HEALTH AND DEMOGRAPHIC SURVEY
MEN'S QUESTIONNAIRE
REPUBLIC OF CHAD
MINISTRY OF PLANNING AND COOPERATION
DIRECTORATE OF STATISTICS, ECONOMIC STUDIES, AND DEMOGRAPHICS
CENTRAL CENSUS BUREAU
IDENTIFICATION:
LOCALITY NAME: ___
NAME OF HEAD OF HOUSEHOLD: ___
PREFECTURE: ___
SUB-PREFECTURE: ___
CANTON: ___
CLUSTER NUMBER (ENUMERATION DISTRICT): ___
STRUCTURE NUMBER: ___
RESIDENCE NUMBER: ___
CENSUS ZONE NUMBER: ___
ABECHE/MOUNFOU/SARH 2
SMALL TOWNS 3
RURAL 4
NAME AND LINE NUMBER OF MAN: ___
DATE: ___
INTERVIEWER NAME: ___
RESULT:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY): ___ 7
NEXT VISIT:
DATE: ___
HOUR: ___
FINAL VISIT:
DAY: ___
MONTH: ___
YEAR: ___
NAME: ___
RESULT:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY): ___ 7
CHADIAN ARABIC 02
SAR 03
BORNOU 04
GOR 05
GORANE 06
GOULEY 07
KANEMBOU 08
LELE 09
MABA (OUADDAIAN) 10
MBAY 11
MOUNDANG 12
MOUSSEYE 13
NGAMBAY 14
TOUPOURI 15
OTHER LANGUAGES 16
NO 2
FIELD EDITED BY:
NAME: ___
DATE ___
OFFICE EDITED BY:
NAME: ___
DATE: ___
KEYED BY:
NAME: ___
DATE: ___
SECTION 1. RESPONDENT'S BACKGROUND
101) RECORD THE TIME
MINUTES: ___
102) To begin, I'd like to ask you some questions about yourself and your household.
During the majority of the first 12 years of your life, did you live in the city of N'Djamena, in Abeche, in Moundou, in Sarh, in another city, in a village, or abroad?
ABECHE/MOUNDOU/SARH 2
TOWN 3
VILLAGE 4
ABROAD 5
103) For how long have you been a long-term resident of (NAME OF CURRENT RESIDENCE)?
ALWAYS 95 (GO TO 105)
JUST VISITING 96 (GO TO 105)
104) Just before moving (NAME OF CURRENT RESIDENCE), did you live in N'Djamena, in Abeche, in Moundou, in Sarh, in another city, in a village, or abroad?
ABECHE/MOUNDOU/SARH 2
TOWN 3
VILLAGE 4
ABROAD 5
105) In what month and year were you born?
DK MONTH 98
DK YEAR 98
106) How old were you at your last birthday?
COMPARE AND CORRECT IF 105 AND/OR 106 ARE INCOMPATIBLE.
107) Have you ever attended school?
NO 2 (GO TO 111)
108) What is the highest level of education that you have attained: primary, secondary, higher, secondary-level professional, higher-level professional, or madrassa?
SECONDARY 2
HIGHER 3
SECONDARY-LEVEL PROFESSIONAL 4
HIGHER-LEVEL PROFESSIONAL 5
MADRASSA 6 (GO TO 111)
109) What was the last class you completed at this level?
INTRODUCTORY CLASS 1
PREPARATORY CLASS 2
ELEMENTARY CLASS 1 3
ELEMENTARY CLASS 2 4
MIDDLE-LEVEL CLASS 1 5
MIDDLE-LEVEL CLASS 2 6
6TH 1
5TH 2
4TH 3
3RD 4
2ND 5
1ST 6
FINAL YEAR 7
FIRST YEAR 1
SECOND YEAR 2
THIRD YEAR 3
FOURTH YEAR AND + 4
6TH OR 1ST YEAR 1
5TH OR 2ND YEAR 2
4TH OR 3RD YEAR 3
3RD OR 4TH YEAR 4
2ND OR 5TH YEAR 5
1ST OR 6TH YEAR 6
FINAL YEAR OR 7TH YEAR 7
1ST YEAR 1
2ND YEAR 2
3RD YEAR 3
4TH YEAR OR + 4
SECONDARY OR MORE: ___ (GO TO 112)
111) Can you read and understand a letter or newspaper easily, with difficulty, or not at all?
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 113)
111A) In what language do you mainly know how to read?
IF MORE THAN ONE LANGUAGE IS CITED, ONLY CIRCLE THE CODE OF THE LANGUAGE FIRST ON THE LIST.
ARABIC 2
OTHER LANGUAGE 3
112) Do you usually read a journal or magazine at least once a week?
NO 2
113) Do you usually listen to the radio every day?
