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REPUBLIC OF CHAD
MINISTRY OF PLANNING, DEVELOPMENT, AND COOPERATION
NATIONAL INSTITUTE OF STATISTICS, ECONOMIC STUDY, AND DEMOGRAPHY
SECOND DEMOGRAPHIC AND HEALTH SURVEY
MAN'S QUESTIONNAIRE

Identification

NAME OF LOCALITY: __
NAME OF HEAD OF HOUSEHOLD:__

DEPARTMENT:__
SUBPREFECTURE:__
MUNICIPALITY:__
CLUSTER NUMBER (EDST): __
STRUCTURE NUMBER: __
HOUSEHOLD NUMBER IN THE STRUCTURE: __
SEQUENTIAL NUMBER OF SELECTED HOUSEHOLD (01-24 URBAN; 01-33 RURAL): __
Urban/rural

URBAN 1
RURAL 2

Residence:

N'DJAMENA=1
ABECHE/MOUNDOU/SARH=2
OTHER DEPARTMENTAL ADMINISTRATIVE CENTER=3
OTHER SMALL CITIES=4
RURAL=5

Man's name and line number (from household questionnaire)

LINE NUMBER:_______

Interviewer visits

1 2 3
DATE___

INTERVIEWER'S NAME___
RESULT*

FINAL VISIT
DAY __
MONTH __
YEAR 200__
NAME _________
RESULT_________

NEXT VISIT
DATE____
TIME____

TOTAL NO. OF VISITS_____

*Result codes

1Completed
2 No household member at home
3 Postponed
4 Refused
5 Partly completed
6 Incapacitated
7 Other (specify)

Language of Interview**
Interpreter

YES=1
NO=2

**Language codes

FRENCH 01
CHADIAN ARABIC 02
SAR 03
BORNOU 04
GOR 05
GORANE 06
COULEY 07
KANEMBOU 08
LELE 09
MABA (OUADDAIEN) 10
MBAY 11
MOUDANG 12
MOUSSEYE 13
NGAMBAY 14
TOUPOURI 15
OTHER LANGUAGES 16

SUPERVISOR
NAME:_____
DATE:_____

FIELD EDITOR
NAME:____
DATE:____

OFFICE EDITOR:___

KEYED BY:___

Section 1. Respondent's Background

Informed consent

Hello. My name is ____ and I work with the National Institute of Statistics, Economic Study and Demographics. In collaboration with the Ministry of Public Healthy, we are conducting a national survey about the health of women and children. We would very much appreciate your participation in this survey. I would like to ask you about your health (and the health of your children). This information will help the government to plan health services. The survey usually takes between 10 and 20 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

At this time, do you have any questions?
May I begin the interview now?

101) Record time

HOURS __ __
MINUTES __ __

105) What year and what month were you born in?

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 __ __

If Respondent under age 15 or over age 59, stop the interview and make the appropriate corrections on the household questionnaire.

107) Have you ever attended school?

YES 1
NO 2- SKIP TO 109

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

MADRASA ONLY 1-SKIP TO 109
PRIMARY 2
SECONDARY 3
HIGHER 4
PROFESSIONAL SECONDARY LEVEL 5
PROFESSIONAL HIGHER LEVEL 6

109) What is the highest (grade/form/year) you completed at this level?*

CLASS __

109a) Can you read Arabic, French, French and Arabic, or can you not read at all?

ARABIC ONLY 1-SKIP TO 112
FRENCH ONLY 2
ARABIC AND FRENCH 3
CANNOT READ AT ALL 4-SKIP TO 113

110) Check 107 and 108:

NEVER ATTENDED SCHOOL OR PRIMARY ONLY OR MADRASA ONLY
SECONDARY OR PROFESSIONAL SECONDARY, OR HIGHER OR PROFESSIONAL HIGHER -SKIP TO 112

111) Now I would like you to read this sentence to me out loud in French; read as much as you can.
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-SKIP TO 113
ABLE TO READ CERTAIN PARTS 2
ABLE TO READ WHOLE SENTENCE 3

112) Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?

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

113) Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?

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

114) Do you watch television almost every day, at least once a week, less than once a week, or not at all?

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

115) What is your religion?

CATHOLIC 1
PROTESTANT 2
ISLAM 3
ANIMIST 4
NO RELIGION 5
OTHER 6

116) What is your ethnicity?

GORANE 01
ARAB 02
OUADDAI 03
BAGUIRMIEN 04
KANEM-BORNOU 05
FITRI-BATHA 06
HADJARAI 07
LAC IRO 08
SARA 09
TANDJILE 10
PEUL 11
MAYO KEBBI 12
OTHER CHADIAN ETHNICITIES 13
FOREIGNER 14
INDETERMINATE 98

117) Do you currently have a job of any kind for which you are paid in cash? Or do you work in agriculture?

