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RWANDA DEMOGRAPHIC AND HEALTH SURVEY- 2005 INDIVIDUAL QUESTIONNAIRE MALE

MINECOFIN
REPUBLIC OF RWANDA
DEPARTMENT OF STATISTICS

IDENTIFICATION

PLACE NAME __________
NAME OF HOUSEHOLD HEAD ___________
PROVINCE ____________
DISTRICT ___________
CLUSTER NUMBER __________
STRUCTURE NUMBER __________
HOUSEHOLD NUMBER ___________

URBAN/ RURAL ___________

URBAN 1
RURAL 2

KIGALI CITY/ OTHER TOWNS/ RURAL ____

KIGALI CITY 1
Other Towns 2
Rural 3

NAME AND LINE NUMBER OF MAN ____________

INTERVIEWER VISITS

FIRST INTERVIEW (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE______
INTERVIEWER’S NAME ______
RESULT* __________

*RESULT CODES:

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

NEXT VISIT: (FOR INTERVIEWERS 1 AND 2)
DATE____
HOUR_____

FINAL VISIT
DAY ___
MONTHS ___
YEAR 200__
CODE ____
RESULT____

TOTAL NUMBER OF VISITS ____

LANGUAGE OF INTERVIEW

KINYARWANDA 1
OTHER LANGUAGE (SPECIFY)________ 2

INTERPRETED

YES 1
NO 2

TEAM LEADER
NAME ____
DATE ____

FIELD CONTROLLER
NAME ____
DATE ____

OFFICE EDITOR_____

KEYED BY ______

SECTION 1. SOCIAL DEMOGRAPHIC CHARACTERISTICS OF RESPONDENT

INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is ________ and I am working with NATIONAL POPULATION OFFICE.
We are conducting a national survey about the health of men, women and children.
We would very much appreciate your participation in this survey.
I would like to ask you some questions related to health. This information will help the government to plan health services. The survey usually takes about 30 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 you can choose not to answer any individual question or all of the questions. 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 YHE INTERVIEW)
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?
IF “FOREIGN”, SPECIFY THE TYPE OF PLACE OF RESIDENCE

KIGALI/CITY 1
OTHER TOWNS 2
COUNTRY SIDE 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?
IF “FOREIGN”, SPECIFY THE TYPE OF PLACE OF RESIDENCE

KIGALI/CITY 1
OTHER TOWNS 2
COUNTRY SIDE 3

105. In the last 12 months, on how many separate occasions have you traveled away from your home community and slept away?

NUMBER OF TRIPS ____
NONE 00 (GO TO 107)

106. In the last 12 months, have you been away from your home community for more than 1 month at a time?

YES 1
NO 2

107. In what month and year were you born?

MONTH ___
DK MONTH 98
YEAR ____
DK YEAR 9998

108 How old were you at your last birthday?
COMPARE AND CORRECT 107 AND/OR 108 IF INCONSISTENT.

AGE IN COMPLETED YEARS ____

109. Have you ever attended school?

YES 1
NO 2 (GO TO 113)

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

PRIMARY 1
POST-PRIMARY 2
SECONDARY 3
TERTIARY 4

111. What is the highest (class/form/year) you completed at that level?

CLASS/YEAR ___

112. CHECK 110:

PRIMARY (GO TO 113)
SECONDARY OR MORE (GO TO 116)

113. Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE:
Can you read any part of the sentence to me?

CANNOT READ AT ALL 1
ABLE TO READ ONLY CERTAIN PARTS 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) ____ 4
BLIND/VISUALLY IMPAIRED 5

114. Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)?

YES 1
NO 2

115. CHECK 113:

CODE ‘2’, ‘3’ OR ‘4’ CIRCLED (GO TO 116)
CODE ‘1’ OR ‘5’ CIRCLED (GO TO 117)

116. 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 3

117. 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 3

118. 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 3

119. Are you currently working for which you earn money?

YES 1 (GO TO 122)
NO 2

120. Have you earned money for any work done in the last 12 months?

YES 1 (GO TO 122)
NO 2

121. What have you been doing for most of the time over the last 12 months?

GOING TO SCHOOL/STUDYING 1 (GO TO 129)
LOOKING FOR WORK 2 (GO TO 129)
RETIRED 3 (GO TO 129)
UNABLE TO WORK, ILL/HANDICAPPED 4 (GO TO 129)
HOUSEWORK/CHILDCARE 5 (GO TO 129)
OTHERS (SPECIFY) _____ 6 (GO TO 129)

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

__________

123. CHECK 122:

WORKS IN AGRICULTURE (GO TO 124)
DOES NOT WORK IN AGRICULTURE (GO TO 125)

124. 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
SHARECROPPER 5

125. During the last 12 months, how many months did you work?

NUMBER OF MONTHS ____

125A. Do you do this work for a member of your family, somebody or on your own?

FOR A MEMBER OF FAMILY 1
FOR SOMEONE ELSE 2
ON HIS OWN 3

126. 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 129)
NOT PAID 4 (GO TO 129)

127. Who mainly decides how the money you earn will be used?

RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5

128. 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?

NONE, HIS INCOME IS SAVED 1
ALMOST NONE 2
LESS THAN HALF 3
HALF 4
MORE THAN HALF 5
ALL/NEARLY HALF 6

129. What is your religion?

CATHOLIC 1
PROTESTANT 2
MUSLIM 3
TRADITIONAL RELIGION 4
7TH DAY ADVENTIST 5
OTHER (SPECIFY) ______ 6
NONE 7

129A. During last four weeks, did you have

a) Have a consultation with a service provider?
YES 1
NO 2
b) Hospitalized for at least a night?
YES 1
NO 2

129B CHECK Q 129A a)

Q. 129A a) YES (GO TO 129C)
Q. 129A a) NO (GO TO 129G)

129C Where did the last consultation with a service provider take place?

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
DBC AGENT 13
OTHER PUBLIC (SPECIFY) _____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
ARBEF CLINIC 24
INFIRMARY 25
OTHER PRIVATE MEDICAL (SPECIFY) ____ 26
OTHER SOURCE
SHOP/KIOSK 31
OTHER (SPECIFY) ____ 96

129D. How much did you pay in total for the last consultation, including the drugs and the tests of laboratory?

