month at a time?
NO 2
106. In what month and year were you born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
107. How old were you at your last birthday?
COMPARE AND CORRECT 106 AND/OR 107 IF INCONSISTENT.
108. Have you ever attended school?
NO 2 (GO TO 112)
109. What is the highest level of school you attended: primary, secondary, or higher?
SECONDARY 2
HIGHER 3
110. What is the highest (grade/form/year) you completed at that level?
SECONDARY OR HIGHER (GO TO 115)
112. Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT.
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE:
Can you read any part of the sentence to me?
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) ____ 4
BLIND/VISUALLY IMPARED 5
113. Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)?
NO 2
CODE '1', OR '5' CIRCLED (GO TO 116)
115. Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
116. Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
117. Do you watch television almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
PROTESTANT 2
NO RELIGION 3
OTHER (SPECIFY) ___ 4
119. What is the main language spoken in your home?
DAMARA/NAMA 02
ENGLISH 03
HERERO 04
KWANGALI 05
LOZI 06
OSHIWAMBO 07
SAN 08
OTHER (SPECIFY) ____ 96
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 (GO TO 206)
DON'T KNOW 8 (GO TO 206)
202. Do you have any sons or daughters that you have fathered who are now living with you?
NO 2 (GO 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 (GO TO 206)
205. How many sons are alive but do not live with you? And how many daughters are alive but do not live with you? IF NONE, RECORD '00'.
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 (GO TO 208)
DON'T KNOW 8 (GO TO 208)
207. How many boys have died? And how many girls have died? IF NONE, RECORD '00'.
GIRLS DEAD ___
208. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'.
HAS HAD ONLY ONE CHILD (GO TO 212)
HAS NOT HAD ANY CHILDREN (GO TO 301)
210. Did all of the children you have fathered have the same biological mother?
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 (GO TO 301)
214. How many years old is your (youngest) child?
OTHER (GO TO 301)
216. What is the name of your (youngest) child?
WRITE NAME OF (YOUNGEST) CHILD
(NAME OF (YOUNGEST) CHILD) __________
217. When (NAME)'s mother was pregnant with (NAME), did she have any antenatal check-ups?
NO 2 (GO TO 219)
DON'T KNOW 3 (GO 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. What was the main reason why (NAME)'s mother did not deliver in a hospital or health facility?
FACILITY CLOSED 02
TOO FAR/NO TRANSPORTATION 03
DON'T TRUST FACILITY/POOR QUALITY SERVICE 04
NO FEMALE PROVIDER 05
NOT THE FIRST CHILD 06
CHILD'S MOTHER DID NOT THINK IT NECESSARY 07
HE DID NOT THINK IT WAS NECESSARY 08
FAMILY DID NOT THINK IT WAS NECESSARY 09
OTHER (SPECIFY) 96
DON'T KNOW 98
221. When a child has diarrhoea, how much should he or she be given to drink: more than usual, the same amount as usual, less than usual, or should he or she not be given anything to drink at all?
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.
Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK:
Have you ever heard of (METHOD)?
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 RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR METHODS 02, 07,
10, AND 11, ASK 302 IF 301 HAS CODE 1 CIRCLED.
302. Have you ever used (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
302. Have you ever used (METHOD)?
NO 2
NO 2
NO 2
NO 2
303. In the last few months have you:
Heard about family planning on the radio?
Seen about family planning on the television?
Read about family planning in a newspaper or magazine?
NO 2
NO 2
NO 2
304. In the last few months, have you discussed the practice of family planning with a health worker or health professional?
NO 2
305. Now I would like to ask you about a woman's risk of pregnancy.
From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?
NO 2
306. 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
307. Do you think that a woman who is breastfeeding her baby can become pregnant?
NO 2
DEPENDS 3
DON'T KNOW 8
308. I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.
a) Contraception is women's business and a man should not have to worry about it.
b) Women who use contraception may become promiscuous.
