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CONTINUOUS DEMOGRAPHIC AND HEALTH SURVEY (EDS-CONTINUOUS 2017)
MAN'S QUESTIONNAIRE

Republic of Senegal
Ministry of the Economy, Finance, and Planning
Ministry of Health and Social Action

ICF International

IDENTIFICATION

PLACE NAME ______

NAME AND NUMBER OF HEAD OF HOUSEHOLD _____

PLOT NUMBER ______

CLUSTER NUMBER ____

REGION ____

DEPARTMENT ____

HEALTH DISTRICT____

URBAN/RURAL

URBAN 1
RURAL 2

DAKAR/REGIONAL CAPITAL/OTHER CITY/RURAL

DAKAR 1
REGIONAL CAPITAL 2
OTHER CITY 3
RURAL 4

MAN'S NAME AND LINE NUMBER ______

HOUSEHOLD SELECTED FOR MEN'S SURVEY?

YES 1
NO 2

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)

DATE _____
INTERVIEWER'S NAME ______
RESULT*

*RESULT CODES

1 COMPLETED
2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT
3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY)

FINAL VISIT:
DAY ____
MONTH ___
YEAR ____
INTERVIEW NUMBER ____
RESULT* _____

NEXT VISIT:
DATE _____
TIME ____

TOTAL NUMBER OF VISITS _____

LANGUAGE OF QUESTIONNAIRE:

LANGUAGE OF INTERVIEW*

*LANGUAGE CODES:

01 FRENCH
02 WOLOF
03 POULAR
04 SERER
05 MANDINGUE
06 DIOLA
07 OTHERS

NATIVE LANGUAGE OF RESPONDENT*

TRANSLATOR USED

YES 1
NO 2

SUPERVISOR:
NAME ______
NUMBER_____
DATE _____

INTRODUCTION AND CONSENT

Hello. My name is _____. I am working with the National Agency for Statistics and Demography in collaboration with the Ministry of Health and Social Action. 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. The questions usually take about 30 to 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?

SIGNATURE OF INTERVIEWER: ______
DATE ______

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

SECTION 1: RESPONDENT'S BACKGROUND

101) RECORD THE TIME.

HOURS ____
MINUTES ____

105) In what month and year were you born?

MONTH ___
DON'T KNOW MONTH 98
YEAR ____
DON'T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS ____

107) Have you ever attended school?

YES 1
NO 2 (GO TO 111)

108) What is the highest level of school you have attended: elementary (primary), middle, secondary, or higher?

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

109) What is the highest (grade/form/year) you completed at this level?
IF LESS THAN ONE YEAR COMPLETED, RECORD 00

GRADE/FORM/YEAR _____

110) CHECK 108

ELEMENTARY (PRIMARY) (GO TO 111)
MIDDLE, SECONDARY, OR HIGHER (GO TO 113)

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?

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

111A) Have you ever participated in a literacy program or any other program that included learning how to read and right (not including primary school)?

YES 1
NO 2 (GO TO 112)

111B) In what languages were these literacy programs?
PROBE: Any other?
RECORD ALL MENTIONED.

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

112) CHECK 111:

CODE 2, 3, OR 4 CIRCLED (GO TO 113)
CODE 1 OR 5 CIRCLED (GO TO 114)

113) 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

114) 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

115) 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

116) Do you own a mobile telephone?

YES 1
NO 2 (GO TO 118)

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

YES 1
NO 2

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

YES 1
NO 2

119) Have you ever used the internet?

YES 1
NO 2 (GO TO 122)

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

YES 1
NO 2 (GO TO 122)

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?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

122) What is your religion?

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

122a) Are you Senegalese?

YES 1
NO 2 (GO TO 201)

123) What is your ethnicity?

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

SECTION 2. REPRODUCTION

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

Have you ever fathered any children with any woman?

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

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

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 who are not 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, who made any movement, sound or effort to breathe, or who showed any other signs of life even if for a very short time?