PRICE _____

FREE 00000
DON’T KNOW 99998

129E. Were there any (other) expenditures for medicines related to this consultation and paid to a pharmacy?

YES 1
NO 2 (GO TO 129G)
DON’T KNOW 8 (GO TO 129G)

129F. How much did you pay to the pharmacy for these medicines?

PRICE _____
DON’T KNOW 99998

129G. CHECK Q 129A b) Q 129A b)

Q 129A b) YES (GO TO 129H)
Q 129A b) NO (GO TO 129J)

129H. Where were you hospitalized the last time for at least a night?

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
OTHER PUBLIC (SPECIFY) _____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
ARBEF CLINIC 22
OTHER PRIVATE MEDICAL (SPECIFY) ____ 26
OTHER (SPECIFY) ____ 96

129I. How much in total did you pay for the hospitalization?

PRICE ____

FREE 00000
DON’T KNOW 99998

129J Which type of insurance do you currently have?

NONE 1
RAMA MUTUAL 2
OTHER MUTUAL (SPECIFY) _____ 3
OTHER NON-MUTUAL (SPECIFY) _____ 6
DON’T KNOW 8

SECTION 2: REPRODUCTION

201. Now I would like to ask about any children you have had during your life. I am interested only in the children that are biologically yours. Have you ever fathered any children with any woman?

YES 1
NO 2 (GO TO 206)
DON’T KNOW (GO TO 206)

202. Do you have any sons or daughters that you have fathered 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 ___
GIRLS AT HOME ___

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

YES 1
NO 2 (GO TO 206)
DON’T KNOW (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 ____
GIRLS ELSEWHERE ____

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

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

207. How many boys have died?
And how many girls have died?
IF NONE, RECORD ‘00’.

BOYS DEAD ___
GIRLS DEAD ___

208. (In addition to the children that you have just told me about), do you have:
any other living sons or daughters who are biologically your children but who are not legally yours or do not have your last name? ____YES ____NO

a) any other sons or daughters who died who were biologically your children but who were not legally yours or did not have your last name? ____YES ____NO

NO TO BOTH (GO TO 209)
YES TO AT LEAST 2 CASES (PROBE AND CORRECT 201-207 AS NECESSARY)

209. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL.
IF NONE, RECORD ‘00’.

TOTAL ____

210. CHECK 209 :

HAS HAD MORE THAN ONE CHILD (GO TO 211)
HAS HAD ONLY ONE CHILD (GO TO 213)
HAS NOT HAD ANY CHILD (GO TO 214)

211. Do the children that you have fathered all have the same biological mother?

YES 1 (GO TO 213)
NO 2

212. In all, with how many women have you fathered children?

NUMBER OF WOMEN ___

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

AGE IN YEARS ____

214. Are there children who depend mainly on you?

YES 1
NO 2 (GO TO 301)

215. Among the children who depend mainly on you, are any less than 18 years old?

YES 1
NO 2 (GO TO 301)

216. Now I would like to speak with you about the children less than 18 years which depend mainly on you. Have you made arrangements for someone to take care of these children if you would fall sick or if you could not take care of them anymore?

YES 1
NO 2
DON’T KNOW 8

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 RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302 IF APPLICABLE.

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

01 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO NEXT METHOD)
02 MALE STERILIZATION 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 avoid 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 INJECTABLES 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 IMPLANTS Women can have several 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 (GO TO NEXT METHOD)
07 CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
08 FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
09 DIAPHRAGM Women can place a thin flexible disk in their vagina before intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
10 FOAM OR JELLY Women can place a suppository, jelly, or cream in their vagina before intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
11 LACTATIONAL AMENORRHEA METHOD (LAM) Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2 (GO TO NEXT METHOD)
12 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)
12A STANARD DAYS METHOD, USING BEADS The woman know days of the month when she can get pregnant by using beads or calendar
YES 1
NO 2 (GO TO NEXT METHOD)
13 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2 (GO TO NEXT METHOD)
14 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)
15 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1 (SPECIFY)______
NO 2

302. Have you ever used (METHOD)?

02 MALE STERILIZATION 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
07 CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
12 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
DON’T KNOW 8
13 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2

303. 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?

YES 1
NO 2 (GO TO 305)
DON’T KNOW 8 (GO TO 305)

304. 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 ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) _____ 6
DON’T KNOW 8

305. Do you think that a woman who is breastfeeding her baby can become pregnant?

YES 1
NO 2
IT DEPENDS 3
DON’T KNOW 8

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

a) Contraception is women’s business and a man should not have to worry about it.
AGREE 1
DISAGREE 2
DON’T KNOW/NO OPINION 3
b) Women who use contraception may become promiscuous.
AGREE 1
DISAGREE 2
DON’T KNOW/NO OPINION 3
c) A woman is the one who gets pregnant so she should be the one to use contraception.
AGREE 1
DISAGREE 2
DON’T KNOW/NO OPINION 3

SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

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

YES, CURRENTLY MARRIED 1
YES, LIVING WITH A MAN 2
NO, NOT IN UNION 3 (GO TO 406)

401A. Is your wife/partner living with you now, or does she live elsewhere?

LIVING TOGETHER CURRENTLY 1
STAYING ELSWHERE 2

401B. CHECK 401:

CURRENTLY MARRIED (GO TO 402)
LIVES WITH A WOMAN (GO TO 404)

402. Do you have one wife or more than one wife?
IF ONLY ONE WIFE, RECORD ‘01’
IF MORE THAN ONE, ASK: How many wives do you currently have?

NUMBER OF WOMEN ___

403. Are there any other women with whom you live as if married?

YES 1
NO 2 (GO TO 405)

404. How many women are you living with as if married?
IF ONLY ONE LIVE-IN PARTNER, RECORD ‘01’

NUMBER OF LIVE-IN PARTNERS ___

405. Apart from the woman/women you have already mentioned, do you currently have any other regular or occasional sexual partners?

