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NATIONAL INSTITUTE OF POPULATION STUDIES
PAKISTAN DEMOGRAPHIC AND HEALTH SURVEY 2012-13
EVER MARRIED MAN'S QUESTIONNAIRE

IDENTIFICATION

PROVINCE/REGION

PUNJAB 1
SINDH 2
KPK 3
BALOCHISTAN 4
GB 5
ICT 6

DISTRICT

TEHSIL

CLUSTER NUMBER

HOUSEHOLD NUMBER

LARGE CITY 1
SMALL CITY 2
TOWN 3
RURAL 4

NAME OF HOUSEHOLD HEAD

NAME AND LINE NUMBER OF MAN\

INTERVIEWER VISITS
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS
DATE ___
INTERVIEWER'S NAME ____
RESULT* _____

NEXT VISIT
DATE ___
TIME ___

FINAL VISIT
DAY __
MONTH __
YEAR ___
INT. NUMBER ___
RESULT __

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

TOTAL NUMBER OF VISITS __

LANGUAGE OF QUESTIONNAIRE: ENGLISH

LANGUAGE OF INTERVIEWER* ___

LANGUAGE MAN SPEAKS AT HOME* ____

URDU 1
PUNJABI 2
SINDHI 3
PUSHTO 4
BALUCHI 5
ENGLISH 6
BARUHI 7
SARAIKI 8
OTHER 9 (SPECIFY) ____

SUPERVISOR
NAME _____

FIELD EDITOR
NAME ____

OFFICE EDITOR

KEYED BY

INFORMED CONSENT

Assalamo Alaikum. My name is ___. I am working with NIPS. We are conducting a survey about health all over Pakistan. The information we collect will help the government to plan health services. Your household is selected for the survey. The questions usually take about 25 to 30 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 questions? May I begin the interview now?

SIGNATURE OF INTERVIEWER: ______
DATE: _____

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

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME.

HOUR ___
MINUTES ____

102) In what month and year were you born?

MONTH __
DON'T KNOW MONTH 98

YEAR ____
DON'T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS __

104) What is your marital status now: are you currently married, or widowed, divorced, or separated?

CURRENTLY MARRIED 1
WIDOWED 2 (GO TO 106A)
DIVORCED 3 (GO TO 106A)
SEPARATED 4 (GO TO 106A)
NEVER MARRIED 5 (END)

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

LIVING WITH HIM 1
STAYING ELSEWHERE 2

106) Do you have other wives?

YES (MORE THAN ONE) 1
NO (ONLY ONE) 2 (GO TO 108)

106A) Did you have other wives?

YES (MORE THAN ONE) 1
NO (ONLY ONE) 2 (GO TO 108)

107) Altogether, how many wives do/did you have?

TOTAL NUMBER OF WIVES __

108) CHECK 106 AND 106A:

ONE WIFE: In what month and year did you start living with your (wife)?
MORE THAN ONE WIFE: 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 ____ (GO TO 110)
DON'T KNOW YEAR 9998

109) How old were you when you first started living with her?

AGE ___

110) Have you ever attended school?

YES 1
NO 2 (GO TO 113)

111) What is the highest class you completed?
IF COMPLETED LESS THAN CLASS ONE, WRITE '00'
IF MA, MPHIL, PHD, MBBS, OR BSC/4 YEARS, WRITE '16'

CLASS ____

112) CHECK 111:

CLASS 00-08 (CONTINUE TO NEXT QUESTION)
CLASS 09 OR HIGHER (GO TO 115)

113) Now I would like 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 SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) ____ 4
BLIND/VISUALLY IMPAIRED 5

114) CHECK 113:

CODE '2', '3', OR '4' CIRCLED (CONTINUE TO NEXT QUESTION)
CODE '1' OR '5' CIRCLED (GO TO 116)

115) Do you read a newspaper or magazine daily, at least once a week, occasionally or not at all?

