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UNITED REPUBLIC OF TANZANIA
BUREAU OF STATISTICS, PLANNING COMMISSION
TANZANIA DEMOGRAPHIC AND HEALTH SURVEY
INDIVIDUAL QUESTIONNAIRE
MALE

IDENTIFICATION
NAME OF HOUSEHOLD HEAD ______________________
TDHS CLUSTER ID ___
HOUSEHOLD NO. ___
REGION _____________________
DISTRICT ___________________
WARD ___________________
ENUMERATION AREA _______________
URBAN/RURAL ___

URBAN 1
RURAL 2

LARGE CITY/SMALL CITY/TOWN/COUNTRYSIDE ___

LARGE CITY 1
SMALL CITY 2
TOWN 3
COUNTRYSIDE 4

NAME AND LINE NUMBER OF MALE RESPONDENT _____________ ___
NAME AND LINE NUMBER OF WIFE ___________________ ___
NAME AND LINE NUMBER OF WIFE ___________________ ___
NAME AND LINE NUMBER OF WIFE ___________________ ___

INTERVIEWER VISITS
INTERVIEWER VISIT 1
DATE ______________
INTERVIEWER'S NAME _______________
RESULT ______________

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) _________ 6

INTERVIEWER VISIT 2
DATE ______________
INTERVIEWER'S NAME _______________
RESULT ______________

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) _________ 6

INTERVIEWER VISIT 3
DATE ______________
INTERVIEWER'S NAME _______________
RESULT ______________

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) _________ 6

NEXT VISIT:
DATE ______
TIME _____

FINAL VISIT
DAY ____
MONTH ____
YEAR ___
ID NO. ___
RESULT ____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) _________ 6

TOTAL NUMBER OF VISITS __

FIELD EDITED BY
NAME ________
DATE ________

OFFICE EDITED BY
NAME ________
DATE ________

KEYED BY
NAME ________
DATE ________

KEYED BY

SECTION 1. RESPONDENT'S BACKGROUND

M101. RECORD THE TIME

HOUR _______
MINUTES _______

M102. First I would like to ask some questions about your background. For most of the time until you were 12 years old, did you live in Dar es Salaam city, another urban area, or in a rural area?

CITY (DAR ES SALAAM) 1
OTHER URBAN AREA 2
RURAL AREA/VILLAGE 3

M103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?

YEARS ___
ALWAYS 95 (GO TO M105)
VISITOR 96 (GO TO M105)

M104. Just before you moved here, did you live in Dar es Salaam city, another urban area, or in a rural area?

CITY (DAR ES SALAAM) 1
OTHER URBAN AREA 2
RURAL AREA/VILLAGE 3

M105. In what month and year were you born?

MONTH ___
DON'T KNOW MONTH 98
YEAR __
DON'T KNOW YEAR 98

M106. How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

AGE IN COMPLETED YEARS ___

M107. Can you read and write kiswahili easily, with difficulty, or not at all?

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO M109)

M108. Do you usually read a newspaper or magazine at least once a week?

YES 1
NO 2

M109. Have you ever attended school?

YES 1
NO 2 (GO TO M111)

M110. What is the highest formal school completed?

LESS THAN 1 YEAR 00
STANDARD 1 01
STANDARD 2 02
STANDARD 3 03
STANDARD 4 04
STANDARD 5 05
STANDARD 6 06
STANDARD 7 07
STANDARD 8 08
FORM 1 09
FORM 2 10
FORM 3 11
FORM 4 12
FORM 5 13
FORM 6 14
UNIVERSITY 15
OTHER (SPECIFY) ________________ 16

M111. Do you usually listen to a radio at least once a week?

YES 1
NO 2

M112. Do you usually watch television at least once a week?

YES 1
NO 2

M113. What kind of work do you mainly do?

_________________________

M114. CHECK M113:

WORKS IN AGRICULTURE __ (GO TO M115)
DOES NOT WORK IN AGRICULTURE __ (GO TO M116)

M115. Do you work mainly on your own land or on family land, or do you rent land, or do you work on someone else's land?

OWN LAND 1
RENT LAND 2
SOMEONE ELSE'S LAND 3

M116. What is your religion?