DISAGREE 2
DK 8
DISAGREE 2
DK 8
309. CHECK 301 (07) KNOWS MALE CONDOM
NO (GO TO 313)
310. Do you know of a place where a person can get condoms?
NO 2 (GO TO 313)
311. Where is that?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER/CLINIC B
FAMILY PLANNING CLINIC C
PHC (MOBILE) D
COMM. HEALTH WORKER E
OTHER PUBLIC (SPECIFY) F
PHARMACY H
PRIVATE DOCTOR I
OTHER PRIVATE MEDICAL (SPECIFY) ____ J
CHURCH L
FRIENDS/RELATIVES M
TRAD. BIRTH ATTENDANT N
TRAD. HEALER O
OTHER (SPECIFY) _____ X
312. If you wanted to, could you yourself get a condom?
NO 2
313. CHECK 301 (08) KNOWS FEMALE CONDOM
NO (GO TO 401)
314. Do you know of a place where a person can get female condoms?
NO 2 (GO TO 401)
315. Where is that?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER/CLINIC B
FAMILY PLANNING CLINIC C
PHC CLINIC (MOBILE) D
COMM. HEALTH WORKER E
OTHER PUBLIC (SPECIFY)______ F
PHARMACY H
PRIVATE DOCTOR I
OTHER PRIVATE MEDICAL (SPECIFY) ____ J
CHURCH L
FRIENDS/RELATIVES M
TRAD. BIRTH ATTENDANT N
TRAD. HEALER O
OTHER (SPECIFY) _____ X
316. If you wanted to, could you yourself get a female condom?
NO 2
SECTION 4. MARRIAGE AND SEXUAL ACTIVITY
401. Are you currently married or living together with a woman as if married?
YES, MARRIED BY CUSTOM 2 (GO TO 404)
YES, LIVING WITH A WOMAN 3 (GO TO 404)
NO, NOT IN UNION 4
402. Have you ever been married or lived together with a woman as if married?
YES, LIVED WITH A WOMAN 2
NO 3 (GO TO 413)
403. What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2 (GO TO 410)
SEPARATED 3 (GO TO 410)
404. Is your wife/partner living with you now or is she staying elsewhere?
STAYING ELSEWHERE 2
405. Do you have more than one wife or woman you live with as if married?
NO 2 (GO TO 407)
406. Altogether, how many wives do you have or other partners do you live with as if married?
407. CHECK 405:
ONE WIFE/PARTER (Please tell me the name of your wife (the woman you are living with as if married).
MORE THAN ONE WIFE/PARTNER (Please tell me the name of each of your current wives (and/or of each woman you are living with as if married).
RECORD THE NAME AND TEH LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE AND LIVE-IN PARTNER.
IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.
ASK 408 FOR EACH PERSON.
408. How old was (NAME) on her last birthday?
MORE THAN ONE WIFE/PARTNER (GO TO 411A)
410. Have you been married or lived with a woman only once or more than once?
MORE THAN ONCE 2 (GO TO 411A)
411. In what month and year did you start living with your wife (partner)?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
411A. Now I would like to ask a question about your first wife/partner. In what month and year did you start living with your first wife/ partner?
DON'T KNOW MONTH 98
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 you 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 __ (GO TO 417)
FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE/PARTNER 95 (GO TO 417)
AGE 25-49 (GO TO 419)
416. Do you intend to wait until you get married to have sexual intercourse for the first time?
NO 2 (GO TO 501)
DON'T KNOW/UNSURE 8 (GO TO 501)
AGE 25-49 (GO TO 419)
419. When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS.
IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___ (GO TO 435)
420. Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question. (GO TO 422)
421. When was the last time you had sexual intercourse with this person?
[Exclude Last Sexual Partner]
WEEKS 2 ___
MONTHS 3 ___
422. The last time you had sexual intercourse (with this second/third person), was a condom used?
NO 2 (GO TO 424)
423. Was a condom used every time you had sexual intercourse with this person in the last
12 months?
NO 2
424. What was your relationship to this (second/third) person with whom you had sexual intercourse?
IF GIRLFRIEND: Were you living together as if married?
IF YES, CIRCLE '02'.
IF NO, CIRCLE '03'.
LIVE-IN PARTNER 2
GIRLFRIEND NOT LIVING WITH RESPONDENT 3
CASUAL ACQUAINTANCE 4
PROSTITUTE 5
OTHER (SPECIFY) ___ 6
425. For how long (have you had/did you have) a sexual relationship with this (second/third) person? IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.
MONTHS 2
YEARS 3
426. The last time you had sexual intercourse with this (second/third) person, did you or this person drink alcohol?
NO 2 (GO TO 428 OR IF THIRD-TO-LAST SEXUAL PARTNER, GO TO 429)
427. Were you or your partner drunk at that time? IF YES: Who was drunk?
PARTNER ONLY 2
RESPONDENT AND PARTNER BOTH 3
NEITHER 4
428. Apart from [this person/these people], have you had sexual intercourse with any other person in the last 12 months?
[Exclude Third-To-Last Partner]
NO 2 (GO TO 430)
429. In total, with how many different people have you had sexual intercourse in the last 12 months? IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'.