NO 2
114) Do you watch television at least once a week?
NO 2
115) Are you currently working?
NO 2
116) Have you done any kind of work in the past 12 months?
NO 2 (GO TO 124)
117) What is your occupation, that is, what do/did you mainly do?
DOES NOT WORK IN AGRICULTURE: ___ (GO TO 120)
119) Do you work on your own land or on family land, or do you rent land, or do you work on someone else's land?
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
120) Do you do this work or a member of your family, for someone else, or are you self-employed?
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3
121) Do you usually work throughout the year, or do you work seasonally, or only once in a while?
SEASONAL WORK 2
ONCE IN A WHILE 3
122) In the last 12 months, how many months did you work?
123) How much do you usually earn for this work?
-IF MAN IS PAID IN KIND, CIRCLE '0'.
-IF MAN EARNS CASH, PROBE:
Is this by the hour, by the day, by the week, by the month, or by the year?
RECORD THE CORRESPONDING CODE AND RECORD THE SUM, PRECEDED BY '0' IF NECESSARY.
IF MAN EARNS NOTHING, RECORD '7'.
PER HOUR: ___ 1
PER DAY: ___ 2
PER WEEK: ___ 3
PER MONTH: ___ 4
PER YEAR: ___ 5
OTHER (SPECIFY): ___ 6
NOTHING 7
PROTESTANT 2
MUSLIM 3
ANIMIST 4
NO RELIGION 5
OTHER (SPECIFY): ___ 6
201) Now I'd like to ask you some questions about your children. I am interested only in the children of whom you are the biological father. Do/did you have any children?
NO 2 (GO TO 206)
202) Do you have sons or daughters currently living with you?
NO 2 (GO TO 204)
203) How many sons live with you? And how many daughters?
IF NONE, ENTER '00'.
DAUGHTERS AT HOME: ___
204) Do you have sons or daughters who are still living and do not currently live with you?
NO 2 (GO TO 206)
205) How many sons are alive but not living with you?
And how many daughters?
IF NONE, ENTER '00'.
NUMBER OF DAUGHTERS ELSEWHERE: ___
206) Have you had a son or daughter who was born alive and then died?
IF NO, PROBE: Any baby who cried or showed signs of life but who only survived a few hours or days?
NO 2 (GO TO 208)
207) How many of your sons have died?
And how many of your daughters?
IF NONE, WRITE '00'.
NUMBER OF DAUGHTERS DECEASED: ___
208) SUM ANSWERS TO 203, 205, AND 207 AND ENTER TOTAL:
IF NONE, RECORD '00'.
I want to make sure I understood: you have had in TOTAL___ births in your life. Is that correct?
NO: ___ (PROBE AND CORRECT 201-208 AS NECESSARY)
HAS NEVER HAD CHILDREN: ___ (GO TO 301)
210A) In what month and what year was your last child born?
YEAR: ___
AFTER JANUARY 1991: ___ (GO TO 301)
211) At the time you were expecting your last child, did you want this child then, did you want to wait until later or did you not want to have any (more) children at all?
LATER 2
NOT AT ALL 3
Now I would like to talk to you about family planning -- the various ways or methods that a couple can use to delay or avoid a pregnancy. Which ways or methods have you heard about?
CIRCLE CODE '1' IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN COLUMN IN 302, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.
CIRCLE CODE '2' IF METHOD IS RECOGNIZED, AND CODE '3' IF NOT RECOGNIZED.
THEN FOR EACH METHOD WITH CODE '1' OR '2' CIRCLED IN 301 OR 302, ASK QUESTION 303.
301) What are the ways or methods that you have heard about?
302) Have you ever heard of (METHOD)?
01. PILL Women can take a pill every day.
YES/DESCRIPTION 2
NO 3
02. IUD Some women have a "sterilet" that a doctor or nurse places in their in their uterus.
YES/DESCRIPTION 2
NO 3
03. INJECTABLES Women can receive an injection by a doctor or nurse to avoid becoming pregnant for several months.
YES/DESCRIPTION 2
NO 3
04. IMPLANT/NORPLANT: Women can have several small rods placed under the skin in their arm by a doctor or nurse, which can prevent pregnancy for several years.
YES/DESCRIPTION 2
NO 3
05. DIAPHRAGM/FOAM/GEL Women can put a sponge, suppository, diaphragm, gel, or cream inside them before intercourse.
YES/DESCRIPTION 2
NO 3
06. CONDOM Men can put a rubber sheath on their penis during sexual intercourse.
YES/DESCRIPTION 2
NO 3
07. FEMALE STERILIZATION Women can have an operation in order to avoid having any more children.
YES/DESCRIPTION 2
NO 3
08. MALE STERILIZATION Men can have an operation in order to avoid having any more children.
YES/DESCRIPTION 2
NO 3
09. RHYTHM, PERIODIC ABSTINENCE Every month that a woman is sexually active, she can avoid having sexual intercourse on certain days of the month when she is more likely to become pregnant.