MUSLIM 1
CATHOLIC 2
PROTESTANT 3
NONE 4
OTHER (SPECIFY) ______________ 5

M117. To which tribe do you belong?

________________

M118. CHECK Q.5 IN THE HOUSEHOLD SCHEDULE:

THE RESPONDENT IS NOT A USUAL RESIDENT OF THE HH __ (GO TO M119)
THE RESPONDENT IS A USUAL RESIDENT OF THE HH __ (GO TO M201)

M119. Now I would like to ask about the place in which you usually live.
Do you usually live in Dar es Salaam City, another urban area, or in the rural area?
IF OTHER URBAN AREA: In which town do you live?*

CITY (DAR ES SALAAM) 1
LARGE URBAN AREA 2
SMALL URBAN AREA 3
RURAL AREA/VILLAGE 4

M120. In which region is that located?
IF USUAL RESIDENCE IS OUTSIDE OF TANZANIA, RECORD COUNTRY OF RESIDENCE.

REGION ______________ ___

M121. Does the household in which you usually live have:

ELECTRICITY
YES 1
NO 2
RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
REFRIGERATOR
YES 1
NO 2

M122. Could you describe the main material of the floor of your home?

EARTH/SAND 11
WOOD PLANKS 21
PARQUET OR POLISHED WOOD 31
CERAMIC TILES 32
CEMENT 33
OTHER (SPECIFY) _____________ 41

M123. Does any member of your household own:

A bicycle?
A motorcycle?
A car?

BICYCLE
YES 1
NO 2
MOTORCYCLE
YES 1
NO 2
CAR
YES 1
NO 2

*M119 LARGE URBAN AREAS ARE MWANZA, ARUSHA, MOROGORO, DODOMA, MOSHI, TANGA, IRINGA, MBEYA, TABORA AND ZANZIBAR. SMALL URBAN AREAS ARE ALL OTHER TOWNS.

SECTION 2. REPRODUCTION

M201. Do you have any sons or daughters who are now living with you?

YES 1
NO 2 (GO TO M203)

M202. How many sons live with you?
And how many daughters live with you?
IF NONE, ENTER '00'.

SONS AT HOME _____
DAUGHTERS AT HOME ______

M203. Do you have any sons or daughters who do not live with you?

YES 1
NO 2 (GO TO M205)

M204. 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, ENTER '00'

SONS ELSEWHERE ____
DAUGHTERS ELSEWHERE ____

M205. Have you ever had a son or daughter who was born alive but later died?

YES 1
NO 2 (GO TO M207)

M206. In all, how many boys have died?
And how many girls have died?
IF NONE, ENTER '00'.

BOYS DEAD ___
GIRLS DEAD ___

M207. SUM ANSWERS TO M202, 204, AND 206, AND ENTER TOTAL.
IF NONE, ENTER '00'.

TOTAL ________

M208. CHECK M207:
Just to make sure that I have this right: you have had in TOTAL ____ children born alive during your life. Is that correct?

YES __ (GO TO M209)
NO __ (PROBE AND CORRECT M201-M207 AS NEEDED)

M209. Between the first day of a woman's period and the first day of her next period, are there certain times when she has a greater chance of becoming pregnant than other times?

YES 1
NO 2 (GO TO M301)
DON'T KNOW 8 (GO TO M301)

M210. During which time of the monthly cycle does a woman have the greatest chance of becoming pregnant?

DURING HER PERIOD 1
RIGHT AFTER HER PERIOD HAS ENDED 2
IN THE MIDDLE OF THE CYCLE 3
JUST BEFORE HER PERIOD BEGINS 4
OTHER (SPECIFY) _________________ 5
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. Which ways or methods have you heard about?

CIRCLE CODE 1 IN M302 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN THE COLUMN, 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 M302, ASK M303 AND M304 BEFORE PROCEEDING TO THE NEXT METHOD.

M302. Have you ever heard of (METHOD)?
READ DESCRIPTION OF EACH METHOD.

