IDENTIFICATION

REGION___

DISTRICT___

WARD___

E.A. NUMBER___

TRCHS CLUSTER NUMBER___

HOUSEHOLD NUMBER___

DAR ES SALAAM, SMALL CITY, TOWN, RURAL/VILLAGE

*(Small cities are: Mwanza, Arusha, Morogoro, Dodoma, Moshi, Tanga, Iringa, Mbeya and Tabora. All other urban areas are towns.)

NAME OF HOUSEHOLD HEAD___

NAME AND LINE NUMBER OF WOMAN___

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE___
INTERVIEWER'S NAME____
RESULT___

RESULT____

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE______
TIME______

FINAL VISIT
DAY____
MONTH____
YEAR 19___
INTER. ID NUMBER___
RESULT___

TOTAL NUMBER OF VISITS_____

SUPERVISOR
NAME____
DATE______

FIELD EDITOR
NAME____
DATE______

OFFICE EDITOR_____
KEYED BY____

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION

Hello. My name is __________ and I am working with the National Bureau of Statistics. 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 20 and 45 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

Participation in this survey is voluntary and you can choose not to answer any individual question or all of the questions. However, we hope that you will participate in this survey since your views are important.

At this time, do you want to ask me anything about the survey?
May I begin the interview now?

Signature of interviewer:______
Date:_______

101. RECORD THE TIME.

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

103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.

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

105. In what month and year were you born?

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

107. Have you ever attended school?

108. What is the highest formal school you completed?

110. CHECK 108:

111. Now I would like you to read out loud as much of this sentence as you can.
SHOW CARD TO RESPONDENT.

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

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

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

117. What is your religion?

SECTION 2: REPRODUCTION

201. Now I would like to ask about all the births you have had during your life. Have you ever given birth?

202. Do you have any sons or daughters to whom you have given birth who are now living with you?

203. How many sons live with you? How many daughters live with you?
IF NONE, RECORD '00".

204. Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?

205. How many sons are alive but do not live with you? How many daughters are alive but do not live with you?
IF NONE, RECORD '00'.

206. Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few hours or days?

207. How many boys have died? How many girls have died?
IF NONE, RECORD '00'.

208. SUM ANSWERS TO 203, 205, AND 207. AND ENTER TOTAL.
IF NONE, RECORD '00'.

209. CHECK 208:

Just to make sure that I have this right: you have had in TOTAL ____ births during your life.
Is that correct?

210. CHECK 208:

211. Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.
RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

212. What name was given to your (first/next baby)?

213. Were any of these births twins?

214. Is (NAME) a boy or a girl?

215. In what month and year was (NAME) born?
PROBE: What is his/her birthday?

216. Is (NAME) still alive?

217. IF ALIVE: How old was (NAME) at his/her last birthday?
RECORD AGE IN COMPLETED YEARS.

218. IF ALIVE: Is (NAME) living with you?

219. IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD.
RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD.

220. IF DEAD: How old was (NAME) when he/she died?
IF '1 YR', PROBE: How many months old was (NAME)?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?
[Repeat question for all births, excluding the most recent birth]

222. Have you had any live births since the birth of (NAME OF LAST BIRTH)?

223. COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 1994 OR LATER.
IF NONE, RECORD '0'.

226. Are you pregnant now?

227. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.

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

229. Did you sleep under a bednet last night?
IF YES: Was the bednet ever treated with a chemical to avoid mosquitos?

230. Altogether how many pregnancies have you ever had?

INCLUDE ALL BIRTHS, MISCARRIAGES, ABORTIONS, AND CURRENT PREGNANCY. MULTIPLE BIRTHS= 1 PREGNANCY.

231. When did your last menstrual period start?

SECTION 3. CONTRACEPTION

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.

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, 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 301, ASK 302.

301. Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?

302. Have you ever used (METHOD)?

303. CHECK 302:

304. Have you ever used anything or tried in any way to delay or avoid getting pregnant?

306. What have you used or done?
CORRECT 302 AND 303 (AND 301 IF NECESSARY)

308. CHECK 302 (01):

309. CHECK 226:

310. Are you currently doing something or using any method to delay or avoid getting pregnant?

311. Which method are you using?
311A. CIRCLE 'A' FOR FEMALE STERILISATION. IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTIONS FOR HIGHEST METHOD ON LIST.