YES/DESCRIPTION 2
NO 3
10. WITHDRAWAL Men can be careful and pull out before ejaculation.
YES/DESCRIPTION 2
NO 3
11. OTHER METHODS? Have you heard of other ways or methods that women or men can use to avoid pregnancy?
NO 3
303) Have you ever used (METHOD)?
01. PILL Women can take a pill every day.
NO/DK 2
02. IUD Some women have a "sterilet" that a doctor or nurse places in their in their uterus.
NO/DK 2
03. INJECTABLES Women can receive an injection by a doctor or nurse to avoid becoming pregnant for several months.
NO/DK 2
04. IMPLANT/NORPLANT: Women can have several small rods placed under the skin in their arm by a doctor or nurse, which can prevent pregnancy for several years.
NO/DK 2
05. DIAPHRAGM/FOAM/GEL Women can put a sponge, suppository, diaphragm, gel, or cream inside them before intercourse.
NO/DK 2
06. CONDOM Men can put a rubber sheath on their penis during sexual intercourse.
NO 2
07. FEMALE STERILIZATION Have you ever had a partner who had an operation to avoid having any more children?
NO/DK 2
08. MALE STERILIZATION Have you ever had an operation to avoid having any more children?
NO 2
09. RHYTHM, PERIODIC ABSTINENCE Every month that a woman is sexually active, she can avoid having sexual intercourse on certain days of the month when she is more likely to become pregnant.
NO, DK 2
10. WITHDRAWAL Men can be careful and pull out before ejaculation.
NO 2
11. OTHER METHODS? Have you heard of other ways or methods that women or men can use to avoid pregnancy?
NO 2
AT LEAST ONE 'YES' (EVER USED): ___ (GO TO 307)
305) Have you, or one of your partners, ever used or tried any way to delay or avoid getting pregnant?
NO 2 (GO TO 309)
306) What have you done or used?
CORRECT 303-304 (AND 302 IF NECESSARY).
307) Right now, are you or one of your partners doing something or using a method to delay or avoid pregnancy?
NO 2 (GO TO 309)
308) What method are you using?
IUD 02 (GO TO 401)
INJECTABLES 03 (GO TO 401)
IMPLANT/NORPLANT 04 (GO TO 401)
DIAPHRAGM/FOAM/GEL 05 (GO TO 401)
CONDOM 06 (GO TO 401)
FEMALE STERILIZATION 07 (GO TO 401)
MALE STERILIZATION 08 (GO TO 401)
PERIODIC ABSTINENCE 09 (GO TO 401)
WITHDRAWAL 10 (GO TO 401)
OTHER (SPECIFY): ___ 96 (GO TO 401)
309) What is the main reason you are not using a method?
INFREQUENT SEX 22
WOMAN MENOPAUSAL/HAS HAD HYSTERECTOMY 23
WOMAN SUBFECUND/STERILE 24
WOMAN POSTPARTUM/BREASTFEEDING 25
WANTS (MORE) CHILDREN 26
WOMAN PREGNANT 27
WIFE/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
KNOWS NO SOURCE 42
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY): ___ 96
DK 98
401) Are you currently married or living with a woman?
YES, LIVING WITH A WOMAN 2 (GO TO 402A)
NON-CONSUMMATED MARRIAGE 3 (GO TO 410F)
NO, NOT IN UNION 4 (GO TO 404)
402) How many wives do you have?
402A) With how many woman do you live as if married?
403) RECORD THE LINE NUMBER FROM HOUSEHOLD QUESTIONNAIRE OF HIS WIFE/WIVES.
IF A WIFE DOES NOT LIVE IN THE HOUSEHOLD, RECORD '00'.
THE NUMBER OF BOXES FILLED MUST BE EQUAL TO THE NUMBER OF WIVES IN 402.
404) Do you currently have a regular sexual partner, an occasional sexual partner, or no sexual partner at all?
OCCASIONAL SEXUAL PARTNER 2
NO SEXUAL PARTNER 3
405) Have you ever been married or lived in a union with a woman?
YES, LIVED WITH A WOMAN 2 (GO TO 407)
NO 3 (GO TO 410F)
406) What is your marital status now: are you a widower, divorced, or separated?
DIVORCED 2
SEPARATED 3
406A) Who initiated the divorce/separation?
WOMAN 2
MAN AND WOMAN/JOINT DECISION 3
FAMILY 4
406B) What was the cause of your divorce/separation?