REGULAR PARTNER(S) ONLY 1 (GO TO 409)
OCCASIONAL PARTNER(S) ONLY 2 (GO TO 409)
REGULAR AND OCCASIONAL PARTNERS 3 (GO TO 409)
NO SEXUAL PARTNER 4 (GO TO 409)

406. Do you currently have any regular sexual partners, occasional sexual partners, or do you have no sexual partner at all?

REGULAR PARTNER(S) ONLY 1
OCCASIONAL PARTNER(S) ONLY 2
REGULAR AND OCCASIONAL PARTNERS 3
NO SEXUAL PARTNER 4

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

YES, FORMERLY MARRIED ONLY 1
YES, LIVED WITH A WOMAN ONLY 2 (GO TO 411)
YES, BOTH
NO 4 (GO TO 416)

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

WIDOWED 1 (GO TO 411)
DIVORCED 2 (GO TO 411)
SEPARATED 3 (GO TO 411)

409. WRITE THE LINE NUMBERS FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE/PARTNER REPORTED IN QUESTIONS 402 AND 404 ONLY.
IF A WIFE/PARTNER IS NOT LISTED IN THE HOUSEHOLD SCHEDULE, RECORD ‘00’ IN THE LINE NUMBER BOXES.
THE NUMBER OF LINES FILLED IN MUST BE EQUAL TO THE NUMBER OF WIVES AND PARTNERS.
(IF RESPONDENT HAS MORE THAN FIVE WIVES/ PARTNERS USE ADDITIONAL QUESTIONNAIRE(S).)

CHECK: 402 AND 404:
THE SUM OF 402 AND 404 EQUALS 1
Please tell me the name of your partner.

THE SUM OF 402 AND 404 EQUALS 2 OR MORE
Please tell me the name of each (wife/partner that you live with as if married), starting with the one you lived with first.)

________________________

LINE NUMBER IN HHD. QUESTION

________________________
WIFE 1
PARTNER 2

410. CHECK: 409

ONLY ONE WIFE/PARTNER (GO TO 411)
2 WIVES/PARTNERS OR MORE (GO TO 412)

411. Have you been married or lived with a woman only once or more than once?

ONCE 1 (GO TO 414)
MORE THAN ONCE 2 (GO TO 413)

412. Have you ever been married to or lived as if married to any woman other than those you have just mentioned?

YES 1
NO 2 (GO TO 414)

413. In total, in your whole life, how many women have you been married to or lived with as if married?

NUMBER OF WOMEN _____

414. CHECK 409 AND 411:

ONLY ONE WIFE PARTNER
In what month and year did you start living with your wife/partner?

MARRIED/LIVING WITH A WOMAN/MORE THAN ONE WOMAN
Now we will talk about your first wife/partner. In what month and year did you start living with her?

MONTH ___
DOESN’T KNOW MONTH 98
YEAR ____ (GO TO 416)
DOESN’T KNOW YEAR 9998

415. How old were you when you started living with her?

AGE ____

416. 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 with a woman (if ever)?

NEVER 00
AGE IN YEARS ___ (GO TO 416B)
1ST TIME WAS WHEN BEGAN LIVING WITH 1ST WIFE/PARTNER 95 (GO TO 416B)

416A. Do you intend to wait until you get married to have sexual intercourse for the first time ?

YES 1 (GO TO 439)
NO 2 (GO TO 439)
NOT SURE (GO TO 439)

416B CHECK : 108

AGE 15-24 YRS (GO TO 416C)
AGE 25-59 YRS (GO TO 417)

416C. The first time you had sexual intercourse, was a condom used?

YES 1
NO 2

416D. How old was the person with whom you had your first sexual relations?

AGE OF PARTNER __ (GO TO 417)
DON’T KNOW 98

416E. Was this person older than you, more young person or had it approximately the same age as you?

OLDER 1
YOUNGER 2 (GO TO 417)
SAME AGE 3 (GO TO 417)
DK/DON’T REMEMBER 8 (GO TO 417)

416F. Would you say that this person had ten years more than you or more, or less than ten years more than you?

TEN OR MORE YEARS 1
LESS THAN TEN YEARS 2
OLDER, DK HOW MANY YEARS 3

417. How long ago that you had your last sexual relations with a woman?
RECORD IN ‘‘NUMBER OF YEARS’’ ONLY IF THE LAST INTERCOURSE TOOK PLACE IN A YEAR OR MORE
IF 12 MONTHS OR MORE, THE ANSWER MUST BE RECORDED IN YEARS.

NUMBER OF DAYS 1 ___
NUMBER OF WEEKS 2 ___
NUMBER OF MONTHS 3 ___
NUMBER OF YEARS 4 ___ (GO TO 436A)

Q. 418- Q. 433 ARE ASKED OF LAST SEXUAL PARTNER, SECOND LAST SEXUAL PARTNER AND THIRD LAST SEXUAL PARTNER.

418. The last time that you had sexual relations with a woman, a condom was used?

YES 1
NO 2 (GO TO 426)

420. Did you use a condom each time you had sexual relations with this person during 12 months last?

YES 1
NO 2

426. The last time that you had sexual intercourse with this third person, did you or your partner drink alcohol?

YES 1
NO 2 (GO TO 428)

427. Was person or yourself drunk at this time?
If YES : Who drank alcohol?

RESPONDENT ONLY 1
PARTNER ONLY 2
RESPONDENT AND PARTNER 3
NEITHER ONE 4

428. What is your relationship to this person with whom you had last sexual intercourse?
IF “GIRLFRIEND “ OR “FIANCÉE”, ASK :
Was your girlfriend/fiancée living with you the last time that you had sex together?
IF ‘YES’, CIRCLE ‘01’
IF ‘NO’, CIRCLE ‘02’

SPOUSE/COHABITATING PARTNER 1
GIRLFRIEND/FIANCE 2
OTHER FRIEND 3
CASUAL ACQUAINTANCE 4
RELATIVE 5
COMMERCIAL SEX WORKER 6
OTHER (SPECIFY) ____ 7

429. For how long you did have sexual intercourse with this woman?
IF HE HAD SEXUAL INTERCOURSE WITH THIS WOMAN ONLY ONCE, RECORD ‘01’ TO DAYS.