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

207)
A) How many boys have died?
B) 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
HAS ONLY HAD ONE CHILD (GO TO 211)
HAS NOT HAD ANY CHILDREN (GO TO 301)

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

YES 1
NO 2

211) CHECK 208:

HAS HAD MORE THAN ONE CHILD:

How old were you when your first child was born?
AGE IN YEARS

HAS HAD ONLY ONE CHILD:

How old were you when your child was born?
AGE IN YEARS

212) CHECK 203 and 205:

AT LEAST ONE LIVING CHILD (GO TO 213)
NO LIVING CHILDREN (GO TO 301)

213) CHECK 203 AND 205:

MORE THAN ONE LIVING CHILD:

How old is your youngest child?
AGE IN YEARS

ONLY ONE LIVING CHILD:

How old is your child?
AGE IN YEARS

214) CHECK 213:

(YOUNGEST) CHILD IS AGE 0-2 YEARS
(YOUNGEST) CHILD IS AGE 3 YEARS OR OLDER (GO TO 301)

215) CHECK 203 AND 205:

MORE THAN ONE LIVING CHILD

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

ONLY ONE LIVING CHILD

What is the name of your child?
(NAME OF (YOUNGEST) CHILD)

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

YES 1
NO 2 (GO TO 218)
DON'T KNOW 8 (GO TO 218)

217) Were you ever present during any of those antenatal check-ups?

PRESENT 1
NOT PRESENT 2

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

HOSPITAL/HEALTH FACILITY 1
OTHER 2

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?

MORE THAN USUAL 1
ABOUT THE SAME 2
LESS THAN USUAL 3
NOTHING TO DRINK 4
DON'T KNOW 8

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)?

Female Sterilization
PROBE: Women can have an operation to avoid having any more children
YES 1
NO 2
Male Sterilization
PROBE: Men can have an operation to avoid having any more children
YES 1
NO 2
IUD
PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse which can prevent pregnancy for one or more months.
YES 1
NO 2
Injectables
PROBE: Women can have an injection by a heath provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
Implants
PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
Pill
PROBE: Women can take a pill every day to avoid becoming pregnant
YES 1
NO 2
Condom
PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
Female condom
PROBE: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
Emergency contraception
PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
YES 1
NO 2
Standard Day Method
PROBE: A woman uses a string of colored beads to know the days she can get pregnant. On the days she can get pregnant, she uses a condom or does not have sexual intercourse.
YES 1
NO 2
Lactational amenorrhea method (LAM)
PROBE: Up to six months after childbirth, before the menstrual period has returned, women use a method requiring frequent breastfeeding day and night.
YES 1
NO 2
Rhythm Method
PROBE: 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
Withdrawal
PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
14) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES, MODERN METHOD A
(SPECIFY)
YES, TRADITIONAL METHOD B
(SPECIFY)

NO Y

302) In the last few months have you

a) Heard about family planning on the radio?
YES 1
NO 2
b) Seen anything about family planning on the television?
YES 1
NO 2
c) Read about family planning in a newspaper or magazine?
YES 1
NO 2
d) Received a voice or text message about family planning on a mobile phone?
YES 1
NO 2
e) Seen or read something about family planning on a poster or sign?
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

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

YES 1
NO 2 (GO TO 306)
DON'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
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

Contraception is a woman's business and a man should not have to worry about it.
AGREE 1
DISAGREE 2
DON'T KNOW 8
Women who use contraception may become promiscuous.
AGREE 1
DISAGREE 2
DON'T KNOW 8

308) Check 301 (07): Know male condom

YES (GO TO 309)
NO (GO TO 312)

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

YES 1
NO 2 (GO TO 312)

310) 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
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
HEALTH POST C
GOVT. FAMILY PLANNING CENTER D
RURAL MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
MOBILE CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) N
OTHER SOURCE
SHOP O
CHURCH P
FRIENDS/RELATIVES Q
BAR R
OTHER (SPECIFY) X

311) If you wanted, could you yourself get a condom?