METHOD 01 PILL Women can take a pill every day.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 04 DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly, or cream inside them before intercourse.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 05 CONDOM Men can use a rubber sheath during sexual intercourse. The rubber sheath is used to avoid pregnancy, to prevent transmission of diseases such as AIDS, or for cleanliness.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 06 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 07 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 08 CALENDAR Couples can have sexual intercourse only during the safe period of the monthly cycle, that is the times during the monthly cycle when the woman is least likely to become pregnant.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 09 MUCUS METHOD A woman can observe daily the state of the mucus and avoid sexual intercourse at the time when the mucus is colorless and extremely elastic.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 10 WITHDRAWAL Men can be careful and pull out before climax.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 11 ANY OTHER METHODS
Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1 (SPECIFY) _____________________
NO 3

M303. Have you (or your wife/partner) ever used (METHOD)?

METHOD 01 PILL Women can take a pill every day.
YES 1
NO 2
METHOD 02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
METHOD 03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
METHOD 04 DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly, or cream inside them before intercourse.
YES 1
NO 2
METHOD 05 CONDOM Men can use a rubber sheath during sexual intercourse. The rubber sheath is used to avoid pregnancy, to prevent transmission of diseases such as AIDS, or for cleanliness.
YES 1
NO 2
METHOD 06 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 07 MALE STERILIZATION Men can have an operation to avoid having any more children.
Have you ever had an operation to avoid having any more children?
YES 1
NO 2
METHOD 08 CALENDAR Couples can have sexual intercourse only during the safe period of the monthly cycle, that is the times during the monthly cycle when the woman is least likely to become pregnant.
YES 1
NO 2
METHOD 09 MUCUS METHOD A woman can observe daily the state of the mucus and avoid sexual intercourse at the time when the mucus is colorless and extremely elastic.
YES 1
NO 2
METHOD 10 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
METHOD 11 ANT OTHER METHOD
Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2

M304. Do you know where a person could go to get (METHOD)?

METHOD 01 PILL Women can take a pill every day.
YES 1
NO 2
METHOD 02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
METHOD 03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
METHOD 04 DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly, or cream inside them before intercourse.
YES 1
NO 2
METHOD 05 CONDOM Men can use a rubber sheath during sexual intercourse. The rubber sheath is used to avoid pregnancy, to prevent transmission of diseases such as AIDS, or for cleanliness.
YES 1
NO 2
METHOD 06 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 07 MALE STERILIZATION Men can have an operation to avoid having any more children: Have you ever had an operation to avoid having any more children?
YES 1
NO 2
METHOD 08 CALENDAR Couples can have sexual intercourse only during the safe period of the monthly cycle, that is the times during the monthly cycle when the woman is least likely to become pregnant.
Do you know where a person can obtain advice on how to use the calendar method?
YES 1
NO 2
METHOD 09 MUCUS METHOD A woman can observe daily the state of the mucus and avoid sexual intercourse at the time when the mucus is colorless and extremely elastic.
Do you know where a person can obtain advice on how to observe changes in the mucus?
YES 1
NO 2

M305. CHECK M303:

NOT A SINGLE 'YES' (NEVER USED) __ (GO TO M306)
AT LEAST ONE 'YES' (EVER USED) __ (GO TO M308)

M306. Have you (or your wife/partner) ever used anything or tried in any way to delay or avoid having a child?

YES 1
NO 2 (GO TO M321)

M307. What have you used or done?
CORRECT M303-M305 (AND M302 IF NECESSARY).

M308. CHECK M303:

MAN NOT STERILIZED ___ (GO TO M309)
MAN STERILIZED ___ (GO TO M310A)

M309. Are you (or your wife/partner) currently doing something or using any method to delay or avoid having a child?

YES 1
NO 2 (GO TO M315)

M310. Which method are you using?
M310A. CIRCLE '07' FOR FEMALE STERILIZATION.

PILL 01
IUD 02
INJECTIONS 03
DIAPHRAGM/FOAM/JELLY 04
CONDOM 05
FEMALE STERILIZATION 06
MALE STERILIZATION 07
CALENDAR 08 (GO TO M315)
MUCUS METHOD 09 (GO TO M315)
WITHDRAWAL 10 (GO TO M315)
OTHER (SPECIFY) _________ 11 (GO TO M315)

M311. CHECK M310:

SHE/HE STERILIZED ___
Where did the sterilization take place?

USING ANOTHER METHOD ___
Where did you (or your wife/partner) obtain (METHOD) last time?

