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REPUBLIC OF SENEGAL DEMOGRAPHIC AND HEALTH SURVEY WITH MULTIPLE INDICATORS (EDSV-MICS_2010) - 2010 MAN'S QUESTIONNAIRE

IDENTIFICATION

PLACE NAME _____
NAME OF HEAD OF HOUSEHOLD _____
HOUSEHOLD NUMBER _____
CONCESSION NUMBER _____
CLUSTER NUMBER _____
REGION _____
DEPARTMENT _____
HEALTH DISTRICT _____

URBAN/RURAL:

URBAN 1
RURAL 2

MILIEU:

DAKAR 1
REGIONAL CAPITAL 2
OTHER CITY 3
RURAL 4

NAME AND LINE NUMBER OF MAN _____

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER'S NAME _____
RESULT___

RESULT _____

1 COMPLETED
2 NO HOUSEHOLD MEMBER AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) _____

NEXT VISIT
DATE _____
TIME _____

FINAL VISIT
DAY _____
MONTH _____
YEAR 201____
INT. NUMBER _____
RESULT _____

TOTAL NO. OF VISITS _____

LANGUAGE OF QUESTIONNAIRE: 1

LANGUAGE OF INTERVIEW

1 FRENCH
2 WOLOF
3 POULAR
4 SERER
5 MANDINGUE
6 DIOLA
8 OTHER

INTERPRETER:

YES 1
NO 2

SUPERVISOR
NAME_____
DATE_____

FIELD EDITOR
NAME_____
DATE _____

OFFICE EDITOR_______
KEYED BY_____

Section 1. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENT

INTRODUCTION AND CONSENT:

INFORMED CONSENT:
Hello. My name is _____. I am working with the ANSD. We are conducting a survey about health all over Senegal. The information we collect will help the government to plan health services. Your household was selected for the survey. I would like to ask you some questions about your household. The questions usually take about 30 and 60 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?

SIGNATURE OF INTERVIEWER _____
DATE _____

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END INTERVIEW)

101. RECORD THE TIME:

HOUR_____
MINUTES_____

102. In what month and year were you born?

MONTH_____
DOESN'T KNOW MONTH 98
YEAR______
DOESN'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. Have you ever attended school?

YES 1
NO 2 (GO TO 108)

105. What is the highest level of school you attended: Primary, Secondary, or Higher?

PRIMARY 1
INTERMEDIATE 2
SECONDARY 3
HIGHER 4
OTHER (SPECIFY) _____ 6

106. What is the highest (grade/year) you completed at this level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

GRADE/YEAR_____

107. CHECK 105:

PRIMARY (GO TO 108)
INTERMEDIATE, SECONDARY OR HIGHER (GO TO 110)

108. 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 PART OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) _____ 4
BLIND/VISUALLY IMPAIRED 5

108A. Have you ever participated in a literacy program or any other program that involved learning to read or write (not including primary school)?

YES 1
NO 2 (GO TO 109)

108B. In what language was the literacy program in which you participated done?
PROBE: any other?
RECORD ALL MENTIONED.

ARABIC/MEDERSA A
WOLOF B
POULAR C
SERER D
DIOLA E
MANDINGUE F
SONINKE G
OTHER (SPECIFY LANGUAGE) _____ X

109. CHECK 108:

CODE '2', '3', OR '4' CIRCLED (GO TO 110)
CODE '1' OR '5' CIRCLED (GO TO 111)

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

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

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

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

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

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

113. What is your religion?

MUSLIM 1
CHRISTIAN 2
ANIMIST 3
NO RELIGION 4
OTHER (SPECIFY) _____ 6

114A. Are you Senegalese?

YES 1
NO 2 (GO TO 115)

114. What is your ethnicity?

WOLOF 01
POULAR 02
SERER 03
MANDINGUE 04
DIOLA 05
SONINKE 06
OTHER (SPECIFY) _____ 96

115. In the last 12 months, how many times have you been away from for one or more nights?

NUMBER OF TIMES_____
NONE 00 (GO TO 201)

116. In the last 12 months, have you been away from home for more than one month at a time?

YES 1
NO 2

SECTION 2. REPRODUCTION

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.