[Third-To-Last Partner Only]
DON'T KNOW 98
NO PARTNERS ARE PROSTITUTES (GO TO 432)
431. CHECK 424 AND 422 (ALL COLUMNS):
OTHER (GO TO 435)
432. In the last 12 months, did you pay anyone in exchange for having sexual intercourse?
NO 2 (GO TO 435)
433. The last time you paid someone in exchange for having sexual intercourse, was a condom used?
NO 2 (GO TO 435)
434. Was a condom used during sexual intercourse every time you paid someone in exchange for having sexual intercourse in the last 12 months?
NO 2
DK 8
435. In total, with how many different people have you had sexual intercourse in your lifetime? IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95.'
DON'T KNOW 98
436. CHECK 422, MOST RECENT PARTNER (FIRST COLUMN):
NO CONDOM USED/NOT ASKED (GO TO 442)
437. You told me that a condom was used the last time you had sex. May I see the package of condoms you were using at that time?
RECORD NAME OF BRAND IF PACKAGE SEEN.
DOES NOT HAVE/NOT SEEN 2
438. Do you know the brand name of the condom used at that time? RECORD NAME OF BRAND.
DON'T KNOW 98
439. How many condoms did you get the last time?
DON'T KNOW 998
440. The last time you obtained the condoms, how much did you pay in total, including the cost of the condom(s) and any consultation you may have had?
FREE 995
DON'T KNOW 998
441. From where did you obtain the condom the last time?
PROBE TO IDENTIFY TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER/CLINIC 12
PHC CLINIC (MOBILE) 13
COMM. HEALTH WORKER
OTHER PUBLIC (SPECIFY)______ 14
PHARMACY 22
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL (SPECIFY) ____ 24
CHURCH 32
FRIENDS/RELATIVES 33
TRAD. BIRTH ATTENDANT 34
TRAD. HEALER 35
OTHER (SPECIFY) _____ 36
442. CHECK 302 (02): RESPONDENT EVER STERILIZED
YES (GO TO 501)
443. The last time you had sex did you or your partner use any method (other than a condom) to avoid or prevent a pregnancy?
NO 2 (GO TO 501)
DON'T KNOW 8 (GO TO 501)
444. What method did you or your partner use?
PROBE:
Did you or your partner use any other method to prevent pregnancy?
RECORD ALL MENTIONED.
PILL B
IUD C
INJECTABLES D
IMPLANTS E
FEMALE CONDOM F
DIAPHRAGM G
FOAM/JELLY H
RHYTHM METHOD I
WITHDRAWAL J
OTHER (SPECIFY) ____ X
SECTION 5. FERTILITY PREFERENCES
501. CHECK 407:
QUESTION NOT ASKED (GO TO 508)
MAN STERILIZED (GO TO 508)
503. (Is your wife (partner)/Are any of your wives (partners)) currently pregnant?
NO 2
DON'T KNOW 8
WIFE(WIVES)/PARTNER(S) PREGNANT (Now I have some questions about the future. After the child(ren) you and your (wife(wifes)/partner(s) are expecting now, would you like to have another child, or would you prefer not to have any more children?
HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 508)
COUPLE INFECUND 3 (GO TO 508)
WIFE(WIVES)/PARTNERS(S) STERILIZED 4 (GO TO 508)
UNDECIDED/DON'T KNOW 8 (GO TO 508)
MORE THAN ONE WIFE/PARTNER (GO TO 507)
WIFE/PARTNER NOT PREGNANT OR DON'T KNOW (How long would you like to wait from now before the borth of (a/another) child?
WIFE/PARTNER PREGNANT (After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?
YEARS 2 ___ (GO TO 508)
SOON/NOW 993 (GO TO 508)
COUPLE INFECUND 994 (GO TO 508)
OTHER (SPECIFY) ____ 996 (GO TO 508)
DON'T KNOW 998 (GO TO 508)
507. How long would you like to wait from now before the birth of (a/another) child?
YEARS 2 ___
SOON/NOW 993
HE/ALL HIS WIVES/PARTNERS ARE INFECUND 994
OTHER (SPECIFY) ____ 996
DON'T KNOW 998
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 NUMBERIC RESPONSE.