GOVERNMENT AND PARASTATAL
CONSULTANT HOSPITAL 11
REGIONAL HOSPITAL 12
DISTRICT HOSPITAL 13
HEALTH CENTRE 14
DISPENSARY 15
PARASTATAL HEALTH FACILITY 16
VILLAGE HEALTH POST/WORKER 17 (GO TO M314)
MEDICAL PRIVATE SECTOR
RELIGIOUS ORG. FACILITY 21
PRIV. DOCTOR/CLINIC/HOSPITAL 22
PHARMACY/MEDICAL STORE 23
UMATI CBD WORKER 24 (GO TO M314)
OTHER PRIVATE SECTOR
SHOP 31
NEIGHBORS/RELATIVES 32 (GO TO M314)
OTHER (SPECIFY) _________________ 41 (GO TO M314)
DON'T KNOW 98 (GO TO M314)

M312. How long does it take to travel from your home to this place?
IF LESS THAN TWO HOURS, RECORD TRAVEL TIME IN MINUTES.
OTHERWISE, RECORD TRAVEL TIME IN HOURS.

MINUTES 1___
HOURS 2 __
DON'T KNOW 9998

M313. Is it easy or difficult to get there?

EASY 1
DIFFICULT 2

M314. CHECK M309/M310:

NOT CURRENTLY USING CONDOM ___ (GO TO M315)
USING CONDOM ___ (GO TO M316)

M315. Have you used a condom in the last four weeks?

YES 1
NO 2 (GO TO M320)

M316. What is the brand name of the condom you last used?

BRAND _______________ ____
DON'T KNOW 98

M317. How much did the condom you last used cost?

COST ___
PARTNER OBTAINED 95
FREE 96
DON'T KNOW 98

M318. Do you use more condoms now than a year ago, about the same number, or fewer?

MORE 1
SAME NUMBER 2 (GO TO M320)
FEWER 3 (GO TO M320)

M319. What is the main reason you use more condoms now than a year ago?

FEAR OF GETTING AIDS 1
FEAR OF GETTING OTHER STD 2
FAMILY PLANNING 3
LESS EXPENSIVE NOW 4
MORE AVAILABLE NOW 5
OTHER (SPECIFY) _______________ 6
DON'T KNOW 8

M320. CHECK M309:

NOT CURRENTLY USING A METHOD ___ (GO TO M320)
USING A METHOD___ (GO TO M331)

M321. Do you intend to use a method to delay or avoid having a child at any time in the future?

YES 1 (GO TO M323)
NO 2
DK 3 (GO TO M327)

M322. What is the main reason you do not intend to use a method?

WANTS CHILDREN 01 (GO TO M327)
LACK OF KNOWLEDGE 02 (GO TO M327)
PARTNER OPPOSED 03 (GO TO M327)
COST TOO MUCH 04 (GO TO M327)
SIDE EFFECTS 05 (GO TO M327)
HEALTH CONCERNS 06 (GO TO M327)
HARD TO GET METHODS 07 (GO TO M327)
RELIGION 08 (GO TO M327)
OPPOSED TO FAMILY PLANNING 09 (GO TO M327)
FATALISTIC 10 (GO TO M327)
OTHER PEOPLE OPPOSED 11 (GO TO M327)
INFREQUENT SEX 12 (GO TO M327)
WIFE/PARTNER INFECUND 13 (GO TO M327)
INCONVENIENT 15 (GO TO M327)
NOT MARRIED/NO PARTNER 16 (GO TO M327)
OTHER (SPECIFY) ______ 17 (GO TO M327)
DON'T KNOW 98 (GO TO M327)

M323. Do you intend to use a method within the next 12 months?

YES 1
NO 2
DON'T KNOW 8

M324. When you use a method, which method would you prefer to use?

PILL 01
IUD 02
INJECTIONS 03
DIAPHRAGM/FOAM/JELLY 04
CONDOM 05
FEMALE STERILIZATION 06
MALE STERILIZATION 07
CALENDAR 08 (GO TO 327)
MUCUS METHOD 09 (GO TO 327)
WITHDRAWAL 10 (GO TO 327)
OTHER (SPECIFY) _________ 11 (GO TO 327)
UNSURE 98 (GO TO 327)

M325. Where can you get (METHOD MENTIONED IN M324)?