DAILY 1
AT LEAST ONCE A WEEK 2
OCCASIONALLY 3
NOT AT ALL 4

116) Do you listen to the radio daily, at least once a week, occasionally or not at all?

DAILY 1
AT LEAST ONCE A WEEK 2
OCCASIONALLY 3
NOT AT ALL 4

117) Do you watch television daily, at least once a week, occasionally or not at all?

DAILY 1
AT LEAST ONCE A WEEK 2
OCCASIONALLY 3
NOT AT ALL 4

118) What is your mother tongue?

URDU 01
PUNJABI 02
SINDHI 03
PUSHTO 04
BALOCHI 05
ENGLISH 06
BARAUHI 07
SIRAIKI 08
HINDKO 09
KASHMIRI 10
SHINA 11
BRUSHASKI 12
WAKHI 13
CHITRALI/KHWAR 14
BALTI 15
PAHARI 16
POTOWARI 17
MARWARI 18
FARSI 19
OTHER 96

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.
Do you have any children?

YES 1
NO 2 (GO TO 206)

202) Do you have any sons or daughters who are now living with you?

YES 1
NO 2 (GO TO 204)

203) How many sons live with you? And how many daughters live with you?
IF NONE, RECORD '00'

SONS AT HOME __
DAUGHTERS AT HOME __

204) Do you have any sons or daughters who are alive but do not live with you?

YES 1
NO 2 (GO TO 206)

205) How many sons are alive but do not live with you?
And how many daughters are alive but do not live with you?
IF NONE, RECORD '00'

SONS ELSEWHERE __
DAUGHTERS ELSEWHERE __

206) Do you have a son or daughter who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

YES 1
NO 2 (GO TO 208)
DON'T KNOW 8 (GO TO 208)

207) How many boys have died? And how many girls have died?
IF NONE, RECORD '00'

BOYS DEAD __
GIRLS DEAD __

208) SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL
IF NONE, RECORD '00'

TOTAL CHILDREN ___

209) CHECK 208:

HAS HAD MORE THAN ONE CHILD 1 (CONTINUE TO 210)
HAS ONLY HAD ONE CHILD 2 (GO TO 212)
HAS NOT HAD ANY CHILDREN 3 (GO TO 301)

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

YES 1 (GO TO 212)
NO 2

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

NUMBER OF WIVES __

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

AGE IN YEARS __

213) CHECK 203 AND 205:

AT LEAST ONE LIVING CHILD 1 (CONTINUE TO 214)
NO LIVING CHILDREN (GO TO 301)

214) How old is your (youngest) child?
IF LESS THAN ONE YEAR, RECORD '00'

AGE IN YEARS ___

215) CHECK 214:

(YOUNGEST) CHILD IS AGE 0-2 YEARS __ (CONTINUE TO 216)
OTHER __ (GO TO 301)

216) What is the name of your (youngest) child?

WRITE NAME OF (YOUNGEST) CHILD
______
[IF NOT LISTED IN THE HOUSEHOLD ROSTER, ENTER '00']

LINE NUMBER ___

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

YES 1
NO 2 (GO TO 219)
DON'T KNOW 8 (GO TO 219)

218) Were you ever present during any of those antenatal checkups or did you just accompanied your wife to any of those antenatal checkups?

PRESENT DURING CHECK-UP 1
ONLY ACCOMPANY 2
NOT ACCOMPANY 3

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 2. 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)?
PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.

01) Female Sterilization. PROBE: Women can have an operation to avoid having any more children.
YES 1
NO 2
02) Male Sterilization. PROBE: Men can have an operation to avoid having any more children.
YES 1
NO 2
03) IUD. PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
04) 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
05) 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
06) Pill. PROBE: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
07) Condom. PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) Standad Days Method. PROBE: A women uses a string of colored beads to know the days she can get pregnant. On the days she can get pregnant, she uses a condom or does not have sexual intercourse.
YES 1
NO 2
09) Lactational Amen. Method (LAM)
YES 1
NO 2
10) Rhythm Method. PROBE: Every month that a women is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month that she is most likely to get pregnant.
YES 1
NO 2
11) Withdrawal, Azal. PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
12) Emergency Contraception. PROBE: As an emergency measure, within three 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 husband or wife can use to avoid pregnancy?
YES 1
NO 2
SPECIFY _____

302) Have you or your wife/wives ever used (METHOD)?