NONE 00 (GO TO 601)
NUMBER ___
OTHER (SPECIFY) ___ 96 (GO TO 601)
509. How many of these children would you like to be boys, how many would you like to be girls and for how many would the sex not matter?
BOYS ___
GIRLS ___
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 done any work in the last 12 months?
NO 2 (GO TO 613)
604. What is your occupation, that is, what kind of work do you mainly do?
DOES NOT WORK IN AGRICULTURE (GO TO 607)
606. Do you work mainly on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
607. Do you do this work for a member of your family, for someone else, or are you self-employed?
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3
608. Do you usually work throughout the year, or do you work seasonally, or only once in a while?
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3
609. Are you paid in cash or kind for this work or are you not paid at all?
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4
QUESTION NOT ASKED (GO TO 613)
OTHER (GO TO 613)
612. Who decides how the money you earn will be used: mainly you, mainly your (wife (wives)/partner(s)), or you and your (wife (wives)/partner(s)) jointly?
WIFE (WIVES)/PARTNER(S) 2
RESPONDENT AND WIFE (WIVES)/PARTNER(S) JOINTLY 3
OTHER (SPECIFY) ___ 6
613. In a couple, who do you think should have the greater say in each of the following decisions: the husband, the wife or both equally:
a) making large household purchases?
b) making small daily household purchases?
c) deciding when to visit the wife's family or relatives?
d) deciding what to do with the money she earns for her
work?
e) deciding how many children to have?
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
614. I will now read you some statements about pregnancy.
Please tell me if you agree or disagree with them.
a) Childbearing is a woman's concern and there is no need for the father to get involved.
b) It is crucial for the mother's and child's health that a woman have assistance from a doctor or nurse at delivery.
DISAGREE 2
DK 8
DISAGREE 2
DK 8
615. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:
If she goes out without telling him?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she burns the food?
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
616. Do you think that if a woman refuses to have sex with her husband when he wants her to, he has the right to?
a) Get angry and reprimand her?
b) Refuse to give her money or other means of support?
c) Use force and have sex with her even if she doesn't want to?
d) Go ahead and have sex with another woman?
NO 2
DK/DEPENDS 8
NO 2
DK/DEPENDS 8
NO 2
DK/DEPENDS 8
NO 2
DK/DEPENDS 8
701. Now I would like to talk about something else. Have you ever heard of an illness called HIV/AIDS?
NO 2 (GO TO 733)
702. Can people reduce their chances of getting the HIV/AIDS virus by having just one uninfected sex partner who has no other sex partners?
NO 2
DON'T KNOW 8
703 Can people get the HIV/AIDS virus from mosquito bites?
NO 2
DON'T KNOW 8
704. Can people reduce their chance of getting the HIV/AIDS virus by using a condom every time they have sex?
NO 2
DON'T KNOW 8
705. Can people get the HIV/AIDS virus by sharing food with a person who has HIV/AIDS?
NO 2
DON'T KNOW 8
706. Can people reduce their chance of getting the HIV/AIDS virus by not having sexual intercourse at all?
NO 2
DON'T KNOW 8
707. Can people get the HIV/AIDS virus because of witchcraft or other supernatural means?
NO 2
DON'T KNOW 8
708. Is it possible for a healthy-looking person to have the HIV/AIDS virus?
NO 2
DON'T KNOW 8
709. Can the virus that causes HIV/AIDS be transmitted from a mother to her baby:
During pregnancy?
During delivery?
By breastfeeding?
YES 1
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
OTHER (GO TO 713)
711. Are there any special drugs that a doctor or a nurse can give to a woman infected with the HIV/AIDS virus to reduce the risk of transmission to the baby?
NO 2
DON'T KNOW 8
712. Have you heard about special antiretroviral drugs (ARV) that people infected with the HIV/AIDS virus can get from a doctor or a nurse to help them live longer?