313. Where did the sterilization take place?

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.

316. In what month and year was the sterilization performed?

319. Where did you obtain (CURRENT METHOD) when you started using it?

319B. For how many months have you been using (METHOD) continuously?
IF LESS THAN 1 MONTH RECORD '00'.

327. Where did you obtain (CURRENT METHOD) the last time?

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.

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

329. Where is that?

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.

330. In the last 12 months, were you visited by a field worker who talked to you about family planning?

331. In the last 12 months, have you attended a health facility for care for yourself (or your children)?

332. Did any staff member at the health facility speak to you about family planning methods?

333. Have you seen or heard of the Green Star symbol?

334. What does the Green Star symbol mean to you?

335. How did you learn about the Green Star?

SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREASTFEEDING

401. CHECK 224:

402. ENTER IN THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH IN 1994 OR LATER. ASK THE QUESTIONS ABOUT ALL THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES).

Now I would like to ask you some questions about the health of all your children born in the last five years. (We will talk about each separately)

403. LINE NUMBER FROM 212

404. FROM 212 AND 216

405. At the time you became pregnant with (NAME) did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?

406. How much longer would you like to have waited?

407. Did you see anyone for antenatal care for this pregnancy? IF YES: Whom did you see?
Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.
[Only for most recent birth]

408. How many months pregnant were you when you first received antenatal care during this pregnancy?
[Only for most recent birth]

409. How many times did you receive antenatal care during this pregnancy?
[Only for most recent birth]

410. CHECK 409:
NUMBER OF TIMES RECEIVED ANTENATAL CARE
[Only for most recent birth]

411. How many months pregnant were you when you the last time you received antenatal care?
[Only for most recent birth]

413. Were you told about the signs of pregnancy complications?
[Only for most recent birth]

414. Were you told where to go if you had these complications?
[Only for most recent birth]

414A. Do you have a card or other document with your immunizations listed?
IF YES: May I see it please?
[Only for most recent birth]

415. During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?
[Only for most recent birth]

415A. During this pregnancy, how many times did you get this injection?
IF CARD SEEN, COPY FROM CARD.
[Only for most recent birth]

416. During this pregnancy, were you given or did you buy any iron tablets or iron syrup?
[Only for most recent birth]

420. During this pregnancy, were you given or did you buy any drugs to prevent you from getting malaria?
[Only for most recent birth]

421. Which drug was that?
RECORD ALL MENTIONED.
[Only for most recent birth]

422. When (NAME) was born, was he/she: very large, larger than average, average, smaller than average, or very small?

423. Was (NAME) weighted at birth?

424. How much did (NAME) weigh?
RECORD WEIGHT FROM HEALTH CARD, IF AVAILABLE.

425. Who assisted with the delivery of (NAME)?
Anyone else?

426. Where did you give birth to (NAME)?

427. Was (NAME) delivered by caesarian section?

428. After (NAME) was born, did a health professional check on your health?

429. How many days or weeks after the delivery did the first check take place?
RECORD '00' DAYS IF SAME DAY.
[Only for most recent birth]

430. Who checked on your health at that time?
PROBE FOR THE MOST QUALIFIED PERSON.
[Only for most recent birth]

432. In the first two months after delivery, did you receive a vitamin A dose like this?
SHOW AMPULE/CAPSULE/SYRUP
[Only for most recent birth]

433. Has your period returned since the birth of (NAME)?
[Only for most recent birth]

434. Did your period return between the birth of (NAME) and your next pregnancy?
[Repeat question for all births, excluding the most recent birth]

435. For how many months after the birth of (NAME) did you not have a period?

436. CHECK 226:
RESPONDENT PREGNANT?
[Only for most recent birth]

437. Have you resumed sexual relations since the birth of (NAME)?
[Only for most recent birth]

438. For how many months after the birth of (NAME) did you not have sexual relations?

439. Did you ever breastfeed (NAME)?

441. CHECK 404:
CHILD ALIVE?

442. Are you still breastfeeding (NAME)?

443. For how many months did you breastfeed (NAME)?

444. CHECK 404:
CHILD ALIVE?

445. How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

446. How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

447. Did (NAME) drink anything from a bottle with a nipple yesterday or last night?

448. Now I would like to ask you about the types of foods and liquids (NAME) was given yesterday. At any time yesterday or last night, was (NAME) given any of the following:

Plain Water?
Tinned, powered, or fresh milk or infant formula?
Tea, fruit juice, soda, sugar water?
Oral rehydration solution?
Any other liquids?
Vitamin, mineral supplements or medicine?
Any solid or semi-solid (mushy) food?