WOMAN'S STERILITY 02
MATERIAL/FINANCIAL CAUSE 04
MARITAL PROBLEM 05
FAMILY PRESSURE 06
OTHER (SPECIFY): ___ 96
407) Have you been married, or have you lived with a woman as if married, once or more than once?
IF ONCE, RECORD '1'.
IF SEVERAL TIMES, ASK AND RECORD NUMBER.
MARRIED/LIVED WITH A WOMAN ONLY ONCE:
In what month and year did you start living with your wife/partner?
MARRIED/ LIVED WITH A WOMAN MORE THAN ONCE:
Now we will talk about your first wife/partner. In what month and year did you start living with her?
DK MONTH 98
YEAR: ___
DK YEAR 98 (GO TO 409A)
409) How old were you when you started living with her?
406: WIDOWER, DIVORCEE, OR SEPARATED: ___ (GO TO 410F)
410) Now I would like to ask you some questions about your sexual activity in order to gain a better understanding of some family planning issues.
When did you last have sexual relations with your (wife/woman you live with)?
IF RESPONSE IS 'NEVER,' RETURN TO 401, RECORD 'NON-CONSUMMATED MARRIAGE' AND FOLLOW THE NEW PATH INSTRUCTIONS.
WEEKS AGO: ___ 2
MONTHS AGO: ___ 3
YEARS AGO: ___ 4
KNOWS CONDOM:
The last time you had sex with your (wife/woman you live with), was a condom used?
DOES NOT KNOW CONDOM:
Some men use a condom, which means that the put a rubber sheath on their penis during sexual intercourse. The last time you had sex with your (wife/woman you live with), was a condom used?
NO 2
DK/NOT SURE 8
410B) Have you had sexual relations with anyone else besides with your (wife/woman you live with) in the past 12 months?
NO 2 (GO TO 410J)
410C) When did you have, for the first time, sexual relations with someone other than with (your wife/woman you live with)?
NUMBER OF WEEKS: ___ 2
NUMBER OF MONTHS: ___ 3
NUMBER OF YEARS: ___ 4
410D) Did you use a condom at this time?
NO 2
DK/NOT SURE 8
410E) In the last 12 months, with how many different people other than (your wife/woman you live with) did you have sexual relations?
DK 98 (GO TO 410J)
410F) Now I would like to ask you some questions about your sexual activity in order to gain a better understanding of some family planning issues.
When did you last have sexual relations (if ever)?
DAYS AGO: ___ 1
WEEKS AGO: ___ 2
MONTHS AGO: ___ 3
YEARS AGO: ___ 4
KNOWS CONDOM:
The last time you had sex, was a condom used?
DOES NOT KNOW CONDOM:
Some men use a condom, which means that the put a rubber sheath on their penis during sexual intercourse. The last time you had sex, was a condom used?
NO 2
DK/NOT SURE 8
12 MONTHS OR MORE SINCE LAST SEXUAL RELATIONS: ___ (GO TO 410J)
410I) Over the past 12 months, with how many different people did you have sexual relations?
DK 98
CURRENTLY MARRIED OR LIVING WITH 1 WOMAN:
The last time that you had sexual relations, was it with (your wife/woman you live with), a regular sex partner, an acquaintance, someone you paid, or someone else?
CURRENTLY NOT MARRIED OR LIVING WITH 1 WOMAN/IN NON-CONSUMMATED MARRIAGE:
The last time that you had sexual relations, was it with a regular sex partner, an acquaintance, someone you paid, or someone else?
REGULAR PARTNER 2
ACQUAINTANCE 3
SOMEONE PAID FOR SEX 4
SOMEONE ELSE 5
413) Do you know of a place where you can get condoms?
NO 2 (GO TO 415)
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
PLEASE NOTE:
IF RESPONSE IS 'MILITARY HOSPITAL/GARRISON,' CIRCLE '12' FOR N'DJAMENA AND THE CODE '13' FOR OTHER CITIES.
PLEASE NOTE:
IF THE RESPONSE IS 'NURSE,' PROBE TO DETERMINE IF A REAL NURSE (CODE '25' 'WORKPLACE HEALTH CENTER), A HOSPITAL, OR A PUBLIC HEALTH CENTER.
MILITARY HOSPITAL/GARRISON 12
HEALTH CENTER/ DISPENSARY/GARRISON 13
WALK-IN CLINIC 14
HOSPITAL OR HEALTH CENTER PHARMACY 15
OTHER PUBLIC (SPECIFY): ___ 16
CLINIC/PRIVATE DOCTOR'S OFFICE 22
CHADIAN FAMILY WELFARE ASSOCIATION 23
PRIVATE HEALTH CENTER 24
WORKPLACE HEALTH CENTER 25
PHARMACY/PHARMACEUTICAL DEPOT 26
OTHER PRIVATE MEDICAL (SPECIFY): ___ 27
FIRST AID WORKER 42 (GO TO 414C)
TRAVELING SALESMAN 43 (GO TO 414C)
FRIENDS/NEIGHBORS/RELATIVES 44 (GO TO 414C)
OTHER (SPECIFY): ___ 96
DK 96
414A) How far away is (NAME OF PLACE IN 414)?
