PAKISTAN
NATIONAL INSTITUTE OF POPULATION STUDIES

IDENTIFICATION

PROVINCE/REGION

DISTRICT ________

TEHSIL _______

NAME OF HOUSEHOLD HEAD ______

CLUSTER NUMBER ______

HOUSEHOLD NUMBER _________

NAME AND LINE NUMBER OF MAN _______

INTERVIEWER VISITS

FIRST VISIT
DATE _______
INTERVIWER'S NAME _______
RESULT ______

NEXT VISIT DATE _____
TIME ______

SECOND VISIT
DATE _______
INTERVIWER'S NAME _______
RESULT ______

NEXT VISIT DATE _____
TIME ______

THIRD VISIT
DATE _______
INTERVIWER'S NAME _______
RESULT ______

NEXT VISIT DATE _____
TIME ______

FINAL VISIT
DAY _____
MONTH ______
YEAR _____
INT. NO. _______
RESULT _______

TOTAL NUMBER OF VISITS _________

LANGUAGE OF QUESTIONNAIRE** 01
LANGUAGE OF QUESTIONNAIRE** ENGLISH
LANGUAGE OF INTERVIEW** ______
NATIVE LANGUAGE OF RESPONDENT** __________

TRANSLATOR USED

**LANGUAGE CODES

SUPERVISOR
NAME ________
NUMBER ___________

FIELD EDITOR
NAME _______
NUMBER ______

KEYED BY
NUMBER _________

INTRODUCTION AND CONSENT

Asalum-o-Alaikum. My name is _________. I am working with National Institute of Population Studies. We are conducting a survey about health and other topics all over Pakistan. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 30 to 35 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 yours 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 ___________

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME

105) In what month and year were you born?

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

107) Have you ever attended school?

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

110) CHECK 109:

111) 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?

112) CHECK 111:

113) Do you read a newspaper or magazine at least once a week, less than once a week or not at all?

114) Do you listen to the radio at least once a week, less than once a week, or not at all?

115) Do you watch television at least once a week, less than once a week, or not at all?

116) Do you own a mobile telephone?

117) Do you use your mobile phone for any financial transactions?

118) Do you have an account in a bank or other financial institution that you yourself use?

119) Have you ever used the internet?

120) In the last 12 months, have you used the internet?
IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.

121) During the last one month, how often did you use the internet: almost every day, at least once a week, less than once a week, or not at all?

121A) What is your mother tongue?

SECTION 2. REPRODUCTION

201) Now I would like to ask about any children you have had during your life. I am interested in all of the children that are biologically yours, even if they are not legally yours or do not have your last name. Have you ever fathered any children with your wife/wives?

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

203) a) How many sons live with you? IF NONE, RECORD '00.'

b) And how many daughters live with you? IF NONE, RECORD '00.'

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

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

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

206) Do you have a son or a daughter who was born alive but later died? IF NO, PROBE: Any baby who cried, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?

207) a) How many boys have died? IF NONE, RECORD '00.'

b) And how many girls have died? IF NONE, RECORD '00.'

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

209) CHECK 208:

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

211) CHECK 208:

212) CHECK 203 AND 205:

213) CHECK 203 AND 205:

214) CHECK 213:

215) CHECK 203 AND 205

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

217) Were you ever present during any of those antenatal check-ups or did you just accompany your wife to any of those antenatal checkups?

218) Was (NAME) born in a hospital or health facility?

219) 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?

SECTION 3. CONTRACEPTION

301) Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy. Have you ever heard of (METHOD)?

302) In the last few months have you:

302AA) CHECK 302:

302BB) What messages did it convey to you? Anything else? RECORD ALL MENTIONED.

302CC) Do you think that the message you heard was effective or not effective in encouraging couples to use family planning?

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

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

305) Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?

306) After the birth of a child, can a woman become pregnant before her menstrual period has returned?

307) I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.

307AA) Do you know of a place where you can obtain a method of family planning?

SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

401) Are you currently married?

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

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

405) Do you have other wives?

406) Altogether, how many wives do you have?

407) CHECK 405: RECORD THE NAME OF THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE. IF WOMAN IS NOT LSITED IN THE HOUSEHOLD, RECORD '00.'

408) How old was (NAME) on her last birthday?

409) CHECK 407:

410) Have you been married or lived with a woman only once or more than once?

411) CHECK 405 AND 410:

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

413) CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

414) I would like to ask some questions about sexual activity in order to gain a better understanding of some important life issues. 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. How old were you when you had sexual intercourse for the very first time?

414A) CHECK 401:

415) I would like to ask you about your recent sexual activity. 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.

438) The last time you had sex did you or your wife use any method to avoid or prevent a pregnancy?

439) What method did you or your wife use? PROBE: Did you or your wife use any other method to prevent pregnancy?

SECTION 5. FERTILITY PREFERENCES

501) CHECK 401:

502) CHECK 439:

503) CHECK 407:

504) Is your wife currently pregnant?

505) Now I have some questions about the future. After the child you and your wife are expecting now, would you like to have another child, or would you prefer not to have any more children?

506) After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

507) CHECK 208:

508) CHECK 208:

509) Are any of your wives currently pregnant?

510) Now I have some questions about the future. After the (child/children) you and your wives are expecting now, would you like to have another child, or would you prefer not to have any more children?

511) After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

512) CHECK 208:

513) CHECK 208:

514) CHECK 203 AND 205:

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

SECTION 6. EMPLOYMENT AND GENDER ROLES

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

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?