201. Have you ever fathered any children with any woman?

YES 1
NO 2 (GO TO 206)
DOESN'T KNOW 8 (GO TO 206)

202. Do you have any sons or daughters that you have fathered and 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 that you have fathered that 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. 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)
DOESN'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_____

209. CHECK 208:

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

210. Did all of the children you have fathered have the same biological mother?

YES 1 (GO TO 212)
NO 2

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

NUMBER OF WOMEN_____

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

AGE IN YEARS_____

213. CHECK 203 AND 205:

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

214. How old is your (youngest) child?

AGE IN YEARS_____

215. CHECK 214:

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

216. What is the name of your (youngest) child?
WRITE NAME OF (YOUNGEST) CHILD.

NAME OF (YOUNGEST) CHILD_____

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

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

218. Were you ever present during any of those antenatal check-ups?

PRESENT 1
NOT PRESENT 2

219. Was (NAME) born in a hospital or a 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
DOESN'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.

301. Have you ever heard of (METHOD)?

01. FEMALE STERILIZATION: Women can have an operation to avoid having any more children
YES 1
NO 2
02. MALE STERILIZATION: Men can have an operation to avoid having any more children
YES 1
NO 2
03. IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
04. INJECTABLES: Women can have an injection by a heath provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
05. IMPLANTS: 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: Women can take a pill every day to avoid becoming pregnant
YES 1
NO 2
07. CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08. FEMALE CONDOM: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09. LACTATIONAL AMENORRHEA METHOD (LAM).
YES 1
NO 2
10. RHYTHM METHOD: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
YES 1
NO 2
11. WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2
12. EMERGENCY CONTRACEPTION: 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 women or men can use to avoid pregnancy? IF YES, LIST UP TO TWO OTHER METHODS.
(SPECIFY) ______
YES 1
NO 2

302. In the last few months have you:

Heard about family planning on the radio?
Heard about family planning on the television?
Read about family planning in a newspaper or magazine?

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

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

YES 1
NO 2

Now I would like to ask you about a woman's risk of pregnancy.

304. 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 306)
DOESN'T KNOW 8 (GO TO 306)

305. 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
DOESN'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 a woman's business and a man should not have to worry about it.
b) Women who use contraception may become promiscuous.

CONTRACEPTION WOMAN'S BUSINESS
AGREE 1
DISAGREE 2
DOESN'T KNOW 8
WOMAN MAY BECOME PROMISCUOUS
AGREE 1
DISAGREE 2
DOESN'T KNOW 8

307. CHECK 301 (07):
KNOW ABOUT MALE CONDOM?

YES (GO TO 308)
NO (GO TO 311)

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

YES 1 (GO TO 309)
NO 2 (GO TO 311)

309. 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.

NAME OF PLACE(S) _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
HEALTH POST C
GOVERNMENT FAMILY PLANNING CLINIC D
RURAL MATERNITY CENTER E
BASIC HEALTH CARE CENTER F
COMMUNITY PHARMACY G
MOBILE CLINIC H [##translator note: original document has "Strat. avanc??/equ. mobile," but was not able to find precise translation of these terms. Mobile clinic is likely the closest without knowing what the abbreviations stand for. The standard questionnaire does not list this location as an option]
OTHER PUBLIC (SPECIFY) _____ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS DISPENSARY M
OTHER PRIVATE MEDICAL (SPECIFY) _____ N
OTHER SOURCE
SHOP O
CHURCH P
FRIEND/RELATIVES Q
BAR R
OTHER (SPECIFY) _____ X

310. If you wanted, could you yourself get a condom?

YES 1
NO 2

311. CHECK 301 (08):
KNOWS FEMALE CONDOM?

YES (GO TO 312)
NO (GO TO 401)

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

YES 1
NO 2 (GO TO 401)

313. 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.