RECORD '95' FOR 95 KILOMETERS OR MORE.
DK 98
414B) How long does it take to get to (NAME OF PLACE IN 414)?
RECORD '300' FOR 5 HOURS OR MORE.
DK 998
414C) How much does one condom cost?
FREE 996
DK 998
415) How old were you when you first had sexual intercourse?
FIRST TIME WHEN MARRIED 96
SECTION 5. FERTILITY PREFERENCES
501) CHECK 401:
CURRENTLY MARRIED/LIVING WITH WOMAN: ___ (GO TO 503)
OCCASIONAL SEX PARTNER: ___ (GO TO NEXT QUESTION)
NO SEX PARTNER: ___ (GO TO 505A)
503) Is your wife (or one of your wives)/partner currently pregnant?
NO 2 (GO TO 505A)
NOT SURE 8 (GO TO 505A)
504) When she became pregnant, did you want her to become pregnant then, did you want her to become pregnant later, or did you not want her to become pregnant at all?
LATER 2 (GO TO 505B)
NOT AT ALL 3 (GO TO 505B)
NOT PREGNANT OR UNSURE:
Now I have some questions about the future. Would you like to have (a/nother) child you would you prefer not have any (more) children?
PREGNANT:
Now I have some questions about the future. After the child your wife/partner is expecting, would you like to have another child or would you prefer to not have any more children?
NO MORE/NONE 2 (GO TO 507)
HE SAYS SHE CAN'T GET PREGNANT 3 (GO TO 507)
HE SAYS HE CANNOT HAVE MORE CHILDREN 4 (GO TO 507)
UNDECIDED OR DK 8 (GO TO 507)
WIFE/PARTNER NOT PREGNANT OR UNSURE OR DOES NOT HAVE WIFE/PARTNER:
How long would you like to wait from now before the birth of (a/another) child?
WIFE/PARTNER PREGNANT:
After the child your wife/partner is now expecting, how long would you like to wait before the birth of another child?
YEARS: ___ 2
SOON/NOW 993
HE SAYS SHE CAN'T GET PREGNANT 994
AFTER MARRIAGE 995
OTHER (SPECIFY): ___ 996
DK 998
507) CHECK 308: USING A METHOD?
NOT CURRENTLY USING: ___ (GO TO NEXT QUESTION)
CURRENTLY USING: ___ (GO TO 512)
508) Do you think you will use a method to delay or avoid pregnancy in the next 12 months?
NO 2
DK 8
509) Do you think you will use a method in the future?
NO 2 (GO TO 511)
DK 8 (GO TO 511)
510) What method would you prefer to use?
IUD 02 (GO TO 512)
INJECTABLES 03 (GO TO 512)
IMPLANT 04 (GO TO 512)
DIAPHRAGM/FOAM/GEL 05 (GO TO 512)
CONDOM 06 (GO TO 512)
FEMALE STERILIZATION 07 (GO TO 512)
MALE STERILIZATION 08 (GO TO 512)
PERIODIC ABSTINENCE 09 (GO TO 512)
WITHDRAWAL 10 (GO TO 512)
OTHER (SPECIFY): ___ 96 (GO TO 512)
DK/UNSURE 98 (GO TO 512)
511) What is the main reason you think you will never use a method?
WOMAN MENOPAUSAL/HYSTERECTOMY 23
WOMAN SUBFECUND/STERILE 24
WANTS (MORE) CHILDREN 26
WIFE/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
KNOWS NO SOURCE 42
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY): ___ 96
DK 98
HAS LIVING CHILDREN:
If you could go back to the time when 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.
OTHER ANSWER (SPECIFY): ___ 96 (GO TO 514)
512A) What is the main reason you would like to have (NUMBER OF CHILDREN FROM 512)?
SUPPORT IN OLD AGE 02
HELP IN WORK 03
SUPPLEMENTAL WORK 04
TO BE ABLE TO WORK 05
UNCERTAINTY ABOUT FUTURE 06
ENSURE GOOD FUTURE/EDUCATION FOR CHILDREN 07
FAMILY PRESTIGE/SOCIAL STANDING 08
WILL OF GOD 09
RELIGIOUS/SOCIAL OBLIGATION10
AFFECTION/COMPANY 11
HEALTH PROBLEMS LINKED TO MOTHERHOOD 12
ILLNESS/DEATH OF CHILDREN 13
OTHER (SPECIFY): ___ 96
DK 98
513) Among the (NUMBER OF CHILDREN FROM 512), of children that you want, how many would you like to be boys, how many would you like to be girls, and for how many would it not matter?