NO 2
DON'T KNOW 8
712A. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
713. I don't want to know the results, but have you ever been tested to see if you have the HIV/AIDS virus?
NO 2 (GO TO 718)
714. When was the last time you were tested?
12-23 MONTHS AGO 2
2 OR MORE YEARS AGO 3
715. The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?
OFFERED AND ACCEPTED 2
REQUIRED 3
716. I don't want to know the results, but did you get the results of the test?
NO 2
717. Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER,
VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER/CLINIC 12
STAND-ALONE VCT CENTER 13
FAMILY PLANNING CLINIC 14
PHC CLINIC (MOBILE) 15
COMM. HEALTH WORKER 16
OTHER PUBLIC (SPECIFY)______ 17
STAND-ALONE BCT CENTER 22
PHARMACY 23
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL (SPECIFY) ____ 26
OTHER (SPECIFY) ____ 96
(ALL GO TO 720)
718. Do you know of a place where people can go to get tested for the AIDS virus?
NO 2 (GO TO 720)
719. Where is that?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER/CLINIC B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
PHC CLINIC (MOBILE) E
COMM. HEALTH WORKER F
OTHER PUBLIC (SPECIFY)______ G
STAND-ALONE BCT CENTER I
PHARMACY J
OTHER PRIVATE MEDICAL (SPECIFY) ____ K
OTHER (SPECIFY) ____ Z
(ALL GO TO 720)
720 Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person ha.d the AIDS virus?
NO 2
DON'T KNOW 8
721. If a member of your family got infected with the AIDS virus, would you want it to remain a secret or not?
NO 2
DK/NOT SURE/DEPENDS 8
722. If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?
NO 2
DK/NOT SURE/DEPENDS 8
723. In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in the school?
SHOULD NOT BE ALLOWED 2
DK/NOT SURE/DEPENDS 8
724. Do you personally know someone who has been denied health services in the last 12 months because he or she has or is suspected to have the AIDS virus?
NO 2
DK ANYONE WITH AIDS 8 (GO TO 729)
725. Do you personally know someone who has been denied involvement in social events, religious services, or community events in the last 12 months because he or she has or is suspected to have the AIDS virus?
NO 2
726. Do you personally know someone who has been verbally abused or teased in the last 12 months because he or she has or is suspected to have the AIDS virus?
NO 2 (GO TO 720)
OTHER (GO TO 728)
728. Do you personally know someone who has or is suspected to have the AIDS virus?
NO 2
729. Do you agree or disagree with the following statement: People with the AIDS virus should be ashamed of themselves.
DISAGREE 2
DON'T KNOW/NO OPINION 8
730. Do you agree or disagree with the following statement: People with the AIDS virus should be blamed for bringing the disease into the community.
DISAGREE 2
DON'T KNOW/NO OPINION 8
731. Should children age 12-14 be taught about using a condom to avoid getting AIDS?
NO 2
DK/NOT SURE/DEPENDS 8
732. Should children age 12-14 be taught to wait until they get married to have sexual intercourse in order to avoid getting AIDS?
NO 2
DK/NOT SURE/DEPENDS 8
732A. In the past six months, have you seen or heard messages promoting HIV/AIDS prevention through abstinence?
NO 2 (GO TO 732C)
732B. Where did you see or hear the message about abstinence?
PROBE: Any where else?
RECORD ALL MENTIONED.
TELEVISION B
NEWSPAPER C
COMMUNITY MEETINGS D
POSTER/BILLBOARDS E
MOBILE CAMPAIGNS F
OTHER (SPECIFY) _____ X
DON'T KNOW Z
732C. In the past six months, have you seen or heard messages promoting HIV/AIDS prevention by being faithful to one partner?
NO 2 (GO TO 732E)
732D. Where did you see or hear the message about being faithful to one partner?
PROBE: Any where else?
RECORD ALL MENTIONED.
TELEVISION B
NEWSPAPER C
COMMUNITY MEETINGS D
POSTER/BILLBOARDS E
MOBILE COMPAIGN F
OTHER (SPECIFY) ___ X
DON'T KNOW Z
732E. In the past six months, have you seen or heard messages promoting HIV/AIDS prevention by using the condoms?
NO 2 (GO TO 732G)
732F. Where did you see or hear the message about using condoms?
PROBE: Any where else?
RECORD ALL MENTIONED.
TELEVISION B
NEWSPAPER C
COMMUNITY MEETINGS D
POSTER/BILLBOARDS E
MOBILE COMPAIGN F
OTHER (SPECIFY) ___ X
DON'T KNOW Z
732G. In the past six months were you visited by a community health worker who talked to you about HIV/AIDS prevention by abstinence?
NO 2
732H. In the past six months were you visited by a community health worker who talked to you about HIV/AIDS prevention by being faithful to one partner?