(NAME OF PLACE) __________
GOVERNMENT AND PARASTATAL
CONSULTANT HOSPITAL 11 (GO T0 M329)
REGIONAL HOSPITAL 12 (GO T0 M329)
DISTRICT HOSPITAL 13 (GO T0 M329)
HEALTH CENTRE 14 (GO T0 M329)
DISPENSARY 15 (GO T0 M329)
PARASTATAL HEALTH FACILITY 16 (GO T0 M329)
VILLAGE HEALTH POST/WORKER 17 (GO TO M331)
MEDICAL PRIVATE SECTOR
RELIGIOUS ORG. FACILITY 21 (GO T0 M329)
PRIV. DOCTOR/CLINIC/HOSPITAL 22 (GO T0 M329)
PHARMACY/MEDICAL STORE 23 (GO T0 M329)
UMATI CBD WORKER 24 (GO TO M331)
OTHER PRIVATE SECTOR
SHOP 31 (GO T0 M329)
NEIGHBORS/RELATIVES 32 (GO TO M331)
OTHER (SPECIFY) _________________ 41 (GO TO M331)
DON'T KNOW 98 (GO TO M327)

M326. CHECK M310:

USING CALENDAR, MUCUS METHOD, WITHDRAWAL OR OTHER TRADITIONAL METHOD ___ (GO TO M327)

USING A MODERN METHOD __ (GO TO M331)

M327. Do you know of a place where you can obtain a method of family planning?

YES 1
NO 2 (GO TO M331)

M328.Where is that?

(NAME OF PLACE) __________
GOVERNMENT AND PARASTATAL
CONSULTANT HOSPITAL 11
REGIONAL HOSPITAL 12
DISTRICT HOSPITAL 13
HEALTH CENTRE 14
DISPENSARY 15
PARASTATAL HEALTH FACILITY 16
VILLAGE HEALTH POST/WORKER 17 (GO TO M331)
MEDICAL PRIVATE SECTOR
RELIGIOUS ORG. FACILITY 21
PRIV. DOCTOR/CLINIC/HOSPITAL 22
PHARMACY/MEDICAL STORE 23
UMATI CBD WORKER 24 (GO TO M331)
OTHER PRIVATE SECTOR
SHOP 31
NEIGHBORS/RELATIVES 32 (GO TO M331)
OTHER (SPECIFY) _________________ 41 (GO TO M331)

M329. How long does it take to travel from your home to this place?
IF LESS THAN ONE HOUR, RECORD TRAVEL TIME IN MINUTES.
OTHERWISE, RECORD TRAVEL TIME IN HOURS.

MINUTES 1___
HOURS 2 __
DON'T KNOW 9998

M330. Is it easy or difficult to get there?

EASY 1
DIFFICULT 2

M331. In the last month, have you heard or seen a message about family planning:

on the radio?
on television?
from a Rural Medical aide?
from an MCN aide?
from neighbors/relatives?
on posters?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
RURAL MEDICAL AIDE
YES 1
NO 2
MCN AIDE
YES 1
NO 2
NEIGHBORS/RELATIVES
YES 1
NO 2
POSTERS
YES 1
NO 2

M332. Is it acceptable or not acceptable to you for family planning information to be provided on the radio or television?

ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8

M333. CHECK M302:

KNOWS CONDOM ___ (GO TO M334)
DOES NOT KNOW CONDOM ___ (GO TO M401)

M334. Do you agree or disagree with the following statements:
READ AND OBTAIN A RESPONSE FOR EACH STATEMENT.

Condoms are used primarily with casual partners.
AGREE 1
DISAGREE 2
Condoms reduce risk of sexually transmitted diseases.
AGREE 1
DISAGREE 2
Most women don't like men to use condoms.
AGREE 1
DISAGREE 2
Using condoms show responsibility.
AGREE 1
DISAGREE 2
Condoms are used primarily for family planning purposes.
AGREE 1
DISAGREE 2
Condoms are embarassing to obtain.
AGREE 1
DISAGREE 2
A condom can be used more than once.
AGREE 1
DISAGREE 2
Condoms make sex less enjoyable.
AGREE 1
DISAGREE 2
Using a condom can give you AIDS.
AGREE 1
DISAGREE 2

SECTION 4. MARRIAGE

M401. Have you ever been married or lived with a woman?