YES 1-SKIP TO 119
NO 2

118) Have you had any kind of job in the last 12 months for which you earned money?

YES 1
NO 2-SKIP TO 125

119) What is your occupation, that is, what kind of work do (did) you mainly do?

OCCUPATION____________

120) Check 119:

WORKS IN AGRICULTURE-SKIP TO 121
DOES NOT WORK IN AGRICULTURE-SKIP TO 122

121) Do you work mainly on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?
If fisher, circle code 6

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
FISHER 6

122) Do you do this work for a member of your family, for someone else, or are you self-employed?

FOR FAMILY MEMBER 1
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3

123) 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

124) On average, how much of your household's expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all?

NONE 1
ALMOST NONE 2
A PORTION 3
ALL/ALMOST ALL 4
ALL SKIP TO 201

125) Are you looking for a job?

YES 1
NO 2

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. Have you fathered any children?

YES 1
NO 2 -SKIP TO 206

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

YES 1
NO 2- SKIP 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 who are alive but do not live with you?

YES 1
NO 2- SKIP 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, recode '00'

SONS ELSEWHERE __ __
DAUGHTERS ELSEWHERE __ __

206) Have you ever had any sons or daughters who were born alive but later died?
If no, PROBE: Any baby who cried or showed signs of life at birth but did not survive?

YES 1
NO 2- SKIP 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:
Just to makes sure that I have this right: you have had in total ____children during your life. Is that correct?

YES
NO-PROBE AND CORRECT 201-208 AS NECESSARY

210) Check 208:

HAS HAD MORE THAN ONE CHILD
HAS HAD ONLY ONE CHILD-SKIP TO 213
HAS NOT HAD ANY CHILDREN-SKIP TO 301

211) Do all of the children you have fathered have the same biological mother?

YES 1-SKIP TO 213
NO 2

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

NUMBER OF WOMEN __ __

213) Check 208:
Has had only one child-In what month and what year was your child born?
Has had more than one child-In what month and what year was your (last) child born?

MONTH __ __
YEAR __ __ __ __

214) Check 208:
Has had only one child-When the mother of your child got pregnant, did you want to have a child then, did you want to wait until later, or did you not want to have any (more) children at all?
Has had more than one child- When the mother of your child got pregnant the last time, did you want to have a child then, did you want to wait until later, or did you not want to have any (more) children at all?

THEN 1
LATER 2
NOT AT ALL 3
DON'T KNOW 8
SECTION 3: CONTRACEPTION

301) Now I would like to ask some questions about family planning-the various ways or methods that a couple can use to delay or avoid a pregnancy.

Circle code 1 in 301a for each method mentioned spontaneously. Then proceed down column 301a, reading the name and description of each method not mentioned spontaneously. Circle code 1 if method is recognized, and code 2 if not recognized. Then, for each method with code 1 circled in 301a, ask 302.

301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?

302) Have you ever heard of (METHOD)?

01) FEMALE STERILIZATION
Women can have an operation to avoid having any more children
YES 1
NO 2

302) Have you ever had a partner who had 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

302) Have you ever had an operation to avoid having any more children?

YES 1
NO 2
03) Pill: women can take a pill every day.

301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?

YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

04) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?

YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

05) INJECTABLES
Women can have an injection by a heath provider which stops them from becoming pregnant for a month or more.

301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?
YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

06) IMPLANTS
Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for a year or more.

301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?
YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

07) CONDOM
Men can put a rubber sheath on their penis before sexual intercourse.

301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?
YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

08) FEMALE CONDOM
Women can place a sheath in their vagina before sexual intercourse.

301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?
YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

09) DIAPHRAGM
Women can place a thin flexible disk in their vagina before intercourse.

301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?
YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

10) Suppository, jelly or vaginal tablets
Women can place a suppository, jelly, or cream in their vagina before intercourse.

301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?
YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

11) Lactational amenorrhea method (LAM)
Up to 6 months after childbirth, and when her menstrual period has not returned, a woman can use a method that requires that she breastfeeds frequently, day and night, without giving him any other food.

301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?
YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

12) Rhythm or Periodic abstinence
Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.

301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?
YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

13) WITHDRAWAL
Men can be careful and pull out before climax.

301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?
YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

14) EMERGENCY CONTRACEPTION
Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.

301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?
YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

15) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?

YES 1
(SPECIFY)__________
(SPECIFY)__________
NO 2

303) Check 302:

NOT A SINGLE 'YES' (NEVER USED)
AT LEAST ONE 'YES' (EVER USED)- SKIP TO 307

304) Have you or any of your partners ever used anything or tried in any way to delay or avoid getting pregnant?