01) Female Sterilization. PROBE: Women can have an operation to avoid having any more children.
YES 1
NO 2
02) Male Sterilization. PROBE: Men can have an operation to avoid having any more children.
YES 1
NO 2
03) IUD. PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
04) 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
05) 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
06) Pill. PROBE: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
07) Condom. PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) Standard Days Method. PROBE: A women uses a string of colored beads to know the days she can get pregnant. On the days she can get pregnant, she uses a condom or does not have sexual intercourse.
YES 1
NO 2
09) Lactational Amen. Method (LAM)
YES 1
NO 2
10) Rhythm Method. PROBE: Every month that a women is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month that she is most likely to get pregnant.
YES 1
NO 2
11) Withdrawal, Azal. PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
12) Emergency Contraception. PROBE: As an emergency measure, within three 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 husband or wife can use to avoid pregnancy?
YES 1
NO 2
SPECIFY _____

303) In the last few months have you:

a) Heard about family planning on the radio?
YES 1
NO 2
b) Seen anything about family planning on the television?
YES 1
NO 2
c) Read about family planning in a newspaper or magazine?
YES 1
NO 2

304) CHECK 303:

HEARD/WATCH/READ ABOUT MESSAGE (ANY YES IN 303) __ (CONTINUE TO 304A)
NOT HEARD/WATCH/READ ABOUT MESSAGE __ (GO TO 304C)

304A) What messages did it convey to you? Anything else?
[CIRCLE ALL MENTIONED]

LIMITING THE FAMILY A
HIGHER AGE AT MARRIAGE B
SPACING OF CHILDREN C
USE ON CONTRACEPTIVES D
WELFARE OF FAMILY E
MATERNAL AND CHILD HEALTH F
LESS CHILDREN MEAN PROSPEROUS LIFE G
MORE CHILDREN MEAN POVERTY AND STARVATION H
IMPORTANCE OF BREASTFEEDING I
OTHER-1 (SPECIFY) X
OTHER-2 (SPECIFY) Y
DON'T KNOW/NOT REMEMBER Z

304B) Do you think that the message you heard or watch or read was effective or not effective in persuading couples to use family planning?

EFFECTIVE 1
NOT EFFECTIVE 2
DON'T KNOW 8

304C) CHECK 104:

CURRENTLY MARRIED __ (CONTINUE TO 305)
WIDOWED/DIVORCED OR SEPARATED __ (GO TO 307)

305) CHECK 302:

MAN NOT STERILIZED __ (CONTINUE TO 306)
MAN STERILIZED __ (GO TO 307)

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 309)
DON'T KNOW 8 (GO TO 309)

308) 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

309) 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

310) CHECK 301 (07): KNOWS CONDOM

YES __ (CONTINUE TO 311)
NO __ (GO TO 401)

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

YES 1
NO 2 (GO TO 401)

312) 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.

PUBLIC SECTOR
GOVT. HOSPITAL/RHSC A
RURAL HEALTH CENTRE B
FAMILY WELFARE CENTRE C
MCH D
DISPENSORY E
MOBILE SERVICE CAMP F
LADY HEALTH WORKER G
LH VISITOR H
BASIC HEALTH UNIT I
MALE MOBILIZER J
OTHER PUBLIC (SPECIFY) ___ K
PRIVATE/NGO MEDICAL SECTOR
PRIVATE/NGO HOSPITAL/CLINIC L
PHARMACY, CHEMISTS M
PRIVATE DOCTOR N
HOMEOPATH O
DISPENSER/COMPOUNDER .P
OTHER PRIVATE MEDICAL (SPECIFY) ____ Q
OTHER SOURCE
SHOP (NOT PHARMACY/CHEMIST) R
FRIEND/RELATIVE S
HAKIM T
DAI, TRAD. BIRTH ATTENDANT U
OTHER (SPECIFY) ___ X
DON'T KNOW Z