NO 2
732I In the past six months were you visited by a community health worker who talked to you about using condoms to prevent
HIV/AIDS?
NO 2
732J. In the past six months, have you ever seen or heard the following radio or television programs?
On television:
Cool Ryder?
Boxing mosquitoes?
Eros and Tohanatos?
Love and cry?
On the radio:
Brother Sholo and Mosquito bites?
No means no and //uuce regrets?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
732K. Have you ever seen or heard the following materials on HIV/AIDS:
OYO magazine?
Sense posters?
Smile posters?
A leaflet on "Twelve steps to living positively with HIV"?
A leaflet on "Not everyone is having sex"?
A leaflet on "Kauna's birthday wish"?
Billboards on "Hope and healing for the hurting"?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
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 injections that can be transmitted through sexual contact?)
NO 2
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 742)
735. CHECK 733: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?
NO 2 (GO TO 737)
736. Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?
NO 2
DON'T KNOW 8
737. Sometimes men experience an abnormal discharge from their penis.
During the last 12 months, have you had an abnormal discharge from your penis?
NO 2
DON'T KNOW 8
738. Sometimes men have a sore or ulcer near their penis.
During the last 12 months, have you had a sore or ulcer near your penis?
NO 2
DON'T KNOW 8
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 742)
740. The last time you had (PROBLEM FROM 736/737/738), did you seek any kind of advice or treatment?
NO 2 (GO TO 742)
741. Where did you go?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER/CLINIC B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
PHC CLINIC (MOBILE) E
COMM. HEALTH WORKER F
OTHER PUBLIC (SPECIFY)______ G
STAND-ALONE BCT CENTER I
PHARMACY J
OTHER PRIVATE MEDICAL (SPECIFY) ____ K
OTHER SOURCE
OTHER (SPECIFY) ____ X
742. Husband and wives do not always agree in everything. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in refusing to have sex with him?
NO 2
DON'T KNOW 8
743. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?
NO 2
DON'T KNOW 8
744. Is a wife justified in refusing to have sex with her husband when she is tired or not in the mood?
NO 2
DON'T KNOW 8
745. Is a wife justified in refusing to have sex with her husband when she knows her husband has sex with women other than his wives?
NO 2
DON'T KNOW 8
746. Do you believe that young men should wait until they are married to have sexual intercourse?
NO 2
DK/NOT SURE/DEPENDS 8
747. Do you think that most young men you know wait until they are married to have sexual intercourse?
NO 2
DK/NOT SURE/DEPENDS 8
748. Do you believe that men who are not married and are having sex should only have sex with one partner?
NO 2
DON'T KNOW 8
749. Do you think that most men you know who are not married and are having sex have sex with only one partner?
NO 2
DON'T KNOW 8
750. Do you believe that married men should only have sex with their wives?
NO 2
DON'T KNOW 8
751. Do you think that most married men you know have sex only with their wives?
NO 2
DON'T KNOW 8
752. Do you believe that young women should wait until they are married to have sexual intercourse?
NO 2
DON'T KNOW 8
753. Do you think that most young women you know wait until they are married to have sexual intercourse?
NO 2
DON'T KNOW 8
754. Do you believe that women who are not married and are having sex should only have sex with one partner?
NO 2
DON'T KNOW 8
755. Do you think that most women you know who are not married and are having sex have sex with only one partner?
NO 2
DON'T KNOW 8
756. Do you believe that married women should only have sex with their husbands?
NO 2
DON'T KNOW 8
757. Do you think that most married women you know have sex only with their husbands?
NO 2
DON'T KNOW 8
SECTION 8. OTHER HEALTH ISSUES
801. Have you ever heard of an illness called tuberculosis or TB?\
NO 2 (GO TO 805)
802. How does tuberculosis spread from one person to another?
PROBE: Any other ways?
RECORD ALL MENTIONED.
THROUGH SHARING UTENSILS B
THROUGH TOUCHING A PERSON WITH TB C
THROUGH FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BIT F
OTHER (SPECIFY) ____ X
DON'T KNOW Z
803. Can tuberculosis be cured?
NO 2
DON'T KNOW 8
804. If a member of your family got tuberculosis, would you want it to remain a secret or not?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
805. Have you ever heard of an illness called malaria?
NO 2 (GO TO 813)
805A What are the signs of malaria?
PROBE: Any other causes?