YES 1
NO 2- SKIP TO 309

306) What have you used or done?
Correct 302 and 303 (and 301a if necessary)

307) Are you or your partner currently doing something or using any method to delay or avoid getting pregnant?

YES 1
NO 2-SKIP TO 309

308) Check 302 (02):

MAN NOT STERILIZED-WHAT METHOD DO YOU USE?
MAN STERILIZED-CIRCLE 02 FOR MALE STERILIZATION
FEMALE STERILIZATION 01
MALE STERILIZATION 02
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
MOUSSE/JELLY/VAGINAL TABLETS 10
LACTATIONAL AMEN. METHOD 11
RHYTHM METHOD 12
WITHDRAWAL 13
OTHER (SPECIFY) 96

(All skip to 401)

309) What is the main reason for which you are not using a method to delay or avoid pregnancy?

NOT MARRIED 11
INFREQUENT SEX/NO SEX 12
WIFE/PARTNER MENOPAUSAL/HYSTERECTOMY 13
COUPLE SUBFECUND/INFECUND 14
WANTS AS MANY CHILDREN AS POSSIBLE 15
IT'S NOT MY RESPONSIBILITY 16
RESPONDENT OPPOSED 21
HUSBAND/PARTNER OPPOSED 22
OTHERS OPPOSED 23
RELIGIOUS PROHIBITION 24
KNOWS NO METHOD 31
KNOWS NO SOURCE 32
HEALTH CONCERNS 41
FEAR OF SIDE EFFECTS 42
LACK OF ACCESS/TOO FAR 43
COSTS TOO MUCH 44
INCONVENIENT TO USE 45
INTERFERES WITH BODY'S NORMAL PROCESSES 46
OTHER (SPECIFY) 96
DON'T KNOW 98

SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

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

YES, CURRENTLY MARRIED 1
YES, LIVING WITH A WOMAN 2-SKIP TO 402A
NO, NOT IN UNION 3-SKIP TO 404

402) How many wives do you have?

402a) With how many women do you live as if married?

NUMBER OF WIVES/WOMEN __ __

403) Record the line number of his wife/wives/partner/partners from the household sheet.

If a woman isn't listed in the household (she doesn't live in the household), record 00

The number of spaces filled should be equal to the number of women in q. 402.

__ __ __ __ __ __ -SKIP TO 406
__ __ __ __ __ __ -SKIP TO 406

404) Have you ever been married or lived with a woman?

YES, HAS BEEN MARRIED 1
YES, HAS LIVED WITH A WOMAN 2-SKIP TO 406
NO 3-SKIP TO 410

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

WIDOWED 1
DIVORCED 2
SEPARATED 3

405a) Who initiated your divorce/separation?

RESPONDENT HIMSELF 1
WIFE/PARTNER 2
WOMAN AND HUSBAND/MUTUAL AGREEMENT 3
FAMILY OF MAN 4
FAMILY OF WIFE/PARTNER 5

405b) What was the main cause of your divorce/separation?

MALE STERILITY (RESPONDENT'S) 01
WOMAN'S STERILITY 02
WOMAN'S ILLNESS 03
FINANCIAL REASONS 04
WOMAN'S INFIDELITY 05
DOMESTIC CONFLICT 06
FAMILY PRESSURE 07
OTHER (SPECIFY) 08

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

ONCE 1-SKIP TO 408
MORE THAN ONCE 2

407) In total, how many women have been married to or have you lived with as if married?

NUMBER OF WOMEN __ __

408) Check 406:
Married/lived with woman only once --in what month and year did you start living with your wife/partner?

Married/lived with woman more than once --I would like to talk about your first wife/partner. In what month and year did you start living with her?

MONTH _____
DON'T KNOW MONTH 98
YEAR ____ - SKIP TO 410
DON'T KNOW YEAR 9998

409) How old were you when you started living with her?

AGE __ __

410) Now I need to ask you some questions about your sexual activity in order to gain a better understanding of some family life issues.
How old were you when you first had sexual intercourse (if ever)?

NEVER 00-SKIP TO 426
AGE IN YEARS __ __
FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE/PARTNER 95

411) Check 106:

AGE 15-24-SKIP TO 412
AGE 25-59-SKIP TO 413

412) Was a condom used the first time you had sexual intercourse?

YES 1
NO 2
DON'T KNOW/FORGOT 8

413) When was the last time you had sexual intercourse?
Record in Number of years only if the last time was over a year ago.
If 12 months of more, the answer should be recorded in years

DAYS AGO 1
WEEKS AGO 2
MONTHS AGO 3
YEARS AGO 4-SKIP TO 425

414) The last time you had sexual intercourse, was a condom used?