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

430. CHECK: 103

MALE AGED 15-24 YEARS (GO TO 431)
MALE AGED 25-59 YEARS (GO TO 434)

431. How old was this person?

AGE OF PARTNER (GO TO 434)
DON’T KNOW 98

432. Was this person older than you, young than you or had almost the same age as you?

OLDER 1
YOUNGER 2 (GO TO 434)
SAME AGE 3 (GO TO 434)
DK 8 (GO TO 434)

433. Do you think he is more than 10 years older than you?

10 OR MORE YEARS OLDER 1
LESS THAN 10 YEARS OLDER 2
OLDER, DK 8

434. Other than this (these) women, have you had sex with any other woman in the last 12 months?

YES 1 (RETURN TO 418 IN NEXT COLUMN)
NO 2 (GO TO 436A)

435. In all, with how many different people have you had sexual relations with in the last 12 months?
IN CASE OF A NON-NUMERICAL ANSWER, INSIST TO OBTAIN ESTIMATION. IF THE NUMBER IS GREATER THAN ‘ 95 ‘, RECORD ‘ 95 ‘;

NUMBER OF PARTNERS ____

436A. In the last 12 months, did you pay anyone in exchange for sex?

YES 1
NO 2 (GO TO 437A)

436B. The last time you paid someone in exchange for sex, was a condom used?

YES 1
NO 2 (GO TO 438)

436C. Did you use a condom during every sexual intercourse every time you paid someone in exchange for sex in the last 12 months?

YES 1 (GO TO 438)
NO 2 (GO TO 438)
DK/NOT SURE 8 (GO TO 438)

437A. Have you ever in your life paid someone in exchange for sex?

YES 1
NO 2 (GO TO 438)

437B. How long has it been since you’ve paid someone in exchange for sex?

NO. OF DAYS 1 ___
NO. OF WEEKS 2 ___
NO. OF MONTHS 3 ___
NO. OF YEARS 4 ___

437C. The last time that you paid someone in exchange for sex, was a condom used?

YES 1
NO 2

438. In total, how many different people have you had sexual intercourse with in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, RECORD ‘95’.

NUMBER OF PARTNERS ___

439. Do you know of a place where a person can get condoms?

YES 1
NO 2 (GO TO 442)

440. Where is that?
IF THE 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.

(NAME OF PLACE) ___________________________________

Any other place?
RECORD ALL SOURCES MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
AGENT DBC C
OTHER PUBLIC (SPECIFY) _____ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
ARBEF CLINIC H
INFIRMARY I
OTHER PRIVATE MEDICAL (SPECIFY) ____ J
OTHER SOURCE
SHOP/KIOSQUE K
CHURCH L
PARENTS/AMIS M
OTHER (SPECIFY) ____ X

440A. Do you know a place where you could go on foot to get a condom?

YES 1
NO 2 (GO TO 442)

440B. How long would it take for you to go and come back, on foot, to the closest place to get a condom?

MINUTES ___
ON THE SPOT 996

442. CHECK 302(07), 416C, 436B AND 437C : USE OF CONDOMS

AT LEAST ONE “YES” (GO TO 443)
NOT ONE “YES” (GO TO 447)

443. How old were you when you used a condom for the first time?

AGE IN YEARS THE 1ST TIME USED CONDOM ____
DON’T KNOW/CAN’T REMEMBER 98

445. Have you run into any problems using a condom?
IF “YES”: What were the problems ?
ASK : Any other problem ?
RECORD ALL PROBLEMS MENTIONED.

EMBARRASSING TO BUY/TOGET A CONDOM A
DIFFICULT TO PUT ON/TO GET OFF B
IT SPOILS THE MOOD C
IT REDUCES MY PLEASURE D
MY WIFE PARTNER DOESN’T LIKE IT E
MY WIFE/PARTNER IS ALREADY PREGNANT F
NOT PRACTICAL TO USE G
IT BREAKS/IT DOESN’T STAY IN PLACE H
OTHER (SPECIFY) ____ X
NO PROBLEMS Y

447. Now I would like to read you certain statements that other people have made on the use of condoms.
Could you tell me if you agree or not with each of the following statements?

a) A condom reduces sexual pleasure for the man.
AGREE 1
NOT AGREE 2
DON’T KNOW/NO OPINION 3
b) A condom is not practical to use.
AGREE 1
NOT AGREE 2
DON’T KNOW/NO OPINION 3
c) A condom can be re-used.
AGREE 1
NOT AGREE 2
DON’T KNOW/NO OPINION 3
d) A condom protects against getting disease.
AGREE 1
NOT AGREE 2
DON’T KNOW/NO OPINION 3
e) Buying condoms is embarrassing.
AGREE 1
NOT AGREE 2
DON’T KNOW/NO OPINION 3
f) A woman doesn’t have the right to tell a man to use a condom.
AGREE 1
NOT AGREE 2
DON’T KNOW/NO OPINION 3

SECTION 5. FERTILITY PREFERENCES

501. CHECK 409:

HAS ONE WIFE/PARTNER (GO TO 502)
HAS 2 WIVES/PARTNERS, OR MORE (GO TO 502)
NOT ASKED (GO TO 505)

502. Is your wife/partner (any of your wives/partners) currently pregnant?

YES 1
NO 2
UNSURE 3

503. CHECK 502:

YES, WIFE(S)/PARTNER(S) PREGNANT
Now I have some questions about the future. After the child(ren) your wife/wives/partner(s) is/are expecting now, would you like to have another child or would you prefer not to have any more children at all?

NO, NO WIFE/PARTNER PREGNANT OR NOT SURE
Now I have some question about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children at all?

HAVE A/ANOTHER CHILD 1
NO MORE/NONE 2 (GO TO 505)
WIFE/WIVES INFECUND/STERILIZED 3 (GO TO 505)
UNDECIDED/DON’T KNOW 8 (GO TO 505)

504. 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) ____ 9996
DON’T KNOW 998

505. 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?

PROBE FOR A NUMERIC RESPONSE.

NO CHILDREN 00 (GO TO 507)
NUMBER ___
OTHER (SPECIFY) ____ 96 (GO TO 507)

506 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

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

APPROVE 1
DISAPPROVE 2
DON’T KNOW/UNSURE 8

508. In the last few months have you heard about family planning:

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

510. 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 512)

511. With who have you discussed it?
Anyone else?
RECORD ALL PERSONS MENTIONED.

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

512. In the last few months, have you discussed the practice of family planning with a health worker or health professional?