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

YES 1
NO 2

SECTION 4. FERTILITY PREFERENCES

401) CHECK 104:

CURRENTLY MARRIED __ (CONTINUE TO 402)
WIDOWED/DIVORCED OR SEPARATED __ (GO TO 409)

402) CHECK 302:

MAN NOT STERILIZED __ (CONTINUE TO 403)
MAN STERILIZED __ (GO TO 409)

403) Is your wife/are any of your (wives) currently pregnant?

YES 1
NO 2 (GO TO 405)
DON'T KNOW 8 (GO TO 405)

404) 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 (GO TO 406)
NO MORE 2 (GO TO 409)
UNDECIDED/DON'T KNOW 8 (GO TO 409)

405) 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 409)
SAYS WIFE (WIVES) CAN'T GET PREGNANT 3 (GO TO 409)
WIFE (WIVES) STERILIZED 4 (GO TO 409)
HE/ALL HIS WIVES/ ARE INFECUND 5 (GO TO 409)
UNDECIDED/DON'T KNOW 8 (GO TO 409)

406) CHECK 106:

ONE WIFE __ (CONTINUE TO 407)
MORE THAN ONE WIFE __ (GO TO 408)

407) CHECK 403:

WIFE NOT 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

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

MONTHS 1 __
YEARS 2 __
SOON/NOW 993
COUPLE INFECUND 994
OTHER (SPECIFY) ___ 996
DON'T KNOW 998

409) CHECK 203 AND 205:

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

NO LIVING CHILDREN __
If you could choose exactly the number of children to have in your whole life, how many would that be?

NONE 00 (GO TO 501)
NUMBER __
OTHER (SPECIFY) ___ 96 (GO TO 501)

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

NUMBER OF BOYS __
NUMBER OF GIRLS __
NUMBER OF EITHER __
OTHER (SPECIFY) ___ 96

SECTION 5. EMPLOYMENT AND GENDER ROLES

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

YES 1 (GO TO 504)
NO 2

502) 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 (GO TO 504)
NO 2

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

YES 1
NO 2 (GO TO 507)

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

_________________

505) 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

506) Are you paid in cash or cash and kind both or kind only for this work or are you not paid at all?

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

507) CHECK 104:

CURRENTLY MARRIED __ (CONTINUE TO 508)
WIDOWED/DIVORCED OR SEPARATED __ (GO TO 512)

508) CHECK 506:

CODE 1 OR 2 CIRCLED __ (CONTINUE TO 509)
OTHER __ (GO TO 510)

509) Who usually decides how the money you earn will be used: you, your wife, or you and your wife jointly or someone else?

RESPONDENT 1
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
FAMILY ELDERS 4
SOMEONE ELSE 6

510) Who usually make decisions about health care for yourself: you, your wife, you are your wife jointly or someone else?

RESPONDENT 1
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
FAMILY ELDERS 4
SOMEONE ELSE 6

511) Who usually makes decisions about making major household purchases: you, your wife, you and your wife jointly or someone else?

RESPONDENT 1
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
FAMILY ELDERS 4
SOMEONE ELSE 6

512) 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

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

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4

514) In your opinion, is a husband justified in hitting or beating his wife in the following situations:

a) If she goes out without telling him?
YES 1
NO 2
DON'T KNOW 8
b) If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
c) If she argues with him?
YES 1
NO 2
DON'T KNOW 8
d) If she burns the food?
YES 1
NO 2
DON'T KNOW 8
e) If she neglects the in-laws?
YES 1
NO 2
DON'T KNOW 8
f) If she refuses to have sex with him?
YES 1
NO 2
DON'T KNOW 8

SECTION 6. HIV AIDS

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

YES 1
NO 2 (GO TO 617)

602) Can people reduce their chance of getting the AIDS virus by having just one uninfected sex partner who has no other sex partners?