YES 1
NO 2

415) What was your relationship to this person with whom you had sexual intercourse?

If girlfriend or fiancé, ask:
Were you living together when you last had sexual intercourse with her?
If yes, circle 01
If no, circle 02

WIFE/LIVE-IN PARTNER 01
GIRLFRIEND/FIANCÉ 02
ANOTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
PROSTITUTE 06
OTHER (SPECIFY) 96

416) In the last 12 months, have you had sexual intercourse with anyone else?

YES 1
NO 2-SKIP TO 425

417) The last time you had sexual intercourse with this other person, was a condom used?

YES 1
NO 2

418) What was your relationship to this person with whom you had sexual intercourse?

If girlfriend or fiancé, ask:
Were you living together when you last had sexual intercourse with her?
If yes, circle 01
If no, circle 02

WIFE/LIVE-IN PARTNER 01
GIRLFRIEND/FIANCÉ 02
ANOTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
PROSTITUTE 06
OTHER (SPECIFY) 96

419) Other than these two people, have you had sexual intercourse with anyone else in the last 12 months?

YES 1
NO 2-SKIP TO 425

420) The last time you had sexual intercourse with this third person, was a condom used?

YES 1
NO 2

421) What was your relationship to this person?

If girlfriend or fiancé, ask:
Were you living together when you last had sexual intercourse with her?
If yes, circle 01
If no, circle 02

WIFE/LIVE-IN PARTNER 01
GIRLFRIEND/FIANCÉ 02
ANOTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
PROSTITUTE 06
OTHER (SPECIFY) 96

422) In total, with how many people have you had sexual intercourse in the last 12 months?

NUMBER OF PARTNERS __ __

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

YES 1
NO 2 --SKIP TO 425

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

YES 1
NO 2

425) In total, with how many different people have you had sex in your lifetime?
PROBE to obtain an exact number
If the number if more than 95, write '95'

NUMBER OF PARTNERS __ __

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

YES 1
NO 2-SKIP TO 501

427) Where is that?
Any other place?
Record all mentioned

(NAME OF PLACE)_____________
PUBLIC SECTOR
HOSPITAL/MATERNITY A
MILITARY HOSPITAL/GARRISON B
HEALTH CENTER/FREE CLINIC/GARRISON C
POLYCLINIC D
HOSPITAL/HEALTH CENTER PHARMACY E
AMASOT/MASOCOT F [##TRANSLATOR NOTE: BOTH ARE ACRONYMS FOR AGENCIES THAT ADVOCATE CONDOMS]
OTHER PUBLIC G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL H
CLINIC/OFFICE I
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING J
PRIVATE HEALTH CENTER K
COMPANY HEALTH CENTER L
CARE OFFICE/NURSE M
PHARMACY/PHARMACY DEPOT N
OTHER PRIVATE MEDICAL O
PUBLIC/PRIVATE SECTOR
VILLAGE PHARMACY/HEALTH CENTER P
OTHER
SHOP/BAR/MARKET/HOTEL Q
FIRST AID WORKER R
MOBILE VENDOR S
FRIENDS/NEIGHBORS/RELATIVES T
OTHER PLACE____________ X

SECTION 5. FERTILITY PREFERENCES

501) CHECK 401: Marital status

CURRENTLY MARRIED/LIVING WITH A WOMAN-SKIP TO 502
NOT CURRENTLY MARRIED/NOT CURRENTLY LIVING WITH A WOMAN-SKIP TO 505A

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

YES 1
NO 2-SKIP TO 505A
DK 8-SKIP TO 505A

504) At the time she became pregnant did you want her to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?

THEN 1
LATER 2
NOT AT ALL 3

ALL SKIP TO 505B

505) CHECK 501 AND 503:
A) Wife/partner not pregnant or not sure or not in union- Now I have some question about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

B) Wife/partner pregnant- Now I have some questions about the future. After the child your wife/partner is expecting now, would you like to have another child, or would you prefer not to have any more children?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2-SKIP TO 507
WIFE/PARTNER CAN'T GET PREGNANCY 3-SKIP TO 507
SAYS HE DOESN'T WANT ANY MORE CHILDREN 4-SKIP TO 507
UNDECIDED/DON'T KNOW 8-SKIP TO 507

506) Check 501 and 503:
A) Wife/partner not pregnant or not sure or not in union- How long would you like to wait from now before the birth of (a/another) child?
B) Wife/partner pregnant- 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
SAYS WIFE CAN'T GET PREGNANT 994
AFTER MARRIAGE 995
OTHER (SPECIFY) 996
DON'T KNOW 998

507) CHECK 307: Currently using a contraceptive method

YES: CURRENTLY USING-SKIP TO 512
NOT ASKED-SKIP TO 508
NO: NOT CURRENTLY USING-SKIP TO 508

508) Do you think you will use a method to delay or avoid pregnancy in the next 12 months?