YES 1
NO 2

SECTION 6. PARTICIPATION IN HEALTH CARE

601. CHECK 209:

HAS HAD ONE OR MORE CHILDREN (GO TO 602)
HAS NOT HAD ANY CHILDREN (GO TO 617)

602. Please tell me the name and sex of your child (who was born most recently).

(NAME OF CHILD) ________________________
BOY 1
GIRL 2

603. In what month and year was (NAME OF CHILD) born?

MONTH ___
YEAR ____

604. Is (NAME OF CHILD) still living?

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

605. How old was (NAME OF CHILD) when he/she died?
IF ‘1 YEAR’, PROBE:
How many months old was (NAME)?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1 ___
MONTHS 2 ___
YEARS 3 ___

DON’T KNOW 998

606. What is the name of (NAME OF CHILD)’s mother?
WRITE THE CHILD’S MOTHER’S NAME AND HER LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE.
IF THE MOTHER IS NOT LISTED IN THE HOUSEHOLD SCHEDULE RECORD ‘00’

LINE NUMBER ____

607. CHECK 603:

(LAST) CHILD BORN SINCE JANUARY 2000 OR LATER (GO TO 608)
(LAST) CHILD BORN BEFORE JANUARY 2000 (GO TO 617)

608. CHECK 603:

LINE NUMBER IS ‘00’ (GO TO 608)
OTHER LINE NUMBER (GO TO 610)

609. What is your relationship with (NAME OF MOTHER OF LAST CHILD BORN)?

CURRENT SPOUSE 01
FORMER SPOUSE 02
CURRENT LIVE-IN PARTNER 03
FORMER LIVE-IN PARTNER 04
REGULAR SEXUAL PARTNER 05
WOMAN IS GIRLFRIEND/FIANCEE 06
OCCASIONAL SEXUAL PARTNER 07
FRIEND/ACQUIANTANCE 08
OTHER (SPECIFY) ______ 96

610. AFTER ASKING Q610A, FIRST ASK Q611 AND Q612 ABOUT PREGNANCY, THEN610B, 611 AND 612 ABOUT DELIVERY, AND PROCEED IN THE SAME WAY FOR THE COLUMN “ 6 WEEKS AFTER DELIVERY”. ALL QUESTIONS REFER TO THE LAST BIRTH.

Now, think back to the time when (NAME OF CHILD’S MOTHER !606) was pregnant with (NAME OF CHILD Q602).

PREGNANCY:
610A. Did (NAME OF CHILD’S MOTHER) recieve any antenatal care from a doctor or any health care provider when she was pregnant with (NAME OF CHILD)?

YES 1
NO 2 (GO TO 612)
DON’T KNOW 8 (GO TO 610B IN NEXT COLUMN)

DELIVERY
610B: Did a doctor or any health care provider assist with the delivery of (NAME OF CHILD)?

YES 1
NO 2 (GO TO 612)
DON’T KNOW 8 (GO TO 610C IN THE NEXT COLUMN)

6 WEEKS AFTER DELIVERY
610C: Did (NAME OF CHILD’S MOTHER) receive any care for herself from a doctor or any health care provider during the six weeks after this delivery?

YES 1
NO 2 (GO TO 612)
DON’T KNOW 8 (GO TO 613 IN THE NEXT COLUMN)

611 Who mainly provided the money or goods or services to pay for this care?

FREE 01 (GO TO 610B IN THE NEXT COLUMN)
INSURANCE 02 (GO TO 610B IN THE NEXT COLUMN)
RESPONDENT 03 (GO TO 610B IN THE NEXT COLUMN)
CHILD’S MOTHER 04 (GO TO 610B IN THE NEXT COLUMN)
RESPONDENT AND CHILD’S MOTHER 05 (GO TO 610B IN THE NEXT COLUMN)
RESPONDENT’S FAMILY 06 (GO TO 610B IN THE NEXT COLUMN)
CHILD’S MOTHER’S FAMIY 07 (GO TO 610B IN THE NEXT COLUMN)
OTHER (SPECIFY) _____ 96 (GO TO 610B IN THE NEXT COLUMN)

612. What was the main reason (NAME OF CHILD’S MOTHER) did not receive any advice or care from a doctor or other health care provider during (pregnancy/ delivery/the six weeks after delivery)?

NOT NECESSARY 01 (GO TO 610B IN THE NEXT COLUMN)
NOT CUSTOMARY 02 (GO TO 610B IN THE NEXT COLUMN)
RESPONDENT DIDN’T ALLOW 03 (GO TO 610B IN THE NEXT COLUMN)
TOO COSTLY 04 (GO TO 610B IN THE NEXT COLUMN)
TOO FAR/NO TRANSPORT 05 (GO TO 610B IN THE NEXT COLUMN)
POOR SERVICE 06 (GO TO 610B IN THE NEXT COLUMN)
LACK OF KNOWLEDGE 07 (GO TO 610B IN THE NEXT COLUMN)
OTHER (SPECIFY) ____ 96 (GO TO 610B IN THE NEXT COLUMN)

613. At any time while (NAME OF CHILD’S MOTHER) was pregnant with (NAME OF CHILD), did you yourself talk with a doctor or any other health care provider about the health of the mother or of the pregnancy?

YES 1
NO 2

614. CHECK 602 AND 604:

NAME OF (LAST) CHILD _____________
(LAST) CHILD LIVING (GO TO 615)
(LAST) CHILD NOT LIVING OR DON’T KNOW (GO TO 617)

615. Does (NAME OF CHILD) live with you in your household?

YES 1
NO 2 (GO TO 617)

616. In your household who usually decides what to do if the (NAME OF CHILD) is ill?
RECORD ALL PERSONS MENTIONED.

RESPONDENT A
CHILD’S MOTHER B
WIFE/PARTNER WHO IS NOT CHILD’S MOTHER C
FEMALE RELATIVE D
MALE RELATIVE E
OTHER (SPECIFY) _____ X
CHILD HAS NEVER BEEN ILL Y

617. Now, I want to talk to you about pregnancy and the health of children.
Sometimes a pregnancy can have complications that lead to miscarriage or even death. What are some of the signs and symptoms that indicate that a pregnancy may be in danger?
PROBE: Any other signs or symptoms?
RECORD ALL SIGNS AND SYMPTOMS MENTIONED.