SUM 'BOYS' AND 'GIRLS' AND 'EITHER', THIS NUMBER SHOULD BE EQUAL TO 512. IF 'NO', CHECK AND CORRECT.
OTHER (SPECIFY): ___ 96
OTHER (SPECIFY): ___ 96
OTHER (SPECIFY): ___ 96
514) In general, do you approve or disapprove of couples using a method to avoid getting pregnant?
DISAPPROVE 2
NO OPINION 3
515) Do you find it acceptable or not acceptable that information on family planning is broadcast:
On the radio?
On television?
NOT ACCEPTABLE 2
DK 8
NOT ACCEPTABLE 2
DK 8
516) In the last few months, have you heard anything about family planning:
On the radio?
On television?
In newspapers or magazines?
From a poster?
From a leaflet or brochure?
NO 2
NO 2
NO 2
NO 2
NO 2
RADIO 'NO': ___ (GO TO 518)
517) In the last few months, have you heard a message on the radio promoting:
Birth spacing?
Mother's health?
NO 2
NO 2
518) In the last few months, have you discussed the practice of family planning with your friends, neighbors, or relatives?
NO 2 (GO TO 520)
519) With whom have you discussed it?
Anyone else?
RECORD ALL MENTIONED.
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER D
MOTHER-IN-LAW G
FRIENDS/NEIGHBORS H
OTHER (SPECIFY): ___ X
YES, LIVING WITH A WOMAN: ___ (GO TO NEXT QUESTION)
NO, NOT IN UNION/IN NON-CONSUMMATED MARRIAGE: ___ (GO TO 601A)
521) Spouses/partners do not always agree on everything. Now I want to ask you some questions about your wife/wives' point of view on family planning.
Do you think that your wife/wives approve(s) or disapprove(s) of couples using a method to avoid pregnancy?
DISAPPROVES 2
DK 8
522) How often have you talked to your wife/wives about this subject in the last 12 months?
ONCE OR TWICE 2
MORE OFTEN 3
SECTION 6. AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES
601A) Have you ever heard of illnesses that can be sexually transmitted?
NO 2 (GO TO 601F)
601B) What illnesses do you know about?
RECORD ALL MENTIONED.
GONORRHEA/ BLENNORRAGY B
AIDS C
GENITAL WART/TUMOR D
OTHER (SPECIFY): ___ W
OTHER (SPECIFY): ___ X
DK Z
HAS NEVER HAD SEXUAL RELATIONS: ___ (GO TO 601F)
601D) In the last 12 months, have you had any of these illnesses?
NO 2 (GO TO 601F)
DK 8 (GO TO 601F)
601E) What illnesses have you had?
RECORD ALL MENTIONED.
GONORRHEA/BLENNORRAGY B
AIDS C
GENITAL WART/TUMOR D
OTHER (SPECIFY): ___ W
DK Z
601F) In the past 12 months, have you had an unusual discharge from your penis?
NO 2
DK 8
601G) In the past 12 months, have you had a sore or ulcer on your penis?
NO 2
DK 8
601H) CHECK 601D, 601F, AND 601G:
NO 'YES': ___ (GO TO 601N)
601I) The last time that you had (DISEASE FROM 601E/DISCHARGE/SORE) did you seek advice or treatment?
NO 2 (GO TO 601JB)
601J) Where did you seek advice or treatment?
Anywhere else?
RECORD ALL MENTIONED.
IF HOSPITAL, HEALTH CENTER, OR CLINIC, RECORD THE NAME OF THE PLACE. PROBE TO DETERMINE THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE
PLEASE NOTE:
IF RESPONSE IS 'MILITARY HOSPITAL/GARRISON,' CIRCLE 'B' FOR N'DJAMENA AND THE CODE 'C' FOR OTHER CITIES.
PLEASE NOTE:
IF THE RESPONSE IS 'NURSE,' PROBE TO DETERMINE IF A REAL NURSE (CODE 'K' "WORKPLACE HEALTH CENTER") OR IF A HOSPITAL OR A PUBLIC HEALTH CENTER.
MILITARY HOSPITAL/GARRISON B
HEALTH CENTER/DISPENSARY/GARRISON C
WALK-IN CLINIC D
HOSPITAL OR HEALTH CENTER PHARMACY E
OTHER PUBLIC (SPECIFY): ___ F
CLINIC/PRIVATE DOCTOR'S OFFICE H
CHADIAN FAMILY WELFARE ASSOCIATION I
PRIVATE HEALTH CENTER J
WORKPLACE HEALTH CENTER K
PHARMACY/PHARMACEUTICAL DEPOT L
OTHER PRIVATE MEDICAL (SPECIFY): ___ M
FIRST AID WORKER P
TRAVELING SALESMAN Q
FRIENDS/NEIGHBORS/RELATIVES R
HEALER S
OTHER (SPECIFY): ___ X
601JA) In all, how much did the treatment cost you?