450. GO BACK TO 405 IN NEXT COLUM; OR, IF NO MORE BIRTHS, GO TO 451.

SECTION 4B. IMMUNIZATION AND HEALTH

451. ENTER IN THE TABLE THE LINE NUMBER, NAME AND SURVIVAL STATUS OT EACH BIRTH IN 1994 OR LATER. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES.

452. LINE NUMBER FROM 212

453. FROM 212 AND 216

454. Has (NAME) ever received a Vitamin A dose like this?
SHOW AMPULE/CAPSULE/SYRUP.

454A. How many months ago did (NAME) take the last capsule?

454B. Where did (name) get this last dose of Vitamin A?

455. Do you have a card where (NAME'S) vaccinations are written down?
IF YES: May I see it please?

456. Did you ever have a vaccination card for (NAME)?

457. COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD. WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED.

458. Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign?

459. Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization day campaign?

460. Please tell me if (NAME) received any of the following vaccinations:

461. Were any of the vaccinations (NAME) received during the last two years given as a part of a national immunization day campaign or a community health day?

462. At which national immunization day campaigns or community health day did (NAME) receive vaccinations?

462A. Has (NAME)'s birth ever been registered?

462B. Where was (NAME)'s birth registered?

462C. Does (NAME) have a birth certificate?
IF YES: May I see please?

CHECK IF OFFICIAL BIRTH CERTIFICATE, NOT BAPTISM CERTIFICATE OR HOSPITAL CERTIFICATE.

462D. Why is (NAME)'s birth not registered?

462E. Do you know where to go to register births?

463. Has (NAME) been ill with a fever at any time in the last two weeks?

464. Has (NAME) had an illness with a cough at any time in the last two weeks?

465. When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, fast breaths?

466. CHECK 463 AND 464:
FEVER OR COUGH?

467. Did you seek advice or treatment for the fever/cough from a doctor, nurse or at a medical facility?

469. CHECK 463:
HAD FEVER?

470. Did (NAME) take any drugs for the fever?

471. What drugs did (NAME) take?
RECORD ALL MENTIONED. IF RESPONDENT DOES NOT KNOW TYPE OF DRUG, ASK TO SEE THE DRUG(S).

472. Has (NAME) had diarrhea in the last 2 weeks?

473. When (NAME) had diarrhea, was he/she offered less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she offered much less than usual to drink or somewhat less?

474. Was he/she offered less than usual to eat, about the same amount, or more than usual, or nothing to eat?
IF LESS PROBE: Was he/she offered much less than usual to eat or somewhat less?

475. Was he/she given any of the following:

Breast milk?
Uji or soup?
Rice water, coconut milk or fruit juice?
A fluid made from a special packet called ORS or maji ya dawa kwa mtoto anayeharisha?
Fresh or tinned milk it infant formula?
Water?
Coke, tea, soda?
Nothing to drink?

476. Did you seek advice or treatment for the diarrhea from a doctor, nurse or at a medical facility?

480. GO BACK TO 453 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 481.

481. Aside from the tetanus injections during you last pregnancy, did you receive any tetanus injection at any time before your pregnancy, either during a previous pregnancy or between pregnancies?

482. How many doses did you receive before your last pregnancy?

483. When did you receive the last dose?

484. When a child is ill, what signs of illness tell you that you should take the child to a health facility immediately?

485. When a woman is pregnant, what signs indicate that she may have a serious problem or complication and she should get medical treatment immediately?

486. How long should a mother breastfeed her baby without giving the baby any other food or liquid other than breast milk?