YES 1-SKIP TO 510
NO 2
DON'T KNOW 8

509) Do you think you will use a method to delay or avoid pregnancy at any time in the future?

YES 1
NO 2-SKIP TO 511
DON'T KNOW 8-SKIP TO 511

510) Which method would you prefer to use?

FEMALE STERILIZATION 01
MALE STERILIZATION 02
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM/FOAM/JELLY 09
LACTATIONAL AMEN. METHOD 10
RHYTHM METHOD 11
WITHDRAWAL 12
OTHER (SPECIFY)__________96
UNSURE 98
ALL SKIP TO 512

511) What is the main reason that you think you will never use a contraceptive method at any time in the future?

NOT MARRIED 11
FERTILITY-RELATED REASONS
NO SEX/INFREQUENT SEX 22
WIFE/PARTNER MENOPAUSAL/HYSTERECTOMY 23
COUPLE SUBFECUND/INFECUND 24
WANTS AS MANY CHILDREN AS POSSIBLE 25
OPPOSITION TO USE
RESPONDENT OPPOSED 31
SPOUSE/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COSTS TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) 96
DON'T KNOW 98

512) CHECK 202 AND 204:
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.

NUMBER __ __
OTHER (SPECIFY) 96-SKIP TO 514

513) How many of these children would you like to be boys, how many would you like to be girls, and for how many would it not matter?

NUMBER OF BOYS__ __
NUMBER OF GIRLS __ __
EITHER __ __
OTHER (SPECIFY) 96

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

APPROVE 1
DISAPPROVE 2
NO OPINION 8

515) In the last few months have you heard about family planning:

On the radio?
YES 1
NO 2
On the television?
YES 1
NO 2
In a newspaper in magazine?
YES 1
NO 2
On a poster?
YES 1
NO 2
In a leaflet/brochure?
YES 1
NO 2

515a) Do you think it's acceptable or unacceptable to talk about family planning:

On the radio?
ACCEPTABLE 1
UNACCEPTABLE 2
On the television?
ACCEPTABLE 1
UNACCEPTABLE 2
In a newspaper in magazine?
ACCEPTABLE 1
UNACCEPTABLE 2
On a poster?
ACCEPTABLE 1
UNACCEPTABLE 2
In a leaflet/brochure?
ACCEPTABLE 1
UNACCEPTABLE 2

516) CHECK 401: Marital status

CURRENTLY MARRIED/LIVING WITH A WOMAN-SKIP TO 516A
NOT CURRENTLY MARRIED/NOT CURRENTLY LIVING WITH A WOMAN-SKIP TO 601

516a) CHECK 402: Number of spouses/partners

ONLY ONE SPOUSE/PARTNER-SKIP TO 517
TWO OR MORE SPOUSES/PARTNERS-SKIP TO 601

517) Now I want to ask you about your spouse/live-in partner's views on family planning.

Do you think your spouse approves or disapproves of couples using a contraceptive method to avoid pregnancy?

APPROVE 1
DISAPPROVE 2
INDIFFERENT 3
DON'T KNOW 8

518) How often have you talked to your spouses/live-in partners about family planning in the last twelve months?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

519) Does your spouse want the same number of children that you want, or does she want more or fewer than you want?

SAME NUMBER 1
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8

SECTION 6. AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

601) How I would like to talk about something else.
Have you ever heard of an illness called AIDS?

YES 1
NO 2-SKIP TO 617

601a) How can you get AIDS?
Any other way?
RECORD ALL MENTIONED

SEXUAL RELATIONS A
NOT USING A CONDOM B
SEXUAL RELATIONS WITH MULTIPLE PARTNERS C
SEXUAL RELATIONS WITH PROSTITUTES D
HOMOSEXUAL RELATIONS E
BLOOD TRANSFUSIONS F
MOTHER TO CHILD G
KISSING H
MOSQUITO BITES I
LIVING WITH SOMEONE WITH AIDS J
DIRTY BLADES, SCISSORS, KNIVES, CUTTING OBJECTS K
FEMALE GENITAL CUTTING/CIRCUMCISION/EAR PIERCING L
EATING/DRINKING FROM SAME DISHES AS SOMEONE WITH AIDS M
OTHER (SPECIFY) X
DON'T KNOW Z

601b) 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
DON'T KNOW 8

601c) Can people get the AIDS virus from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

601d) Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?

YES 1
NO 2
DON'T KNOW 8

601e) Can people get the AIDS virus by sharing food with a person who has AIDS?

YES 1
NO 2
DON'T KNOW 8

601f) Can people reduce their chance of getting the AIDS virus by not having sexual intercourse at all?