IF MORE THAN 99,994 CAF, RECORD '99994'.
FREE 99995
DK 99998
HAS NEVER HAD SEXUAL RELATIONS: ___ (GO TO 601N)
601K) When you had the (DISEASE(S) FROM 601E/DISCHARGE/SORE), did you tell your partner(s)?
NO 2
601L) When you had the (DISEASE(S) FROM 601E/DISCHARGE/SORE), did you do something to avoid infecting your partner(s)?
NO 2 (GO TO 601N)
PARTNER ALREADY INFECTED 3 (GO 601N)
RECORD ALL MENTIONED.
USED CONDOMS B
TOOK MEDICATION C
OTHER (SPECIFY): ___ X
MENTIONED AIDS: ___ (6010A)
601O) Have you ever heard of an illness called AIDS?
NO 2 (GO TO 611C)
601OA) Where did you hear about AIDS for the first time?
TV 02
NEWSPAPERS/MAGAZINES 03
PAMPHLETS/BROCHURES 04
HEALTH WORKER 05
MOSQUE/CHURCH 06
SCHOOLS/TEACHER 07
COMMUNITY MEETINGS 08
FRIENDS/RELATIVES 09
WORK PLACE 10
OTHER (SPECIFY): ___ 96
602) From which sources of information have you learned most about AIDS?
Any other sources?
RECORD ALL MENTIONED.
TV B
NEWSPAPERS/MAGAZINES C
PAMPHLETS/BROCHURES D
HEALTH WORKER E
MOSQUE/CHURCH F
SCHOOLS/TEACHER G
COMMUNITY MEETINGS H
FRIENDS/RELATIVES I
WORK PLACE J
OTHER (SPECIFY): ___ X
Any other way?
RECORD ALL MENTIONED.
NOT USING CONDOMS C
SEX WITH MULTIPLE PARTNERS E
SEX WITH PROSTITUTES G
HOMOSEXUAL SEX H
BLOOD TRANSFUSIONS I
INJECTIONS J
FROM MOTHER TO CHILD K
KISSING L
MOSQUITO BITES M
LIVING WITH SOMEONE WITH AIDS N
CONTAMINATED BLADES, SCISSORS, KNIVES, OTHER CUTTING INSTRUMENTS Q
EXCISION/CIRCUMCISION/EAR-PIERCING R
EATING/DRINKING FROM SAME DISHES AS SOMEONE INFECTED WITH AIDS S
OTHER (SPECIFY): ___ X
DK Z
603) Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?
NO 2 (GO TO 607)
DK 8 (GO TO 607)
Anything else?
RECORD ALL MENTIONED.
USE CONDOMS C
HAVE ONLY ONE SEX PARTNER D
BE FAITHFUL F
AVOID SEX WITH PROSTITUTES G
AVOID SEX WITH HOMOSEXUALS H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID KISSING L
AVOID MOSQUITO BITES M
AVOID LIVING WITH PEOPLE WITH AIDS N
SEEK PROTECTION FROM GOD/PRAY P
AVOID CONTAMINATED BLADES, SCISSORS, KNIVES, CUTTING INSTRUMENTS Q
AVOID EXCISION/CIRCUMCISION/EAR PIERCING R
AVOID EATING/DRINKING FROM SAME DISHES AS SOMEONE INFECTED WITH AIDS S
OTHER (SPECIFY): ___ X
DK Z
607) Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DK 8
608) Do you think that a person with AIDS almost never die from the disease, sometimes die, or almost always die from the disease?
SOMETIMES 2
ALMOST ALWAYS 3
DK 8
608A) Can one be cured of AIDS?
NO 2
DK 8
608B) Can AIDS be transmitted from mother to child during pregnancy or birth?
NO 2
DK 8
608C) Do you know someone personally who has AIDS or who died of AIDS?
NO 2
DK 8
609) Do you think your chances of getting AIDS are small, moderate, great, or no risk at all?
MODERATE 2 (GO TO 609C)
GREAT 3 (GO TO 609C)
NO RISK AT ALL 4
HAS AIDS 5 (GO TO 611A)
609B) Why do you think that you have (NO/LITTLE) risk of getting AIDS?
Any other reason?
RECORD ALL MENTIONED.