YES 1
NO 2

312) Check 301 (08): Knows female condom

YES
NO (GO TO 401)

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

YES 1
NO 2 (GO TO 401)

314) 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
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
HEALTH POST C
GOVT. FAMILY PLANNING CENTER D
RURAL MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
MOBILE CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) N
OTHER SOURCE
SHOP O
CHURCH P
FRIENDS/RELATIVES Q
BAR R
OTHER (SPECIFY) X

315) 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
DIVORCED 2
SEPARATED 3
ALL SKIP 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 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
MORE THAN ONE WIFE/PARTNER (GO TO 411)

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 411)

411) CHECK 405 AND 410:

BOTH ARE CODE '2'

In what year and month did you start living with your (wife/partner)?
MONTH
DON'T KNOW MONTH 98
YEAR (GO TO 413)
DON'T KNOW YEAR 9998

OTHER:

b) Now I would like to ask about your first (wife/partner). In what month and year did you start living with her?
MONTH
DON'T KNOW MONTH 98
YEAR (GO TO 413)
DON'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.

414) Now I need to ask you 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?

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. 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.


LAST SEXUAL PARTNER


DAYS AGO 1 (GO TO 417)
WEEKS AGO 2 (GO TO 417)
MONTHS AGO 3 (GO TO 417)
YEARS AGO 4 (GO TO 427)


SECOND-TO-LAST SEXUAL PARTNER


DAYS AGO 1 (GO TO 417)
WEEKS AGO 2 (GO TO 417)
MONTHS AGO 3 (GO TO 417)
YEARS AGO 4 (GO TO 427)


THIRD-TO-LAST SEXUAL PARTNER


DAYS AGO 1 (GO TO 417)
WEEKS AGO 2 (GO TO 417)
MONTHS AGO 3 (GO TO 417)
YEARS AGO 4 (GO TO 427)

416) When was the last time you had sexual intercourse with this person?

DAYS AGO 1
WEEKS AGO 2
MONTHS AGO 3

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

YES 1
NO 2 (GO TO 419)

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

YES 1
NO 2

419) 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
CASUAL ACQUAINTANCE 4
CLIENT/SEX WORKER 5
OTHER (SPECIFY) 6

420) 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

421) How many times during the last 12 months did you have sexual intercourse with this person?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNER IS 95 OR MORE, RECORD 95.

NUMBER OF TIMES

422) How old is this person?

AGE OF PARTNER
DON'T KNOW 98

423) Apart from this person, have you had sexual intercourse with any other person in the last 12 months?

YES 1 (GO BACK TO 416 IN NEXT COLUMN)
NO 2 (GO TO 425)

424) 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 PARTNER IS 95 OR MORE, RECORD 95.

NUMBER OF PARTNERS IN LAST 12 MONTHS
DON'T KNOW 98

425) Check 419 (all columns):

AT LEAST ONE PARTNER IS A SEX WORKER
NO PARTNERS ARE SEX WORKERS (GO TO 427)

426) CHECK 420 AND 418 (ALL COLUMNS)

OTHER-SKIP TO 430
CONDOM USED WITH EVERY SEX WORKER (GO TO 431)

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

YES 1 (GO TO 429)
NO 2

428) Have you ever paid anyone in exchange for having sexual intercourse?

YES 1 (GO TO 431)
NO 2 (GO TO 431)

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

YES 1
NO 2 (GO TO 431)

430) 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
DK 8

431) In the past 12 months have you given any gifts or other goods in order to have sex or to become sexually involved with anyone?

YES 1 (GO TO 433)
NO 2

432) Have you ever given any gift or other goods in order to have sex or to become sexually involved with anyone?

YES 1
NO 2

433) In total, with how many different people have you had sexual intercourse in your life?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNER IS 95 OR MORE, RECORD 95.

NUMBER OF PARTNERS IN LIFETIME
DON'T KNOW 98

434) CHECK 417, MOST RECENT PARTNER: CONDOM USED

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

435) You told me that a condom was used the last time you had sex. What is the brand name of the condom you used at that time?
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
TROJAN 13
OTHER (SPECIFY) 96
DON'T KNOW 98

436) 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 THE PLACE).

PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
HEALTH POST 13
GOVT. FAMILY PLANNING CENTER 14
RURAL MATERNITY 15
HEALTH HUT 16
COMMUNITY PHARMACY 17
MOBILE CLINIC 18
OTHER PUBLIC SECTOR (SPECIFY) 19
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE 21
PHARMACY 22
PRIVATE DOCTOR 23
RELIGIOUS FREE CLINIC 24
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
BAR 34
OTHER (SPECIFY) 96

437) 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 (GO TO 439)
NO 2 (GO TO 440)
DON'T KNOW 8 (GO TO 440)

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

YES 1
NO 2 (GO TO 440)
DON'T KNOW 8 (GO TO 440)

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 (GO TO 501)
MALE STERILIZATION B (GO TO 501)
IUD C (GO TO 501)
INJECTABLES D (GO TO 501)
IMPLANTS E (GO TO 501)
PILL F (GO TO 501)
CONDOM G (GO TO 501)
FEMALE CONDOM H (GO TO 501)
EMERGENCY CONTRACEPTION I (GO TO 501)
STANDARD DAYS METHOD J (GO TO 501)
LACTATIONAL AMEN. METHOD K (GO TO 501)
RHYTHM METHOD L (GO TO 501)
WITHDRAWAL M (GO TO 501)
OTHER MODERN METHOD X (GO TO 501)
OTHER TRADITIONAL METHOD Y (GO TO 501)

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

YES 1
NO 2

SECTION 5. FERTILITY PREFERENCES

501) CHECK 401:

CURRENTLY MARRIED OR LIVING WITH A PARTNER
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (GO TO 514)

502) CHECK 439:

MAN NOT STERILIZED
MAN STERILIZED (GO TO 514)

503) CHECK 407:

ONE WIFE/PARTNER (GO TO 504)
MORE THAN ONE WIFE/PARTNERS (GO TO 509)

504) Is your (wife/partner) currently?

YES 1
NO 2 (GO TO 507)
DK 8 (GO TO 507)

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

HAVE ANOTHER CHILD 1
NO MORE 2 (GO TO 514)
UNDECIDED/DON'T KNOW 8 (GO TO 514)

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

MONTHS 1
YEARS 2
SOON/NOW 993
OTHER (SPECIFY) 996
DON'T KNOW 998
ALL SKIP TO 514

507) CHECK 208:

HAS FATHERED CHILDREN

Now I have some questions about the future. Would you like to have another child, or would you prefer not to have any more children?

HAS NOT FATHERED CHILDREN

Now I have some questions about the future. Would you like to have a child, or would you prefer not to have any children?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 514)
SAYS COUPLE CAN'T GET PREGNANT 3 (GO TO 514)
WIFE/PARTNER STERILIZED 4 (GO TO 514)
UNDECIDED/DON'T KNOW 8 (GO TO 514)

508) CHECK 208:

HAS FATHERED CHILDREN

How long would you wait before the birth of another child?

HAS NOT FATHERED CHILDREN

How long would you wait before the birth of a child?

MONTHS 1
YEARS 2
SOON/NOW 993
SAYS COUPLE CAN'T GET PREGNANT 994
OTHER (SPECIFY) 996
DON'T KNOW 998
ALL SKIP TO 514

509) Are any of your (wives/partners) currently pregnant?

YES 1
NO 2 (GO TO 512)
DON'T KNOW 8 (GO TO 512)

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

HAVE ANOTHER CHILD 1
NO MORE 2 (GO TO 514)
UNDECIDED/DON'T KNOW 8 (GO TO 514)

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

MONTHS 1
YEARS 2
SOON/NOW 993
OTHER (SPECIFY) 996
DON'T KNOW 998
ALL SKIP TO 514

512) CHECK 208:

HAS FATHERED CHILDREN

Now I have some questions about the future. Would you like to have another child, or would you prefer not to have any more children?