VAGINAL BLEEDING A
HIGH FEVER B
ABDOMINAL PAIN C
SWELLING OF HANDS AND FEET D
DIFFICULT LABOR FOR MORE THAN 12 HOURS E
CONVULSIONS F
OTHER (SPECIFY) _____ X
DON’T KNOW ANY SIGNS OR SYMPTOMS Y

618. When a child has diarrhoea, should he/she be given less to drink than usual, about the same amount, or more than usual?

LESS 1
ABOUT THE SAME 2
MORE 3
DON’T KNOW 8

619. Have you ever heard of a special product called [LOCAL NAME FOR ORS PACKET] you can get for the treatment of diarrhea?

YES 1
NO 2

620. Now, please tell me about yourself.
Do you currently smoke cigarettes or tobacco?
IF YES: What type of tobacco do you smoke?
RECORD ALL TYPES MENTIONED.

YES, CIGARETTES A
YES, PIPE B
YES, OTHER TOBACCO C
NO Y

621. CHECK 620:

CODE ‘1 CIRCLED (GO TO 622)
CODE ‘A’ NOT CIRCLED (GO TO 623)

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

CIGARETTES ____

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

YES 1
NO 2 (GO TO 701)

624. In the last 3 months, on how many days did you drink an alcohol-containing beverage?
IF EVERY DAY, RECORD ‘90’.

NUMBER OF DAYS ___
NONE/NEVER 95

625. Have you ever gotten “drunk” from drinking an alcohol-containing beverage?

YES 1
NO 2 (GO TO 701)

626. CHECK 624:

DRANK ALCOHOL AT LEAST 1 DAY (GO TO 627)
NONE (GO TO 701)

627. In the last 3 months, on how many occasions did you get “drunk”?

NUMBER OF TIMES ___
NONE/NEVER 95

SECTION 7. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

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

YES 1
NO 2 (GO TO 735)

702. Can people reduce their chances of getting the AIDS virus by having just one sex partner who is not infected and has no other partners?

YES 1
NO 2
DON’T KNOW 8

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

YES 1
NO 2
DON’T KNOW 8

704. 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

705. Can a person get the AIDS virus by sharing food with a person who has AIDS?

YES 1
NO 2
DON’T KNOW 8

706. Can people reduce their chance of getting the AIDS virus by not having sex at all?

YES 1
NO 2
DON’T KNOW 8

707. Can people get the AIDS virus because of witchcraft or other supernatural means?

YES 1
NO 2
DON’T KNOW 8

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

YES 1
NO 2 (GO TO 710)
DON’T KNOW 8 (GO TO 710)

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

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL PERTNERS 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 SHARING RAZORS/BLADES K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM TRADITIONAL PRACTITIONER N
OTHER (SPECIFY) ____ W
OTHER (SPECIFY) ____ X
DON’T KNOW Z

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

YES 1
NO 2
DON’T KNOW 8

711. Can the virus that causes AIDS be transmitted from a mother to her child...

During pregnancy?
During delivery?
By breastfeeding?

DURING PREG
YES 1
NO 2
DK 8
DURING DELV
YES 1
NO 2
DK 8
DURING BRSTFD
YES 1
NO 2
DK 8

712. CHECK 711:

A YES IN AT LEAST ONCE (GO TO 713)
OTHER (GO TO 714)

713. Are there special drugs that a doctor or a nurse can give to a woman infected with the AIDS virus to reduce the risk of transmission to the baby during pregnancy?

YES 1
NO 2
DON’T KNOW 8

714. Are there special drugs, which a person infected with the AIDS virus can get from the doctor or the nurse?

YES 1
NO 2
DON’T KNOW 8

715. I don’t 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 720)

716. When was the last time you were tested?

LESS THAN 12 MONTHS 1
12-23 MONTHS 2
2 YEARS OR MORE 3

717. 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?

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

718. I don’t want to know the results, but did you get the results of the test?

YES 1
NO 2

719. 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 THE APPROPRIATE CODE

(NAME OF PLACE)______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
VCT CENTER 13
OTHER PUBLIC (SPECIFY) _____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 22
VCT CENTER 23
ARBEF CLINIC 24
INFIRMARY 25
OTHER PRIVATE MEDICAL (SPECIFY) ____ 26

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

YES 1
NO 2 (GO TO 722)

721. Where?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITES THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE

(NAME OF PLACE)_____________

Are there other places?
RECORD ALL PLACES MENTIONED

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
VCT CENTER C
OTHER (SPECIFY) _____ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PRIVATE DOCTOR F
VCT CENTER G
ARBEF CLINIC H
INFIRMARY I
OTHER PRIVATE MEDICAL (SPECIFY) ____ X

722. Would you buy fresh vegetables from a vendor who has the AIDS virus?

YES 1
NO 2
DON’T KNOW 8

722A. In your opinion, is it acceptable or unacceptable for AIDS to be discussed:

on the radio?
on the TV?
in newspapers?

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

722B. During the last three, have you ever heard or seen on AIDS through the media?

YES 1
NOT ACCEPTABLE 1
ACCEPTABLE 2

722C. In what media coverage did you hear or see something about AIDS
The radio?
The TV?
In newspapers?
On posters, leaflets or logo

ON THE RADIO
NOT ACCEPTABLE 1
ACCEPTABLE 2
ON THE TV
NOT ACCEPTABLE 1
ACCEPTABLE 2
NEWSPAPERS
NOT ACCEPTABLE 1
ACCEPTABLE 2
POSTER/SLEAFLETS OR LOGO
NOT ACCEPTABLE 1
ACCEPTABLE 2

722D. Have you changed your behavior as results of things you have ever heard or seen about AIDS?

YES 1
NO 2 (GO TO 722F)
DON’T KNOW 8 (GO TO 722F)

722E. How and In what way did you change your behavior?
RECORD ALL WAYS MENTIONED.