YES 1
NO 2
DON'T KNOW 8

601g) Can people get the AIDS virus because of witchcraft?

YES
NO 2
DON'T KNOW 8

601h) Can people get the AIDS virus through contact with sharp-edged objects contaminated with blood, used, for example, during circumcisions, female genital cutting, scarification?

YES 1
NO 2
DON'T KNOW 8

601i) Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?

YES 1
NO 2-SKIP TO 609
DON'T KNOW 8-SKIP TO 609

601j) What can a person do?
Anything else?
RECORD ALL WAYS MENTIONED.

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS INTRAVENOUSLY H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING RAZORS/BLADES K
AVOID CIRCUMCISION/FEMALE GENITAL CUTTING/SCARIFICATION L
AVOID KISSING M
AVOID MOSQUITO BITES N
SEEK PROTECTION FROM TRADITIONAL PRACTITIONER O
OTHER (SPECIFY) W
OTHER (SPECIFY) X
DON'T KNOW Z

609) Is it possible for a healthy-looking person to have the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

610) Do you know someone personally who has the virus that causes AIDS or someone who died of AIDS?

YES 1
NO 2

611) Can the virus that causes AIDS be transmitted from a mother to a child?

YES 1
NO 2-SKIP TO 613
DON'T KNOW 8-SKIP TO 613

612) Can the virus that causes AIDS be transmitted from a mother to a child:

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

613) Check 401:

YES, CURRENTLY MARRIED/LIVING WITH A WOMAN-SKIP TO 614
NO, NOT IN UNION/NOT LIVING WITH A WOMAN- SKIP TO 616A

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

YES 1
NO 2

614A) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

615) If a member of your family got infected with the AIDS virus, would you want it to remain a secret or not?

YES 1
NO 2
DK/NOT SURE 8

616) If a relative of yours became sick with the virus that causes AIDS, would you be willing to care for her or him in your own household?

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

616a) 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 BE ALLOWED 2
DK/NOT SURE/DEPENDS 8

616aa) do you think that sex education can contribute to AIDS prevention?

YES 1
NO 2
DON'T KNOW 8

616ab) Do you think it is acceptable or not to teach sex education at school?

ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8

616b) Should children age 12-14 be taught about using a condom to avoid getting AIDS?

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

616j) I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?

YES 1
NO 2 --SKIP TO 616O

616k) When was the last time you were tested?

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

616l) The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

616m) I don't want to know the results, but did you get the results of the test?

YES 1
NO 2

616n) Where was the test done?
You only have to circle one code

PUBLIC SECTOR
TESTING CENTER 11 [##TRANSLATOR NOTE: THIS IS AN OFFICIAL LOCATION NAME]
HOSPITAL/MATERNITY 12
MILITARY HOSPITAL/GARRISON 13
HEALTH CENTER/FREE CLINIC/GARRISON 14
NATIONAL PROGRAM FIGHTING AIDS (PNLS) 15 [##TRANSLATOR NOTE: THIS IS AN OFFICIAL LOCATION NAME]
POLYCLINIC 16
HOSPITAL/HEALTH CENTER PHARMACY 17
OTHER PUBLIC 18
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 21
CLINIC/OFFICE 22
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING 23
PRIVATE HEALTH CENTER 24
COMPANY HEALTH CENTER 25
CARE OFFICE/NURSE 26
PHARMACY/PHARMACY DEPOT 27
OTHER PRIVATE MEDICAL 28
PUBLIC/PRIVATE SECTOR
VILLAGE PHARMACY/HEALTH CENTER 31
OTHER PLACE 96
ALL SKIP TO 617

616o) Would you like to have an AIDS test?

YES 1
NO 2
DON'T KNOW 8

616p) Do you know a place where you can be tested for AIDS?

YES 1
NO 2-SKIP TO 617

616q) Where can you go for this test?
Anywhere else?
RECORD ALL MENTIONED

PUBLIC SECTOR
TESTING CENTER A [##TRANSLATOR NOTE: THIS IS AN OFFICIAL LOCATION NAME]
HOSPITAL/MATERNITY B
MILITARY HOSPITAL/GARRISON C
HEALTH CENTER/FREE CLINIC/GARRISON D
NATIONAL PROGRAM FIGHTING AIDS (PNLS) E [##TRANSLATOR NOTE: THIS IS AN OFFICIAL LOCATION NAME]
POLYCLINIC F
HOSPITAL/HEALTH CENTER PHARMACY G
OTHER PUBLIC H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL I
CLINIC/OFFICE J
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING K
PRIVATE HEALTH CENTER L
COMPANY HEALTH CENTER M
CARE OFFICE/NURSE N
PHARMACY/PHARMACY DEPOT O
OTHER PRIVATE MEDICAL P
PUBLIC/PRIVATE SECTOR
VILLAGE PHARMACY/HEALTH CENTER Q
OTHER PLACE X

617) CHECK 401:

CURRENTLY MARRIED/LIVING WITH A WOMAN-SKIP TO 618
NOT CURRENTLY IN A UNION-SKIP TO 619

618) Have you ever talked about ways to prevent getting the virus that causes AIDS with your wife/partner?