HAS NOT FATHERED CHILDREN

Now I have some questions about the future. Would you like to have a child, or would you prefer not to have any children?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 514)
SAYS COUPLE CAN'T GET PREGNANT 3 (GO TO 514)
WIFE (WIVES)/PARTNER(S) STERILIZED 4 (GO TO 514)
UNDECIDED/DON'T KNOW 8 (GO TO 514)

513) CHECK 208:

HAS FATHERED CHILDREN

How long would you wait before the birth of another child?

HAS NOT FATHERED CHILDREN

How long would you wait before the birth of a child?

MONTHS 1
YEARS 2
SOON/NOW 993
SAYS COUPLE CAN'T GET PREGNANT 994
OTHER (SPECIFY) 996
DON'T KNOW 998

514) 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)

515) 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
NUMBER GIRLS
NUMBER 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 vacation, illness, 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 607)

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

608) CHECK 606:

CODE 1 OR 2 CIRCLED
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 (GO TO 615)

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

YES 1
NO 2 (GO TO 615)
DON'T KNOW 8 (GO TO 615)

614) Is your name on the title deed?

YES 1
NO 2
DON'T KNOW 8

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

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4 (GO TO 618)

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

YES 1
NO 2 (GO TO 618)
DON'T KNOW 8 (GO TO 618)

617) Is your name on the title deed?

YES 1
NO 2
DON'T KNOW 8

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

If she goes out without telling him?
YES 1
NO 2
DK 8
If she neglects the children?
YES 1
NO 2
DK 8
If she argues with him?
YES 1
NO 2
DK 8
If she refuses to have sex with him?
YES 1
NO 2
DK 8
If she burns the food?
YES 1
NO 2
DK 8

SECTION 7. HIV/AIDS

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

YES 1
NO 2 (GO TO 727)

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?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

708) Can the virus that causes HIV be transmitted from a mother to a child?

During pregnancy?
YES 1
NO 2
DK 8
During delivery?
YES 1
NO 2
DK 8
By breastfeeding?
YES 1
NO 2
DK 8

709) Check 708:

AT LEAST ONE YES
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
DK 8

711) Check for the 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?

YES 1
NO 2 (GO TO 716)

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

MONTHS AGO
TWO OR MORE YEARS 95

714) I don't want to know the results, but 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
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
HEALTH POST 13
GOVT. FAMILY PLANNING CENTER 14
RURAL MATERNITY 15
HEALTH HUT 16
COMMUNITY PHARMACY 17
MOBILE CLINIC 18
OTHER PUBLIC SECTOR (SPECIFY) 19
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE 21/22
PHARMACY 23
PRIVATE DOCTOR 24
RELIGIOUS FREE CLINIC 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
BAR 34
OTHER (SPECIFY) 96

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

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
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
HEALTH POST C
GOVT. FAMILY PLANNING CENTER D
RURAL MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
MOBILE CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) N
OTHER SOURCE
SHOP O
CHURCH P
FRIENDS/RELATIVES Q
BAR R
OTHER (SPECIFY) X

718) Have you ever heard of test kits people can use to test themselves for HIV?

YES 1
NO 2 (GO TO 720)

719) Have you ever tested yourself for HIV using a self-testing kit?

YES 1
NO 2

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

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

720a) 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
DK/NOT SURE/DEPENDS 8

720b) 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
DK/NOT SURE/DEPENDS 8

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

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

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

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

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

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

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

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

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

AGREE 1
DISAGREE 2
DK/NOT SURE/DEPENDS 8

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

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

727) CHECK 701:

Heard about HIV or AIDS- Apart from HIV, have you heard about other infections that can be transmitted through sexual contact?

Not heard about HIV or AIDS- Have you heard about infections that can be transmitted through sexual contact?

YES 1
NO 2

728) CHECK 414:

HAS HAD SEXUAL INTERCOURSE (GO TO 729)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 736)

729) CHECK 727: Heard about other sexually transmitted infections?

YES
NO (GO TO 731)

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?

YES 1
NO 2
DON'T KNOW 8

731) 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

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?