NAME OF PLACE(S) _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
HEALTH POST C
GOVERNMENT FAMILY PLANNING CLINIC D
RURAL MATERNITY CENTER E
BASIC HEALTH CARE CENTER F
COMMUNITY PHARMACY G
MOBILE CLINIC H [##translator note: original document has "Strat. avanc??/equ. mobile," but was not able to find precise translation of these terms. Mobile clinic is likely the closest without knowing what the abbreviations stand for. The standard questionnaire does not list this location as an option]
OTHER PUBLIC (SPECIFY) _____ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS DISPENSARY M
OTHER PRIVATE MEDICAL (SPECIFY) _____ N
OTHER SOURCE
SHOP O
CHURCH P
FRIENDS/RELATIVES Q
BAR R
OTHER (SPECIFY) _____ X

314. If you wanted, could you yourself get a female condom?

YES 1
NO 2

SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

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

YES, CURRENTLY MARRIED 1 (GO TO 404)
YES, LIVING WITH A WOMAN 2 (GO TO 404)
NO, NOT IN UNION 3

402. Have you ever been married or lived together with a woman as if married?

YES, FORMERLY MARRIED 1
YES, LIVED WITH A WOMAN 2
NO 3 (GO TO 413)

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

WIDOWED 1 (GO TO 410)
DIVORCED 2 (GO TO 410)
SEPARATED 3 (GO TO 410)

404. Is your (wife/partner) living with you now or is she staying elsewhere?

LIVING WITH HIM 1
STAYING ELSEWHERE 2

405. Do you have other wives or do you live with other women as if married?

YES (MORE THAN ONE) 1
NO (ONLY ONE) 2 (GO TO 407)

406. Altogether, how many wives or live-in partners do you have?

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS_____

407. CHECK 405:

ONE WIFE/PARTNER: Please tell me the name of (your wife/the woman you are living with as if married).

MORE THAN ONE WIFE/PARTNER: Please tell me the name of each of your wives or each woman you are living with as if married.

RECORD THE NAME AND THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE AND LIVE-IN PARTNER. IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'. ASK 408 FOR EACH PERSON.

NAME_____
LINE NUMBER_____

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

AGE_____

409. CHECK 407:

ONE WIFE/PARTNER (GO TO 410)
MORE THAN ONE WIFE/PARTNER (GO TO 411A)

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

ONLY ONCE 1
MORE THAN ONCE 2 (GO TO 411A)

411. In what month and year did you start living with your (wife/partner)?
411A. Now we are going to 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 413)
DOESN'T KNOW YEAR 9998

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

AGE_____

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

Now I would like to ask some questions about sexual activity in order to gain a better understanding of some important life issues.

414. How old were you when you had sexual intercourse for the very first time?

NEVER HAD SEXUAL INTERCOURSE 00 (GO TO 501)

AGE IN YEARS _____

FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE/PARTNER 95

415. Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.

416. 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.

DAYS AGO 1 _____
WEEKS AGO 2 _____
MONTHS AGO 3 _____
YEARS AGO 4 _____ (GO TO 430)

[ASK QUESTIONS 417-427 FOR THE LAST (THREE) SEXUAL PARTNER(S)]

417. When was the last time you had sexual intercourse with this person?
[DO NOT ASK FOR MOST RECENT SEXUAL PARTNER]

DAYS AGO 1 _____
WEEKS AGO 2 _____
MONTHS AGO 3 _____

418. The last time you had sexual intercourse (with this second/third) person, was a condom used?

YES 1
NO 2 (GO TO 420)

419. Was a condom used every time you had sexual intercourse with this person in the last 12 months?

YES 1
NO 2

420. What was your relationship to this person with whom you had sexual intercourse?
IF GIRLFRIEND: Were you living together as if married?
IF YES, CIRCLE '2'. IF NO, CIRCLE '3'.