YES 1
NO 2

619) Do you think it's acceptable or unacceptable to talk about AIDS:

a) on the radio?
ACCEPTABLE 1
NOT ACCEPTABLE 2
b) On television?
ACCEPTABLE 1
NOT ACCEPTABLE 2
c) In the newspaper?
ACCEPTABLE 1
NOT ACCEPTABLE 2
d) On posters?
ACCEPTABLE 1
NOT ACCEPTABLE 2
e) In places of worship?
ACCEPTABLE 1
NOT ACCEPTABLE 2

619a) Do you think there are some segments of the population who have a higher risk of getting age because of, for example, their behavior or their job?

YES 1
NO 2-SKIP TO 619D
DON'T KNOW 8-SKIP TO 619D

619b) Do you think that you are part of an at-risk group?

YES 1
NO 2
DON'T KNOW 8

619c) What segments of the population do you think are more at risk of getting AIDS?
Any other group?
Record all mentioned

PROSTITUTE A
HOMOSEXUAL B
DRUG ADDICTS C
TRUCKER D
MILITARY/POLICE E
MIGRANT F
REFUGEE G
OTHER (SPECIFY) X

619d) Is there treatment for people with AIDS?

YES 1
NO 2-SKIP TO 620
DON'T KNOW 8-SKIP TO 620

619e) What treatments do you know?
Any other treatment?
RECORD ALL MENTIONED

TRI-THERAPY/ARV/ART/ANTIRETROVIRAL A
OTHER MODERN DRUGS B
OTHER TRADITIONAL DRUGS C
OTHER (SPECIFY) X

619f) Do you know where a person with AIDS can go for treatment?
If yes, where can he/she go?
Any other place?
RECORD ALL MENTIONED.

PUBLIC SECTOR
TESTING CENTER A [##TRANSLATOR NOTE: THIS IS AN OFFICIAL LOCATION NAME]
HOSPITAL/MATERNITY B
MILITARY HOSPITAL/GARRISON C
HEALTH CENTER/FREE CLINIC/GARRISON D
NATIONAL PROGRAM FIGHTING AIDS (PNLS) E [##TRANSLATOR NOTE: THIS IS AN OFFICIAL LOCATION NAME]
POLYCLINIC F
HOSPITAL/HEALTH CENTER PHARMACY G
OTHER PUBLIC H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL I
CLINIC/OFFICE J
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING K
PRIVATE HEALTH CENTER L
COMPANY HEALTH CENTER M
CARE OFFICE/NURSE N
PHARMACY/PHARMACY DEPOT O
OTHER PRIVATE MEDICAL P
PUBLIC/PRIVATE SECTOR
VILLAGE PHARMACY/HEALTH CENTER Q
TRADITIONAL PRACTITIONER/MARABOU R
OTHER PLACE X
NOWHERE/NO ONE Y

620) Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

YES 1
NO 2-SKIP TO 622A

621) If a man has a sexually transmitted disease, what symptoms might he have?
Any other sign or symptom?
RECORD ALL SYMPTOMS MENTIONED

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

622) If a woman has a sexually transmitted disease, what symptoms might she have?
Any other sign or symptom?
RECORD ALL SYMPTOMS MENTIONED

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
HARD TO GET PREGNANT/HAVE A CHILD L
OTHER (SPECIFY) W
OTHER (SPECIFY) X
NO SYMPTOMS Y
DON'T KNOW Z

622a) CHECK 410:

HAD HAD SEXUAL INTERCOURSE-SKIP TO 622B
HAS NOT HAD SEXUAL INTERCOURSE (IF 00 IS CIRCLED) -SKIP TO 701

622b) CHECK 620:

HAS HEARD OF SEXUALLY TRANSMITTED INFECTIONS-SKIP TO 622C
HAS NOT HEARD OF SEXUALLY TRANSMITTED INFECTIONS-SKIP TO 622D

622c) Now I would like to ask you some questions about your health. During the last 12 months, have you had a disease which you got through sexual contact?

YES 1
NO 2
DON'T KNOW 8

622d) Sometimes men have abnormal discharge from their penis. Have you had any abnormal discharge from your penis in the last 12 months?