YES 1
NO 2
DON'T KNOW 8

733) CHECK 730, 731, AND 732:

HAS HAD AN INFECTION (ANY YES)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 736)

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

YES 1
NO 2 (GO TO 736)

735) 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)

PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
HEALTH POST C
GOVT. FAMILY PLANNING CENTER D
RURAL MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
MOBILE CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) N
OTHER SOURCE
SHOP O
CHURCH P
FRIENDS/RELATIVES Q
BAR R
OTHER (SPECIFY) X

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?

YES 1
NO 2
DON'T KNOW 8

737) 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
DON'T KNOW 8

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.

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 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)

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
DON'T KNOW 8

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

EVERY DAY 1 (GO TO 811)
SOME SAYS 2
NOT AT ALL 3 (GO TO 810)

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

YES 1 (GO TO 812)
NO 2 (GO TO 812)

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

EVERY DAY 1 (GO TO 813)
SOME SAYS 2 (GO TO 813)
NOT AT ALL 3 (GO TO 813)

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 REPORT USING THE PRODUCT BUT NOT EVERY DAY, RECORD "888." IF THE PRODUCT IS NOT USED AT ALL, RECORD "000".

a) Manufactured cigarettes?
NUMBER DAILY
b) Hand-rolled cigarettes?
NUMBER DAILY
d) Pipes full of tobacco?
NUMBER DAILY
e) Cigars, cheroots, or cigarillos?
NUMBER DAILY
f) Number of water pipe sessions?
NUMBER DAILY
g) Any others? (specify)
NUMBER DAILY
ALL SKIP TO 813

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 REPORT USING THE PRODUCT BUT NOT EVERY DAY, RECORD "888." IF THE PRODUCT IS NOT USED AT ALL, RECORD "000".

a) Manufactured cigarettes?
NUMBER WEEKLY
b) Hand-rolled cigarettes?
NUMBER WEEKLY
d) Pipes full of tobacco?
NUMBER WEEKLY
e) Cigars, cheroots, or cigarillos?
NUMBER WEEKLY
f) Number of water pipe sessions?
NUMBER WEEKLY
g) Any others? (specify)
NUMBER WEEKLY

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

EVERY DAY 1
SOME DAYS 2 (GO TO 815)
NOT AT ALL 3 (GO TO 901)

814) On average, how many of the following products do you currently use each day? Also, let me know if you use the product, but not every day.

IF RESPONDENT REPORT USING THE PRODUCT BUT NOT EVERY DAY, RECORD "888." IF THE PRODUCT IS NOT USED AT ALL, RECORD "000".

a) Snuff, by mouth?
NUMBER DAILY
b) Snuff, by nose?
NUMBER DAILY
c) Chewing tobacco?
NUMBER DAILY
e) Any others? (specify)
NUMBER DAILY
ALL SKIP TO 901

815) On average, how many of the following products do you currently use each week? Also, let me know if you use the product, but not every week.

IF RESPONDENT REPORT USING THE PRODUCT BUT NOT EVERY DAY, RECORD "888." IF THE PRODUCT IS NOT USED AT ALL, RECORD "000".

a) Snuff, by mouth?
NUMBER WEEKLY
b) Snuff, by nose?
NUMBER WEEKLY
c) Chewing tobacco?
NUMBER WEEKLY
e) Any others? (specify)
NUMBER WEEKLY

SECTION 9. FEMALE CIRCUMCISION

901) Have you ever heard of female circumcision?

YES 1 (GO TO 903)
NO 2

>902) In some countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard about this practice?

YES 1
NO 2 (GO TO 905)

903) Do you believe that female circumcision is required by your religion?

YES 1
NO 2
NO RELIGION 3
DON'T KNOW 8

904) Do you think that female circumcision should be continued, or should it be stopped?

CONTINUED 1
STOPPED 2
DEPENDS 3
DON'T KNOW 8

905) Record the time

HOURS
MINUTES

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

Comments about respondent:

Comments on specific questions:

Any other comments:
>SUPERVISOR'S OBSERVATIONS

EDITOR'S OBSERVATIONS