WIFE 1
LIVE-IN PARTNER 2
GIRLFRIEND NOT LIVING WITH RESPONDENT 3 (GO TO 423)
CASUAL ACQUAINTANCE 4 (GO TO 423)
CLIENT/PROSTITUTE 5 (GO TO 423)
OTHER (SPECIFY) _____ 6 (GO TO 423)

421. CHECK 410:

MARRIED ONLY ONCE (GO TO 422)
MARRIED MORE THAN ONCE (GO TO 423)

422. CHECK 414:

FIRST TIME WHEN STARTED LIVING WITH FIRST WIFE (GO TO 424)
OTHER (GO TO 423)

423. How long ago did you first have sexual intercourse with this (second/third) person?

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

424. How many times during the last 12 months did you have sexual intercourse with this person?

NUMBER OF TIMES_____

425. How old is this person?

AGE OF PARTNER_____
DOESN'T KNOW 98

426. Apart from (this person/these two people), have you had sexual intercourse with any other person in the last 12 months?
[DO NOT ASK FOR THIRD-TO-LAST SEXUAL PARTNER]

YES 1 (GO BACK TO 417 IN NEXT COLUMN)
NO 2 (GO TO 428)

427. In total, with how many different people have you had sexual intercourse in the last 12 months?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, WRITE '95'.
[ASK ONLY FOR THIRD-TO-LAST SEXUAL PARTNER]

NUMBER OF PARTNERS IN LAST 12 MONTHS_____
DOESN'T KNOW 98

428. CHECK 420 (ALL COLUMNS):

AT LEAST ONE PARTNER IS PROSTITUTE (GO TO 429)
NO PARTNERS ARE PROSTITUTES (GO TO 430)

429. CHECK 420 AND 418 (ALL COLUMNS):

OTHER (GO TO 434)
CONDOM USED WITH EVERY PROSTITUTE (GO TO 433)

430. In the last 12 months, did you pay anyone in exchange for having sexual intercourse?

YES 1 (GO TO 432)
NO 2

431. Have you ever paid anyone in exchange for having sexual intercourse?

YES 1 (GO TO 434)
NO 2 (GO TO 434)

432. The last time you paid someone in exchange for having sexual intercourse, was a condom used?

YES 1
NO 2 (GO TO 434)

433. Was a condom used during sexual intercourse every time you paid someone in exchange for having sexual intercourse in the last 12 months?

YES 1
NO 2
DOESN'T KNOW 8

434. In total, with how many different people have you had sexual intercourse in your life?
IF NON-NUMERIC NUMBER, PROBE TO GET AN ESTIMATE. IF THE NUMBER IS MORE THAN 95, WRITE '95'.

NUMBER OF PARTNERS IN LIFETIME_____
DOESN'T KNOW 98

435. CHECK 418, MOST RECENT PARTNER (FIRST COLUMN):

CONDOM USED (GO TO 436)
NOT ASKED (GO TO 438)
NO CONDOM USED (GO TO 438)

436. What is the brand name of the condom that you currently use?
IF BRAND NOT KNOWN, ASK TO SEE THE PACKAGE.

PROTEC 01
FAGAROU 02
VISA 03
MANIX 04
PRESA 05
KAMA SUTRA 06
PROTEX 07
INNOTEX 08
CASANOVA 09
INTIMY 10
CONTEX 11
STAR 12
TROJAM 13
DOESN'T KNOW 98

437. From where did you obtain the condom the last time?

PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
HEALTH POST C
GOVERNMENT FAMILY PLANNING CLINIC D
RURAL MATERNITY CENTER E
BASIC HEALTH CARE CENTER F
COMMUNITY PHARMACY G
MOBILE CLINIC H [##translator note: original document has "Strat. avanc??/equ. mobile," but was not able to find precise translation of these terms. Mobile clinic is likely the closest without knowing what the abbreviations stand for. The standard questionnaire does not list this location as an option]
OTHER PUBLIC (SPECIFY) _____ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS DISPENSARY M
OTHER PRIVATE MEDICAL (SPECIFY) _____ N
OTHER SOURCE
SHOP O
CHURCH P
FRIENDS/RELATIVES Q
BAR R
OTHER (SPECIFY) _____ X

438. The last time you had sex did you or your partner use any method (other than a condom) to avoid or prevent a pregnancy?

YES 1
NO 2 (GO TO 501)
DOESN'T KNOW 8 (GO TO 501)

439. What method did you or your partner use?
PROBE: Did you or your partner use any other method to prevent pregnancy?
RECORD ALL MENTIONED.