YES 1
NO 2
DON'T KNOW 8

603) Can people get the AIDS virus from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

604) Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?

YES 1
NO 2
DON'T KNOW 8

605) Can people get the AIDS virus by sharing food with someone who has AIDS?

YES 1
NO 2
DON'T KNOW 8

606) Can people get the AIDS virus because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

608) Can the virus that causes AIDS be transmitted from a mother to her baby:

a) during pregnancy?
YES 1
NO 2
DON'T KNOW 8
b) during delivery?
YES 1
NO 2
DON'T KNOW 8
c) by breastfeeding?
YES 1
NO 2
DON'T KNOW 8

609) CHECK 608:

AT LEAST ONE 'YES' __ (CONTINUE TO 610)
OTHER __ (GO TO 611)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 613)

612) 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.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
STAND-ALONE VCT CENTER C
OTHER PUBLIC SECTOR (SPECIFY) ____ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC.PRIVATE DOCTOR H
STAND-ALONE VCT CENTER I
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ____ M
OTHER (SPECIFY) ____ X

613) 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

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

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

615) 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

616) 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

617) CHECK 601:

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 (GO TO 701)

618) 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 (GO TO 701)
DON'T KNOW 8 (GO TO 701)

619) The last time you has problems, did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 701)

620) 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.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER F
OTHER PUBLIC SECTOR (SPECIFY) ____ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
STAND-ALONE VCT CENTER I
PHARMACY J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ____ M
OTHER SOURCE
SHOP N
OTHER (SPECIFY) ____ X

SECTION 7. OTHER HEALTH ISSUES

701) Have you ever heard of an illness called tuberculosis or TB?

YES 1
NO 2 (GO TO 706)

702) 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

703) Can tuberculosis be cured?

YES 1
NO 2 (GO TO 705)
DON'T KNOW 8 (GO TO 705)

704) What is the duration of treatment of TB now a days?
[IF MORE THAN 7 MONTHS, RECORD 7]

MONTHS __
DON'T KNOW 8

705) Have you ever been told by a doctor or nurse or LHV that Gos forbid you have/had tuberculosis?

YES 1
NO 2
DON'T KNOW 8

706) Have you ever heard of an illness called Hepatitis B or C?

YES 1
NO 2 (GO TO 709)
DON'T KNOW 8 (GO TO 709)

707) Is there anything a person can do to avoid getting Hepatitis B or C?

YES 1
NO 2 (GO TO 709)
DON'T KNOW 8 (GO TO 709)

708) What can a person do to avoid getting Hepatitis B or C?
PROBE: Any other ways?
[CIRCLE ALL MENTIONED]

SAFE SEX A
SAFE BLOOD TRANSFUSION B
USE OF DISPOSABLE SYRINGE C
AVOID CONTAMINATED FOOD/WATER D
AVOID CONTACT WITH INFECTED PERSON E
MAKING SURE THAT THE INSTRUMENTS OF DENTISTS ARE PROPERLY STERILIZED F
OTHER (SPECIFY) ___ X
NO RESPONSE Y
DON'T KNOW Z

709) Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS __
NONE 00 (GO TO 712)

710) 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 __
NONE 00 (GO TO 712)

711) 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

712) Do you presently smoke cigarettes?

YES 1
NO 2 (GO TO 714)

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

NUMBER OF CIGARETTES __

714) Do you currently smoke or use any other type of tobacco?

YES 1
NO 2 (GO TO 716)

715) What (other) type of tobacco do you currently smoke or use?
[CIRCLE ALL MENTIONED]

PIPE A
CHEWING TOBACCO/NUSWAR B
SNUFF C
HUKAA/SHEESHA D
OTHER (SPECIFY) ____ X

716) RECORD THE TIME.

HOUR __
MINUTES __