YES 1
NO 2 (GO TO M405)

M402. Are you now married or living with a partner, or are you now widowed, or divorced or no longer living together?

MARRIED 1
LIVING TOGETHER 2
WIDOWED 3 (GO TO M404)
DIVORCED/NO LONGER LIVING TOGETHER 4 (GO TO M404)

M403. How many wives do you have?

NUMBER ___

M404. How old were you when you started living your (first) wife of partner?

AGE ___ (GO TO M406)

M405. IF EVER MARRIED OR LIVED WITH A WOMAN:
Have you ever had sexual intercourse?

YES 1
NO 2 (GO TO M413)

M406. Now we need some details about your sexual activity in order to get a better understanding of family planning and health.
How many times did you have sexual intercourse in the last four weeks?

TIMES ___

M407. How many times in a month do you usually have sexual intercourse?

TIMES ___

M408. CHECK M406:

HAD SEXUAL INTERCOURSE ONE OR MORE TIMES IN THE LAST FOUR WEEKS ___ (GO TO 5M409)

ZERO TIMES ___ (GO TO M411)

M409. With how many different women did you have sex in the last four weeks?

NUMBER OF WOMEN ___

M410. Did you use a condom with any of these women?

YES 1
NO 2

M411. When was the last time you had sexual intercourse?

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

M412. How old were you when you first had sexual intercourse?

AGE __
FIRST TIME WHEN MARRIED 96

M413. PRESENCE OF OTHERS AT THIS POINT.

CHILDREN UNDER 10
YES 1
NO 2
WIFE
YES 1
NO 2
OTHER FEMALES
YES 1
NO 2
OTHER MALES
YES 1
NO 2

SECTION 5. AIDS KNOWLEDGE

M501. Now I have a few questions about a very important topic.
Have you heard of an illness called AIDS?

YES 1
NO 2 (GO TO M601)

M502. From which sources of information or persons have you heard about AIDS in the last month?
RECORD ALL MENTIONED.

RADIO A
TV B
NEWSPAPERS C
HEALTH WORKERS D
MOSQUES/CHURCHES E
FRIENDS/RELATIVES F
SCHOOLS/QURAN TEACHERS G
SLOGANS/PAMPHLETS/POSTERS H
COMMUNITY MEETINGS I
CCM OFFICE J
OTHER (SPECIFY) __________________ K
NONE L

M503. How is AIDS transmitted?
RECORD ALL MENTIONED.

SEXUAL INTERCOURSE A
NEEDLES/BLADES/SKIN PUNCTURES B
MOTHER TO CHILD C
TRANSFUSION OF INFECTED BLOOD D
OTHER (SPECIFY) __________________ E
DON'T KNOW F

M504. Do you think that you can get AIDS from:

shaking hands with someone who has AIDS?
hugging someone who has AIDS?
kissing someone who has AIDS?
wearing the clothes of someone who has AIDS?
sharing eating utensils with someone who has AIDS?
stepping on the urine or stool of someone who has AIDS?
mosquito, flea or bedbug bites?

HANDSHAKING
YES 1
NO 2
HUGGING
YES 1
NO 2
KISSING
YES 1
NO 2
SHARING CLOTHES
YES 1
NO 2
SHARING EATING UTENSILS
YES 1
NO 2
STEPPING ON URINE/STOOL
YES 1
NO 2
MOSQUITO/FLEA/BEDBUG BITES
YES 1
NO 2

M505. Is it possible for a healthy looking person to have AIDS?

YES 1
NO 2
DON'T KNOW 8

M506. Is it possible for a woman who has the AIDS virus to give birth to a child with the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

M507. What do you suggest is the most important thing the government should do for people who have AIDS?

PROVIDE MEDICAL TREATMENT 1
HELP RELATIVES PROVIDE CARE 2
ISOLATE/QUARANTINE/JAIL 3
NOT BE INVOLVED 4
OTHER (SPECIFY) ___________________ 5

M508. If your relative is suffering with AIDS, who would you prefer to care for him/her?