FEMALE STERILIZATION A
MALE STERILIZATION B
IUD C
INJECTABLES D
IMPLANTS E
PILL F
FEMALE CONDOM G
DIAPHRAGM H
FOAM/JELLY I
LAM J
RHYTHM METHOD K
WITHDRAWAL L
OTHER MODERN METHOD X
OTHER TRADITIONAL METHOD Y

SECTION 5. FERTILITY PREFERENCES

501. CHECK 401:

CURRENTLY MARRIED OR LIVING WITH A PARTNER (GO TO 502)
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (GO TO 509)

502. CHECK 439:

MAN NOT STERILIZED (GO TO 503)
MAN STERILIZED (GO TO 509)

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

YES 1
NO 2 (GO TO 505)
DOESN'T KNOW 8 (GO TO 505)

Now I have some questions about the future.

504. After the (child/children) you and your (wife(wives)/partner(s)) are expecting now, would you like to have another child, or would you prefer not having any more children?

HAVE ANOTHER CHILD 1 (GO TO 506)
NO MORE 2 (GO TO 509)
UNDECIDED/DOESN'T KNOW 8 (GO TO 509)

505. 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 509)
SAYS COUPLE CAN'T GET PREGNANT 3 (GO TO 509)
WIFE (WIVES)/PARTNER(S) STERILIZED 4 (GO TO 509)
UNDECIDED/DOESN'T KNOW 8 (GO TO 509)

506. CHECK 407:

ONE WIFE/PARTNER (GO TO 507)
MORE THAN ONE WIFE/PARTNER (GO TO 508)

507. Check 503:

WIFE/PARTNER NOT PREGNANT OR DOESN'T KNOW: How long would you like to wait from now before the birth of (a/another) child?

WIFE/PARTNER PREGNANT: After the birth of the child you are expecting now, how long would you wait before the birth of another child?

MONTHS 1 _____ (GO TO 509)
YEARS 2 _____ (GO TO 509)

SOON/NOW 993 (GO TO 509)
COUPLE INFECUND 994 (GO TO 509)
OTHER (SPECIFY) _____ 996 (GO TO 509)
DOESN'T KNOW 998 (GO TO 509)

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

MONTHS 1 _____
YEARS 2 _____

SOON/NOW 993
HE/ALL HIS WIVES/PARTNERS ARE INFECUND 994
OTHER (SPECIFY) _____ 996
DOESN'T KNOW 998

509. 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.

NONE 00 (GO TO 601)

NUMBER _____

OTHER (SPECIFY) _____ 96 (GO TO 601)

510. 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 OF BOYS _____
NUMBER OF GIRLS _____
NUMBER OF EITHER _____
OTHER (SPECIFY) _____ 96

SECTION 6. EMPLOYMENT AND GENDER ROLES

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

YES 1 (GO TO 604)
NO 2

602. Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave, or any other such reason?

YES 1 (GO TO 604)
NO 2

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

YES 1
NO 2 (GO TO 610)

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

OCCUPATION _____

605. 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

606. 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
NOT PAID 4

607. CHECK 401:

CURRENTLY MARRIED OR LIVING WITH A PARTNER (GO TO 608)
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (GO TO 612)

608. CHECK 606:

CODE '1' OR '2' CIRCLED (GO TO 609)
OTHER (GO TO 610)

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

RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
OTHER (SPECIFY) _____ 6

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

RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) _____ 6

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

RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) _____ 6

612. 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

613. 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

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

If she goes out without telling him?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she burns the food?

GOES OUT WITHOUT TELLING
YES 1
NO 2
DOESN'T KNOW 8
NEGLECTS CHILDREN
YES 1
NO 2
DOESN'T KNOW 8
ARGUES WITH HIM
YES 1
NO 2
DOESN'T KNOW 8
REFUSES SEX
YES 1
NO 2
DOESN'T KNOW 8
BURNS THE FOOD
YES 1
NO 2
DOESN'T KNOW 8

SECTION 7. HIV/AIDS

Now I would like to talk about something else.

701. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 733)

702. 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
DOESN'T KNOW 8

703. Can people get the AIDS virus from mosquito bites?

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

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

During pregnancy?
During delivery?
By breastfeeding?

PREGNANCY
YES 1
NO 2
DOESN'T KNOW 8
DELIVERY
YES 1
NO 2
DOESN'T KNOW 8
BREASTFEEDING
YES 1
NO 2
DOESN'T KNOW 8

709. CHECK 708:

AT LEAST ONE 'YES' (GO TO 710)
OTHER (GO TO 711)

710. Are there any 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?

YES 1
NO 2
DOESN'T KNOW 8

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

712. Have you ever been tested to see if you have the AIDS virus?

YES 1
NO 2 (GO TO 716)

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

MONTHS AGO_____
TWO OR MORE YEARS 95

714. Did you get the results of the test?

YES 1
NO 2

715. Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

NAME OF PLACE _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 718)
GOVERNMENT HEALTH CENTER 12 (GO TO 718)
HEALTH POST 13 (GO TO 718)
GOVERNMENT FAMILY PLANNING CLINIC 14 (GO TO 718)
HEALTH HUT/RURAL MATERNITY 15 (GO TO 718)
BASIC HEALTH CARE CENTER 16 (GO TO 718)
COMMUNITY PHARMACY 17 (GO TO 718)
MOBILE CLINIC 18 [##translator note: original document has "Strat. avanc??/equ. mobile," but was not able to find precise translation of these terms. Mobile clinic is likely the closest without knowing what the abbreviations stand for. The standard questionnaire does not list this location as an option] (GO TO 718)
OTHER PUBLIC (SPECIFY) _____ 19 (GO TO 718)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE 21 (GO TO 718)
PHARMACY 22 (GO TO 718)
PRIVATE DOCTOR 23 (GO TO 718)
RELIGIOUS DISPENSARY 24 (GO TO 718)
OTHER PRIVATE MEDICAL (SPECIFY) _____ 26 (GO TO 718)
OTHER SOURCE
SHOP 31 (GO TO 718)
CHURCH 32 (GO TO 718)
RELATIVES/FRIENDS 33 (GO TO 718)
BAR 34 (GO TO 718)
OTHER (SPECIFY) _____ 96 (GO TO 718)

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

YES 1
NO 2 (GO TO 718)

717. Where is that?
Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
HEALTH POST C
GOVERNMENT FAMILY PLANNING CLINIC D
HEALTH HUT/RURAL MATERNITY E
BASIC HEALTH CARE CENTER F
COMMUNITY PHARMACY G
MOBILE CLINIC H [##translator note: original document has "Strat. avanc??/equ. mobile," but was not able to find precise translation of these terms. Mobile clinic is likely the closest without knowing what the abbreviations stand for. The standard questionnaire does not list this location as an option]
OTHER PUBLIC (SPECIFY) _____ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS DISPENSARY M
OTHER PRIVATE MEDICAL (SPECIFY) _____ N
OTHER SOURCE
SHOP O
CHURCH P
RELATIVES/FRIENDS Q
BAR R
OTHER (SPECIFY) _____ X

718. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

YES 1
NO 2
DOESN'T KNOW 8

719. 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
DOESN'T KNOW/NOT SURE/DEPENDS 8

720. If a member of your family 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
DOESN'T KNOW/NOT SURE/DEPENDS 8

721. 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
DOESN'T KNOW/NOT SURE/DEPENDS 8

722. Should children age 12-14 be taught about using a condom to avoid getting AIDS?

YES 1
NO 2
DOESN'T KNOW/NOT SURE/DEPENDS 8

723. CHECK 701:

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

724. CHECK 414:

HAS HAD SEXUAL INTERCOURSE (GOT TO 725)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 732)

725. CHECK 723:
HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES (GO TO 726)
NO (GO TO 727)

Now I would like to ask you some questions about your health in the last 12 months.

726. During the last 12 months, have you had a disease which you got through sexual contact?

YES 1
NO 2
DOESN'T KNOW 8

727. 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
DOESN'T KNOW 8

728. 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?