USES CONDOMS C (GO TO 609CA)
HAS ONLY 1 SEX PARTNER D (GO TO 609CA)
HAS LIMITED NUMBER OF SEX PARTNERS E (GO TO 609CA)
PARTNER HAS NO OTHER PARTNERS F (GO TO 609CA)
DOES NOT HAVE SEX WITH PROSTITUTES G (GO TO 609CA)
DOES NOT HAVE SEX WITH HOMOSEXUALS H (GO TO 609CA)
DOES NOT HAVE BLOOD TRANSFUSIONS I (GO TO 609CA)
DOES NOT HAVE INJECTIONS J (GO TO 609CA)
PROTECTED BY TRADITIONAL HEALERS O (GO TO 609CA)
PROTECTED BY GOD P (GO TO 609CA)
AVOIDS CONTAMINATED BLADES, SCISSORS, KNIVES, CUTTING INSTRUMENTS Q (GO TO 609CA)
AVOIDS EXCISION/CIRCUMCISION/EAR PIERCING R (GO TO 609CA)
AVOIDS EATING/DRINKING FROM SAME DISHES AS SOMEONE INFECTED WITH AIDS S (GO TO 609CA)
OTHER (SPECIFY): ___ X (GO TO 609CA)
609C) Why do you think that you have (MODERATE/GREAT) risk of getting AIDS?
No other reason?
RECORD ALL MENTIONED.
MORE THAN 1 SEX PARTNER D
MANY SEX PARTNERS E
PARTNER HAS OTHER PARTNERS(S) F
SEX WITH PROSTITUTES G
SEX WITH HOMOSEXUALS H
BLOOD TRANSFUSIONS I
INJECTIONS J
CONTAMINATED BLADES, SCISSORS, KNIVES, CUTTING INSTRUMENTS Q
EXCISION/CIRCUMCISION/EAR PIERCING R
EATS/DRINKS FROM SAME DISHES AS SOMEONE INFECTED WITH AIDS S
OTHER (SPECIFY): ___ X
609CA) In your opinion, what should be done with people sick with AIDS?
KEEP THEM AT HOME 02
ISOLATE THEM 03
HELP THEM 04
OTHER (SPECIFY): ___ 96
611A) Since you have heard about AIDS, have you changed your behavior to avoid getting AIDS?
IF YES, What have you done?
RECORD ALL MENTIONED.
STOPPED ALL SEX B (GO TO 611C)
STARTED USING CONDOMS C (GO TO 611C)
RESTRICTED SEX TO 1 PARTNER D (GO TO 611C)
REDUCED NUMBER OF PARTNERS E (GO TO 611C)
ASKED PARTNER TO BE FAITHFUL F (GO TO 611C)
STOPPED SEX WITH PROSTITUTES G (GO TO 611C)
STOPPED SEX WITH HOMOSEXUALS H (GO TO 611C)
STOPPED INJECTION J
SOUGHT PROTECTION FROM TRADITIONAL HEALERS O
SOUGHT PROTECTION FROM GOD/PRAYER P
AVOIDS CONTAMINATED BLADES/SCISSORS/KNIVES/CUTTING TOOLS Q
AVOIDS EXCISION/CIRCUMCISION/EAR-PIERCING R
AVOIDS EATING/DRINKING FROM SAME DISHES AS PERSON WITH AIDS S
OTHER (SPECIFY): ___ X
NO CHANGE Y
611B) Has your knowledge of AIDS influenced or changed your decision to have sex or your sexual behavior?
IF YES, in what way?
RECORD ALL MENTIONED.
STOPPED ALL SEX B
STARTED USING CONDOMS C
RESTRICTED SEX TO 1 PARTNER D
REDUCED NUMBER OF PARTNERS E
ASKED PARTNER TO BE FAITHFUL F
STOPPED SEX WITH HOMOSEXUALS H
OTHER (SPECIFY): ___ X
NO CHANGE Y
611C) Some people use a condom during sexual relations to avoid getting AIDS or other sexually transmitted diseases. Have you ever heard about them?
NO 2 (GO TO 611F)
HAS NEVER HAD SEX: ___ (GO TO 613)
611E) It is possible that we have already talked about this. Have you ever used a condom during sex to avoid getting or transmitting illnesses, such as AIDS?
NO 2 (GO TO 611G)
HAS NEVER HAD SEX: ___ (GO TO 613)
611G) In the last 12 months, have you given or received money, presents, or favors in exchange for sexual relations?
NO 2
MINUTES: ___
INTERVIEWER'S OBSERVATIONS:
(To be filled in after completing interview)
COMMENTS ABOUT RESPONDENT: ___
COMMENTS ON SPECIFIC QUESTIONS: ___
ANY OTHER COMMENTS: ___
TEAM LEADER OBSERVATIONS:
TEAM LEADER NAME: ___
DATE: ___
SUPERVISOR'S OBSERVATIONS:
NAME OF SUPERVISOR: ___
DATE: ___