LIMIT NUMBER OF SEX PARTNERS A
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER B
AVOID SEX WITH OCCASIONAL PARTNERS C
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS D
USE CONDOM FOR SEX WITH OCCASIONAL PARTNER E
ABSTAIN FROM SEX F
AVOID BLOOD INJECTIONS
GAVOID TRANSFUSIONS H
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X

722F. CHECK 501:

YES, CURRENTLY MARRIED/LIVING WITH A WOMAN (GO TO 722G)
NO, NOT IN UNION (GO TO 723)

722G. Have you ever talked with (your wife/the woman you are living with) about ways to prevent getting the virus that causes AIDS?

YES 1
NO 2

722H. In the last six-month, have you ever advised any one about ways to prevent getting the virus that causes AIDS?

YES 1
NO 2
DON’T KNOW 8

723. If a member of your family got infected with the virus that causes AIDS, would you want it to remain a secret or not?

YES 1
NO 2
DON’T KNOW 8

724. 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
DON’T KNOW/UNSURE/DEPENDS 8

725. If a female teacher has the AIDS virus, should she be allowed to continue teaching in the school?

CAN CONTINUE 1
SHOULD NOT CONTINUE 2
DON’T KNOW/UNSURE/DEPENDS 8

726. Do you know any person who has ever been denied of medical services during the last 12 months because he/she is suspected to have AIDS or because he/she has AIDS?

YES 1
NO 2
DON’T KNOW A PERSON WITH AIDS 8 (GO TO 731)

727. Do you know any person who has ever been denied of participation in the social mobilization, religious services on in the community events during the last 12 months because he/she is suspected to have AIDS or because he/she has AIDS?

YES 1
NO 2

728. Do you know any person who has ever been insulted or abused during the last 12 months because he/she is suspected to have AIDS or because he/she has AIDS?

YES 1
NO 2

729. CHECK 726, 727,728:

OTHER (GO TO 730)
AT LEAST ONE YES (GO TO 731)

730. Do you know any person who is suspected to have AIDS, haS AIDS or who has died of AIDS?

YES 1
NO 2

731. Would you agree or disagree with the affirmation that:
People who have AIDS should feel ashamed?

AGREE 1
DON’T AGREE 2
DON’T KNOW/NO OPINION 8

732. Would you agree or disagree with the affirmation that:
People who have AIDS should be blamed for bringing the disease into the community?

AGREE 1
DON’T AGREE 2
DON’T KNOW/NO OPINION 8

733. Should children between age 12 and 14 be taught about using a condom to prevent AIDS?

YES 1
NO 2
DON’T KNOW/UNSURE/DEPENDS 8

734. Should children between age 12 and 14 wait until the get married to have sexual intercourse in order to avoid AIDS?

YES 1
NO 2
DON’T KNOW/UNSURE/DEPENDS 8

735. Do you think young men should be wait until they are married to have sexual intercourse?

YES 1
NO 2
DON’T KNOW/UNSURE/DEPENDS 8

736. Would you think that most young men that you know wait until they are married to have sexual intercourse?

YES 1
NO 2
DON’T KNOW/UNSURE/DEPENDS 8

737. Do you think that most men you know who are not married and are having sex, have sex with only one partner?

YES 1
NO 2
DON’T KNOW/UNSURE/DEPENDS 8

738. Do you think that most men you know who are not married and are having sex, have sex with only one partner?

YES 1
NO 2
DON’T KNOW/UNSURE/DEPENDS 8

739. Do you believe that married men should only have sex with their wives?

YES 1
NO 2
DON’T KNOW/UNSURE/DEPENDS 8

740. Do you think that most married men you know have sex only with their wives?

YES 1
NO 2
DON’T KNOW/UNSURE/DEPENDS 8

741. Do you believe that young women should wait until they are married to have sexual intercourse?

YES 1
NO 2
DON’T KNOW/UNSURE/DEPENDS 8

742. Do you think that most young women you know wait until they are married to have sexual intercourse?

YES 1
NO 2
DON’T KNOW/UNSURE/DEPENDS 8

743. Do you believe that women who are not married and are having sex should only have sex with one partner?

YES 1
NO 2
DON’T KNOW/UNSURE/DEPENDS 8

744. Do you think that most women you know who are not married and are having sex, have sex with only one partner?

YES 1
NO 2
DON’T KNOW/UNSURE/DEPENDS 8

745. Do you believe that married women should only have sex with their husbands?

YES 1
NO 2
DON’T KNOW/UNSURE/DEPENDS 8

746. Do you think that most married women you know have sex only with their husbands?

YES 1
NO 2
DON’T KNOW/UNSURE/DEPENDS 8

SECTION 8: OTHER HEALTH PROBLEMS

801. Some men are circumcised, are also circumcised?

YES 1
NO 2

802. CHECK 701:

HEARD OF AIDS
Apart from AIDS have you ever heard of any other sexually transmitted disease?

NOT HEARD OF AIDS
Have you ever heard of any other sexually transmitted disease?

YES 1
NO 2 (GO TO 805)

803. What are the symptoms which indicate that a man is infected with a sexually transmitted infection?
Is there any other symptom?
RECORD ALL MENTIONED SYMPTOMS

ABDOMINAL PAIN A
GENITAL DISCHARGE/RIPPING B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
READINES/INFAMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
IMPOTANCE L
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
NO SYMPTOMS Y
DON’T KNOW Z

804. Are there other symptoms which can indicate that a women is infected a sexually transmitted infection?
Is there any other symptom?
RECORD ALL MENTIONED SYMPTOMS

ABDOMINAL PAIN A
GENITAL DISCHARGE/RIPPING B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
READINES/INFAMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
IMPORTANCE L
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
NO SYMPTOMS Y
DON’T KNOW Z

805. CHECK 416:

HAD SEX (GO TO 806)
NOT HAD SEX (GO TO 816)

806. CHECK 802:

HEARD ABOUT SEXUALLY TRANSMITTED INFECTIONS (GO TO 807)
NOT HEARD ABOUT SEXUALLY TRANSMITTED INFECTIONS (GO TO 808)

807. Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months have you had a disease which you got through sexual contact?