RELATIVES/FRIENDS 1
GOVERNMENT 2
RELIGIOUS ORG./MISSION 3
NOBODY/ABANDON 4
OTHER (SPECIFY) ________________ 5

SECTION 6. FERTILITY PREFERENCES

M601. CHECK M310:

SHE/HE NOT STERILIZED __ (GO TO M602)
HE OR SHE STERILIZED __ (GO TO M605)

M602. CHECK M401 AND M402:

CURRENTLY MARRIED OR LIVING TOGETHER __ (GO TO M603)
NOT MARRIED/NOT LIVING TOGETHER __ (GO TO M609)

M603.Now I have some questions about the future. Would you like to have a (another) child or would you prefer not to have any more children?

HAVE A (ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO M608)
SAYS WIFE CAN'T GET PREGNANT 3 (GO TO M608)
UNDECIDED OR DON'T KNOW 8 (GO TO M608)

M604. How long would you like to wait from now before the birth of a (another) child?

MONTHS 1 ___ (GO TO M608)
YEARS 2 ___ (GO TO M608)
SOON/NOW 995 (GO TO M608)
OTHER (SPECIFY) _____ 996 (GO TO M608)
DON'T KNOW 998

M605. Given your present circumstances, if you had to do it over again, do you think you would make the same decision to have an operation not to have any more children?

YES 1
NO 2

M606. Do you regret that you (your wife) had the operation not to have any (more) children?

YES 1
NO 2 (GO TO M609)

M607. Why do you regret it?

RESPONDENT WANTS ANOTHER CHILD 1 (GO TO M609)
PARTNER WANTS ANOTHER CHILD 2 (GO TO M609)
SIDE EFFECTS 3 (GO TO M609)
OTHER REASON (SPECIFY) ____________ 4 (GO TO M609)

M608. Do you think that your wife(wives)/partner(s) approves or disapproves of couples using a method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

M609. How long should a couple wait before starting sexual intercourse after the birth of a baby?

MONTHS 1 __
YEARS 2 __
OTHER (SPECIFY) ________ 996

M610. Should a mother wait until she has completely stopped breastfeeding before starting to have sexual relations again, or doesn't it matter?

WAIT 1
DOESN'T MATTER 2

M611. In general, do you approve or disapprove of couples using a method to avoid pregnancy?

APPROVE 1
DISAPPROVE 2

M612. CHECK M202 AND M204:

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?

RECORD SINGLE NUMBER OR OTHER ANSWER.

NUMBER ______
OTHER ANSWER (SPECIFY) ____________96 (GO TO M614)

M613. How many of those children would be sons?
And how many would be daughters?

NUMBER OF SONS ___
NUMBER OF DAUGHTERS ___
NO SEX PREFERENCE 95
OTHER ANSWER (SPECIFY) ________________ 96

M614. What do you think is the best number of months or years between the birth of one child and the birth of the next child?

MONTHS 1 __
YEARS 2 __
OTHER (SPECIFY) ______ 996
DON'T KNOW 998

M615. RECORD THE TIME.

HOURS ___
MINUTES ___

SECTION 7. LANGUAGE INFORMATION

M701. IN WHAT LANGUAGE DID YOU CONDUCT THE INTERVIEW?

KISWAHILI 01
OTHER _______________ ___

M702. FOR HOW MUCH OF THE INTERVIEW DID YOU DEPEND ON A THIRD PERSON TO INTERPRET FOR YOU?

NONE OF THE INTERVIEW 1 (END)
SOME OF THE INTERVIEW 2
MOST OF THE INTERVIEW 3
ALL OF THE INTERVIEW 4
OTHER (SPECIFY) __________________ 5

M703. IF AN INTERPRETER WAS USED, INDICATE THE SEX AND APPROXIMATE AGE OF INTERPRETER.

ADULT FEMALE 1
TEENAGE FEMALE 2
ADULT MALE 3
TEENAGE MALE 4
OTHER (SPECIFY) ______________ 5

INTERVIEWER'S OBSERVATIONS
(To be filled in after completing interview)

Comments About Respondent:
________________________________

Comments on Specific Questions:
_________________________________

Any Other Comments:
_________________________________

SUPERVISOR'S OBSERVATIONS
_________________________________

Name of Supervisor: ________________
Date: _________________

EDITOR'S OBSERVATIONS
_________________________________

Name of Field Editor: ________________
Date: _________________