YES 1
NO 2
DON'T KNOW 8

622e) 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

622f) Check 622c, 622d, and 622e:

YES TO Q. 622C, D OR E, HAS HAD AN INFECTION-SKIP TO 622G
NO TO Q. 622C, D OR E, HAS NOT HAD AN INFECTION-SKIP TO 622L

622g) The last time you had (infection from 622c, 622d, and/or 622e), did you seek any kind of advice or treatment from a health professional?

YES 1
NO 2-SKIP TO 622I

622h) The last time you had (infection from 622C, 622D, and/or 622E), did you do any other following? Did you…

a) Seek advice or treatment from a health care professional or in a health care establishment?
YES 1
NO 2
b) Seek advice or treatment from a traditional practitioner/marabou
YES 1
NO 2
c) Seek advice or buy drugs from a shop, a market, or a pharmacy?
YES 1
NO 2
d) Seek advice from friends or relatives?
YES 1
NO 2

622i) When you had (infection from 622C, 622D, and/or 622E), did you inform the people were you having sexual intercourse with?

YES 1
NO 2
SOME PEOPLE/NOT ALL 3

622j) When you had (infection from 622C, 622D, and/or 622E), did you do something to avoid infecting your sexual partner(s)?

YES 1
NO 2
PARTNER(S) ALREADY INFECTED 3
DIDN'T HAVE PARTNER 4
2-8 SKIP TO 622L

622k) What did you do to prevent infection in your partner(s)? Did you…

Stop sexual intercourse?
YES 1
NO 2
Use a condom during sexual intercourse?
YES 1
NO 2
Taken drugs?
YES 1
NO 2

622l) Husband and wives do not always agree in everything. Please tell me if you think a woman is justified refusing to have sex with her husband when:

She knows her husband has a disease that she can get during sexual intercourse?
YES 1
NO 2
DK 8
She knows her husband has sex with other women?
YES 1
NO 2
DK 8
She recently gave birth?
YES 1
NO 2
DK 8
She is tired or not in the mood?
YES 1
NO 2
DK 8

622m) 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

SECTION 7. FEMALE GENITAL CUTTING

701) Have you ever heard of female circumcision?

YES 1-SKIP TO 703
NO 2

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

YES 1
NO 2-SKIP TO 711

703) What benefits do girls get if they undergo this genital cutting?
PROBE: Other benefits?
RECORD ALL MENTIONED

CLEANLINESS/HYGIENE A
SOCIAL ACCEPTANCE B
BETTER MARRIAGE PROSPECTS C
APPEASES WOMAN'S SEXUAL DESIRE D
MORE SEXUAL PLEASURE FOR THE MAN E
RELIGIOUS APPROVAL F
OTHER (SPECIFY) X
NO BENEFITS Y

704) What benefits do girls get if they do not undergo this genital cutting?
PROBE: Anything else?
RECORD ALL MENTIONED

FEWER MEDICAL PROBLEMS A
FEWER CHILDBIRTH PROBLEMS B
AVOIDING PAIN C
MORE SEXUAL PLEASURE FOR HER D
MORE SEXUAL PLEASURE FOR THE MAN E
FOLLOWS RELIGION F
OTHER (SPECIFY) X
NO ADVANTAGES Y

705) CHECK 703 AND 704:

CODE 'D' NOT CIRCLED FOR Q. 703 OR Q. 704-SKIP TO 705
CODE 'D' CIRCLED FOR Q. 703 OR Q. 704 -SKIP TO 707

706) Would you say that this practice is a way to appease women's sexual desire or does it have no effect?

PREVENT SEX 1
NO EFFECT 2
DON'T KNOW 8

707) CHECK 703 AND 704:

CODE 'F' NOT CIRCLED FOR Q. 703 OR Q. 704
CODE 'F' CIRCLED FOR Q. 703 OR Q. 704 -SKIP TO 709

708) Do you believe that this practice is required by your religion?

YES 1
NO 2
DON'T KNOW 8

709) Do you think that this practice should be continued, or should it be discontinued?

CONTINUED 1
DISCONTINUED 2
DEPENDS 3
DON'T KNOW 8

710) Do you think that women want this practice to be continued, or discontinued?

CONTINUED 1
DISCONTINUED 2
DEPENDS 3
DON'T KNOW 8

711) Some men are not circumcised. Are you circumcised?

YES 1
NO 2

712) RECORD TIME

HOURS __ __
MINUTES __ __

INTERVIEWER'S OBSERVATIONS

To be filled in after completing interview

Comments about respondent:

________________________
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Comments on specific questions:

________________________
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Any other comments:

________________________
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Supervisor's observations

________________________
________________________
________________________

Name of supervisor__________
Date ______

Editor's observations

________________________
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________________________

Name of editor___________
Date________