YES 1
NO 2
DOESN'T KNOW 8

729. CHECK 726, 727, AND 728:

HAS HAD AN INFECTION (ANY YES) (GO TO 730)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 732)

730. The last time you had (INFECTION FROM 726/727/728), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 732)

731. Where did you go?
Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
HEALTH POST C
GOVERNMENT FAMILY PLANNING CLINIC D
RURAL MATERNITY CENTER E
BASIC HEALTH CARE CENTER F
COMMUNITY PHARMACY G
MOBILE CLINIC H [##translator note: original document has "Strat. avanc??/equ. mobile," but was not able to find precise translation of these terms. Mobile clinic is likely the closest without knowing what the abbreviations stand for. The standard questionnaire does not list this location as an option]
OTHER PUBLIC (SPECIFY) _____ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS DISPENSARY M
OTHER PRIVATE MEDICAL (SPECIFY) _____ N
OTHER SOURCE
SHOP O
CHURCH P
FRIEND/RELATIVES Q
BAR R
OTHER (SPECIFY) _____ X

732. 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?

YES 1
NO 2
DOESN'T KNOW 8

733. Is a wife justified in refusing to have sex with her husband when she knows her husband has sex with other women?

YES 1
NO 2
DOESN'T KNOW 8

SECTION 8. OTHER HEALTH ISSUES

Now I would like to ask you some other questions relating to health matters.

805. 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 808)

806. Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or another healthcare worker?

IF THE NUMBER OF INJECTIONS IS OVER 90 OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF RESPONSE IS NOT NUMERIC, PROBE TO OBTAIN AN ESTIMATE.

NUMBER OF INJECTIONS_____
NONE 00 (GO TO 808)

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

YES 1
NO 2
DOESN'T KNOW 8

808. Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 810)

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

NUMBER OF CIGARETTES_____

810. Do you currently smoke or use any (other) type of tobacco?

YES 1
NO 2 (GO TO 812)

811. What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.

PIPE A
CHEWING TOBACCO B
SNUFF C
OTHER (SPECIFY) _____ X

812. Are you covered by any health insurance?

YES 1
NO 2 (GO TO 813A)

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

MUTUAL HEALTH ORGANIZATION/COMMUNITY-BASED HEALTH INSURANCE A
HEALTH INSURANCE THROUGH EMPLOYER B
SOCIAL SECURITY C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
BUDGETARY ALLOCATION E
OTHER (SPECIFY) ______ X

813A. Do you suffer from any of the following illnesses:

Diabetes?
High blood pressure/stroke?
Cardiac illnesses?
Kidney failure?
Cancer?
Paralysis? [##translator note: The word that is used, 'paralysie,' means both palsy and paralysis, and there is no information provided to specify]
Asthma/Chronic bronchitis?

RECORD ALL MENTIONED.

NONE A (GO TO 814)
DIABETES B
HIGH BLOOD PRESSURE/STROKE C
CARDIAC ILLNESSES D
KIDNEY FAILURE E
CANCER F
PARALYSIS [##translator note: the word that is used, 'paralysie,' means both palsy and paralysis, and there is no information provided to specify] G
ASTHMA/CHRONIC BRONCHITIS H

813B. Was a diagnosis made by a health care personnel?

YES 1
NO 2
DOESN'T KNOW 8

813C. What type(s) of treatment have you used for this/these illness(s)?
RECORD ALL MENTIONED.

PRESCRIBED MEDICAL TREATMENT A
SELF-PRESCRIBED MEDICAL TREATMENT B
TRADITIONAL TREATMENT C
NO TREATMENT D
OTHER (SPECIFY) _____ X

814. RECORD THE TIME.

HOUR_____
MINUTES_____

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW.

COMMENTS ABOUT RESPONDENT _____

COMMENTS ON SPECIFIC QUESTIONS _____

ANY OTHER COMMENTS _____

SUPERVISOR'S OBSERVATIONS _____
NAME OF SUPERVISOR_____
DATE_____

EDITOR'S OBSERVATIONS _____
NAME OF EDITOR_____
DATE_____