YES 1
NO 2
DON’T KNOW 8

808. Sometimes men experience an abnormal discharge from their penis. During the last 12 months, have you had an abnormal discharge from your penis?

YES 1
NO 2
DON’T KNOW 8

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

YES 1
NO 2
DON’T KNOW 8

810. CHECK 807, 808 AND 809:

HAS ONE INJECTION (AT LEAST ONE YES) (GO TO 811)
NOT HAD ANY INFECTION OR DON’T KNOW (GO TO 808)

811. The last time you suffered (PROBLEME MENTIONED 807/808 /809), did you seek any kind of advise or treatment?

YES 1
NO 2

812. Where did you go?
Is there any other place?
RECORD ALL PLACES MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL/ASSISTED A
GOVERNMENT HEALTH CENTER/ASSISTED B
CBD AGENT C
VCT CENTER D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) _____ F
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR H
PHARMACY I
ARBEF CLINIC J
VCT CENTRE K
INFIRMARY L
OTHER PRIVATE MEDICAL (SPECIFY) ____ M
OTHER SOURCE
SHOP N
OTHER (SPECIFY) ____ X

813. The last time you suffered (PROBLEM(S) OF 807/808/809), did you inform your sexual partner(s) ?

YES 1
NO 2
SOME/NOT ALL 3
HAVE NO PARTER 4

814. The last time you suffered (PROBLEM(S) OF 807/808/809), did you do any thing to avoid infecting your partner?

YES 1
NO 2
PARTNER(S) ALREADY INFECTED 8

815. What did you do to prevent you partner from being unfected?
Took medicine?
Stopped sex?
Used Condom?

TOOK MEDICINE
YES 1
NO 2
STOPPED SEX
YES 1
NO 2
USED CONDOM
YES 1
NO 2

816. Let us now talk about your health status in the last 6 month. During the last six months, have you ever been injected for any reason?
IF YES: How many injection did you receive?

IF THE NUMBER OF INJECTION IS MORE THAN 94 OR IF HE RECEIVED INJECTION IN 3 MONTH CONSECUTIVELY RECORD 95. IN THE CASE RESPONSE IN NON- NUMERICAL PROBE TO OBTAIN THE ESTIMATIONS.

NUMBER OF INJECTIONS ____
NONE 95

817. For the number of injections you have mentioned, how many were provided by the doctor, a nurse, pharmacist, dentist or any other medical practitioner?

NUMBER OF INJECTIONS ___
NONE 95

IF THE NUMBER OF INJECTION IS MORE THAN 99 OR IF IF HE RECEIVED INJECTION IN 3 MONTH CONSECUTIVELY RECORD 95

IN THE CASE RESPONSE IN NONO- NUMERICAL PROBE TO OBTAIN THE ESTIMATIONS

818. Where did you go for injection the last time you got injection?

PUBLIC SECTOR
GOVERNMENT HOSPITAL/ASSISTED 11
GOVERNMENT HEALTH CENTER/ASSISTED 12
BDC AGENT 13
OTHER PUBLIC (SPECIFY) _____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
DENTIST 22
PHARMACIST 23
PRIVATE DOCTOR/NURSE 24
ARBEF CLINIC 25
OTHER PRIVATE (SPECIFY) ____ 26
OTHER CARE
AT HOME 31
OTHER (SPECIFY) ____ 96

819. The last time you were injected, did the person who injected you remove the injection from the cover which has never been open before?

YES 1
NO 2
DON’T KNOW 8

SECTION 9. ATTITUDES TOWARDS GENDER ROLES

901. 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?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON’T KNOW/DEPENDS 8
b) making small daily household purchases?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON’T KNOW/DEPENDS 8
c) deciding when to visit family, friends or relatives?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON’T KNOW/DEPENDS 8
d) deciding what to do with the money she earns for her work?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON’T KNOW/DEPENDS 8
e) deciding how many children to have and when to have them?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON’T KNOW/DEPENDS 8

902. Sometimes a husband is annoyed or angered by things that his wife/partner does. 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/DEPENDS 8
b) If she neglects the children?
YES 1
NO 2
DON’T KNOW/DEPENDS 8
c) If she argues with him?
YES 1
NO 2
DON’T KNOW/DEPENDS 8
d) If she refuses to have sex with him?
YES 1
NO 2
DON’T KNOW/DEPENDS 8
e) If she burns the food?
YES 1
NO 2
DON’T KNOW/DEPENDS 8

903. When a wife knows her husband has a disease that can transmitted through sexual contact, is she justified in asking that they use a condom?

YES 1
NO 2
DON’T KNOW 8

904. Husbands and wives do not always agree on everything.
Please tell me if you think a wife is justified in refusing to have sex with her husband if...

a) She is tired and not in the mood?
YES 1
NO 2
DON’T KNOW/DEPENDS 8
b) She has recently given birth?
YES 1
NO 2
DON’T KNOW/DEPENDS 8
c) She knows her husband has sex with other women?
YES 1
NO 2
DON’T KNOW/DEPENDS 8
d) She knows her husband has a sexually transmitted disease?
YES 1
NO 2
DON’T KNOW/DEPENDS 8

805. 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?
YES 1
NO 2
DON’T KNOW/DEPENDS 8
b) Refuse to give her money or other means of financial support?
YES 1
NO 2
DON’T KNOW/DEPENDS 8
c) Use force and have sex with her even if she doesn’t want to?
YES 1
NO 2
DON’T KNOW/DEPENDS 8
d) Go and have sex with another woman?
YES 1
NO 2
DON’T KNOW/DEPENDS 8

809. RECORD THE HOURS

HOUR____
MINUTES ____

INTERVIEWER’S OBSERVATIONS

TO BE COMPLETED AFTER INTERVIEW

COMMENTS ABOUT RESPONDENT:
________________

COMMENTS ON PARTICULAR QUESTIONS:
________________

OTHER COMMENTS:
________________

SUPERVISOR’S OBSERVATIONS:
________________

NAME OF SUPERVISOR: __________
DATE: ______

EDITOR’S OBSERVATIONS
________________

NAME OF EDITOR: ______
DATE: ______