RECORD ALL MENTIONED.
CHILLS B
HIGH TEMPERATURE C
BODY PAIN D
LOSS OF ENERGY E
OTHER (SPECIFY) X
DON'T KNOW Z
806. What causes malaria?
PROBE: Any other casues?
RECORD ALL MENTIONED.
RAIN B
UNHIGIENIC ENVIRONMENT C
SLEEPING WITH SOMEONE WITH MALARIA D
OTHER (SPECIFY) X
DON'T KNOW Z (GO TO 813)
807. What would you do if you suspected that you have malaria?
GO TO A HEALTH FACILITY/HEALTH PERSONNEL 2
GO TO A TRADITIONAL HEALER 3
OTHER (SPECIFY) ____ 6
808. What do you do to prevent getting malaria?
Anything else?
RECORD ALL MENTIONED.
USE REPELLENTS B
USE MOSQUITO NETS C
USE MOSQUITO COILS D
BURN LEAVES E
OTHER (SPECIFY) ____ X
DON'T KNOW Z
813. Now I would like to talk about male circumcision. Some men are circumcised. Are you circumcised?
NO 2 (GO TO 820)
814. At what age were you circumcised?
13-19 YEARS OLD 2
20 OR MORE YEARS 3
815. Who performed the circumcision?
HEALTH PROFESSIONAL 2
DON'T KNOW 8
816. What do you think of male circumcision?
GOOD FOR HEALTH/HYGIENE 2
INCREASE SEXUAL SATISFACTION 3
EASIER TO PUT ON CONDOM 4
OTHER (SPECIFY) ____ 6
DON'T KNOW 8
820. Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (GO TO 824)
821. 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 GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (GO TO 824)
822. The last time you had an injection given to you by a health worker, where did you go to get the injection?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER PRIVATE HOSPITAL/CLINIC/ OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE. (NAME OF PLACE) ______
GOVT. HEALTH CENTER/CLINIC 12
OTHER PUBLIC (SPECIFY)______ 16
DENTAL CLINIC/OFFICE 22
PHARMACY 23
OFFICE OR HOME OF NURSE/HEALTH WORKE 24
OTHER PRIVATE MEDICAL (SPECIFY) ____ 26
OTHER (SPECIFY) _____ 96
823. Did the person who gave you that injection take the syringe and needle from a new, unopened package?
NO 2
DON'T KNOW 8
824. Do you currently smoke any type of tobacco?
YES, PIPE 2 (GO TO 826)
YES, CHEWING TOBACCO 3 (GO TO 826)
YES, SNUFF 4 (GO TO 826)
NO 5 (GO TO 826)
825. In the last 24 hours, how many cigarettes, including rolled cigarettes did you smoke?
826. Have you ever drunk an alcohol-containing beverage?
NO 2 (GO TO 830)
827. In the last month, on how many days did you drink an alcohol-containing beverage?
NONE/NEVER 95
828. Have you ever gotten drunk from drinking an alcohol-containing beverage?
NO 2 (GO TO 830)
829. In the last month, how many times did you get drunk?
NONE/NEVER 95
830. Are you covered by any health insurance?
NO 2 (GO TO 832)
831. What type of health insurance?
RECORD ALL MENTIONED.
HEALTH INSURANCE THROUGH EMPLOYER B
SOCIAL SECURITY C
OTHER PRIVATELY PURCHASED COMMERICIAL HEALTH INSURANCE D
OTHER (SPECIFY) ____ X
833. Now I would like to ask you about your own child(ren) who (is/are) under the age of 18.
Have you made arrangements for someone to care for (him/her/them) in the event that you fall sick or are unable to care for (him/her/them)?
NO 2
UNSURE 8
834. (Besides your own child/children), are you the primary caregiver for any children under the age of 18?
NO 2 (GO TO 826)
835. Have you made arrangements for someone to care for (this child/these children) in the event that you fall sick or are unable to care for (him/her/them)?
NO 2
UNSURE 8
MINUTES ___
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT RESPONDENT:
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COMMENTS ON SPECIFIC QUESTIONS:
__________________________________
ANY OTHER COMMENTS:
__________________________________
SUPERVISOR'S OBSERVATIONS
______________________________
NAME OF SUPERVISOR:_____ DATE:_____
EDITOR'S OBSERVATIONS
______________________________
NAME OF EDITOR:_______ DATE: _____