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

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

605) Do you usually work throughout the year, or do you work seasonally, or only once in a while?

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

607) CHECK 401:

608) CHECK 606:

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

610) Who usually makes decisions about health care for yourself: you, your wife, you and your wife jointly, or someone else?

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

612) Do you own this or any other house either alone or jointly with someone else?

613) Do you have a title deed for any house you own?

614) Is your name on the title deed?

614A) Do you have the autonomy to sell the house you own?

615) Do you own any agricultural or non-agricultural land either alone or jointly with someone else?

616) Do you have a title deed for any land you own?

617) Is your name on the title deed?

617A) Do you have the autonomy to sell the land you own?

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

SECTION 7. HIV/AIDS

701) Now I would like to talk about something else. Have you ever heard of HIV or AIDS?

702) HIV is the virus that can lead to AIDS. Can people reduce their chance of getting HIV by having just one uninfected sex partner who has no other sex partners?

703) Can people get HIV from mosquito bites?

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

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

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

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

708) Can HIV be transmitted from a mother to a baby:

709) CHECK 708:

710) Are there any special drugs that a doctor or a nurse can give a woman infected with HIV to reduce the risk of transmission to the baby?

711) CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

712) I don't want to know the results, but have you ever been tested for HIV?

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

714) I don't want to know the results, but did you get the results of the test?

715) Where was the test done? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

717) Where is that? Any other place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

717A) Do you think there is a treatment for HIV?

717B) Do you know from where HIV treatment (Anti Retroviral Treatment) can be received?

720) Would you buy fresh vegetables from a shopkeeper or vendor if you know that this person had HIV?

721) Do you think children living with HIV should be allowed to attend school with children who do not have HIV?

722) Do you think people hesitate to take an HIV test because they are afraid of how other people will react if the test result is positive for HIV?

723) Do people talk badly about people living with HIV, or who are thought to be living with HIV?

724) Do people living with HIV, or thought to be living with HIV, lose the respect of other people?

724A) Do people living with HIV get discriminatory treatment from the health service providers?

725) Do you agree or disagree with the following statement: I would be ashamed if someone in my family had HIV.

726) Do you fear that you could get HIV if you come into contact with the saliva of a person living with HIV?

727) CHECK 701:

728) CHECK 414:

729) CHECK 727: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

730) 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?

731) Sometimes women experience an abnormal discharge from their penis. During the last 12 months, have you had an abnormal discharge from their penis?

732) 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?

733) CHECK 730, 731 AND 732:

734) The last time you had (PROBLEM FROM 730/731/732), did you seek any kind of advice or treatment?

735) Where did you go? Any other place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

736) 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?

737) Is a wife justified in refusing to have sex with her husband when she knows he has sex with women other than his wives?

SECTION 8. OTHER HEALTH ISSUES

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

806) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker? IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90.' IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

807) The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

808) Do you currently smoke tobacco every day, some days, or not at all?

809) In the past, have you smoked tobacco every day?

810) In the past, have you ever smoked tobacco every day, some days, or not at all?

811) On average, how many of the following products do you currently smoke each day? Also, let me know if you use the product, but not every day. IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY DAY, RECORD '888.' IF THE PRODUCT IS NOT USED AT ALL, RECORD '000.'

812) On average, how many of the following products do you currently smoke each week? Also, let me know if you use the product, but not every week. IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY DAY, RECORD '888.' IF THE PRODUCT IS NOT USED AT ALL, RECORD '000.'

812AA) How old were you when you started smoking?

813) Do you currently use smokeless tobacco every day, some days, or not at all?

814) On average, how many times a day do you use the following products? Also, let me know if you the product, but not every day. IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY DAY, RECORD '888.' IF THE PRODUCT IS NOT USED AT ALL, RECORD '000.'

815) On average, how many times a week do you use the following products? Also, let me know if you the product, but not every week. IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY WEEK, RECORD '888.' IF THE PRODUCT IS NOT USED AT ALL, RECORD '000.'

815AA) Do you currently use any types of drugs?

815BB) Have you ever heard of an illness called tuberculosis or TB?

815CC) How does tuberculosis spread from one person to another? Any other ways? RECORD ALL MENTIONED.

815DD) Can tuberculosis be cured?

815EE) What is the duration of treatment of TB now a days? IF MORE THAN 7 MONTHS, RECORD 7.

815FF) Have you ever been told by a doctor or nurse or LHV that god forbid you to have/had tuberculosis?

815GG) Have you ever heard of illness called Hepatitis B or C?

815HH) Is there anything a person can do to avoid getting Hepatitis B or C?

815II) What can a person do to avoid getting Hepatitis B or C? Any other ways? RECORD ALL MENTIONED.

815JJ) I don't want to know the results, but have you ever been tested for Hepatitis B or C?

815KK) How many months ago was your most recent test for Hepatitis B or C?

816) Are you covered by any health insurance?

817) What type of health insurance are you covered by? RECORD ALL MENTIONED.

817A) Do you receive any cash/kind benefit from Benazir Income Support Program through the government of Pakistan?

818) RECORD THE TIME.

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT INTERVIEW: ______________________

COMMENTS ON SPECIFIC QUESTIONS: _______________________

ANY OTHER COMMENTS: ______________________

SUPERVISOR'S OBSERVATIONS:_____________

EDITOR'S OBSERVATIONS ______________________