SECTION 5 MARRIAGE AND SEXUAL ACTIVITY

501. Are you currently married or living with a man?

502. Have you ever been married or lived with a man?

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

505. Is your husband/partner living with you nor or is he staying elsewhere?

506. RECORD THE HUSBAND'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

507. Have you been married or lived with a man only once, or more than once?

508. CHECK 507:

MARRIED/LIVED WITH A MAN ONLY ONCE: In what month and year did you start living with your husband/partner?

MARRIED/LIVED WITH A MAN MORE THAN ONCE: Now, we will talk about your first husband/partner. In what month and year did you start living with him?

509. How old were you when you started living with him?

514. Now I need to ask you some questions about 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)?

515. When was the last time you had sexual intercourse?
RECORD 'YEARS AGO' ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO.

516. The last time you had sexual intercourse, was a condom used?

517. What is your relationship to the man with whom you last had sex?
IF "BOYFRIEND" OR 'FIANCEE", ASK: Was your boyfriend/fiancé living with you when you last had sex?
IF YES, RECORD '1'. IF NO, RECORD '2'.

518. For how long have you had a sexual relationship with this man?

519. Have you had sex with anyone else in the last 12 months?

520. The last time you had sexual intercourse with another man, was a condom used?

521. What is your relationship to this other man?
IF 'BOYFRIEND' OR 'FIANCEE', ASK: Was your boyfriend/fiancé living with you when you last had sex?
IF YES, RECORD '1'. IF NO, RECORD '2'.

522. For how long have you had a sexual relationship with this man?

523. In total, how many men have you had sex with in the last 12 months?

524. Do you know of a place where one can get condoms?

525. Where is that?

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.

526. Is it acceptable for a woman to ask a man to use a condom?

527. What if a woman's husband has a sexually transmitted disease. Would it be acceptable for her to ask him to use a condom or to refuse to have sex with him?

SECTION 6. FERTILITY PREFERENCES.

601. CHECK 311/311A:

602. CHECK 226:

NOT PREGNANT OR UNSURE: 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?

PREGNANT: Now I have some questions about the future. After the child you are expecting now, would you like to have another child, or would you prefer not to have any more children?

603. CHECK 226:

NOT PREGNANT OR UNSURE: How long would you like to wait from now before the births of (a/another) child?

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

604. CHECK 226:

605. CHECK 310:
USING A METHOD?

606. CHECK 603:

607. CHECK 602:

WANTS A/ANOTHER CHILD: You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why?

WANTS NO (MORE) CHILDREN: You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy. Can you tell me why?

RECORD ALL MENTIONED.

608. In the next few weeks, if you discovered that you were pregnant, would that be a big problem, a small problem, or no problem for you?

IF WOMAN IS PREGNANT, DO NOT ASK, BUT WRITE 'PREGNANT'.

609. CHECK 310:
USING A METHOD?

610. Do you think you will use a method to delay or avoid pregnancy within the next 12 months?

612. What is the main reason that you think you will not use a method in the next 12 months?

613. CHECK 216:

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.

616. Would you say that you approve or disapprove of couples using a method to avoid getting pregnant?

617. In the last six months have you heard about family planning:

On the radio?
On the television?
In a newspaper or magazine?
From a poster?
From a leaflet or pamphlet?
From billboards?
At community events?
From live drama?
From a doctor or a nurse?

618. In the last six months, what drama series have you listened to on the radio?

CIRCLE THE SERIES MENTIONED SPONTANEOUSLY. FOR THOSE NOT MENTIONED, ASK: In the last 6 months, have you listened to:

Zinduka, a radio show featuring a character named Dr. Kurwa?
Twende na Wakati, a show featuring a character named Mkwaju?
Geuza Mwendo?
Ukimwi Kifo?
Sema Naye?
Vijana wetu?

618A. CHECK 618:

618B. How often do you listen to Zinduka?

618C. As a result of listening to Zinduka, did you do anything or take any action related to family planning?

618D. What did you do as a result of listening to Zinduka?
RECORD ALL MENTIONED.

618E. CHECK 618:

618F. How often do you listen to Twende na Wakati?

618G. As a result of listening to Twende na Wakati did you do anything or take any action related to family planning?

618H. What did you do as a result of listening to Twende na Wakati?
RECORD ALL MENTIONED.

618I. CHECK 618:

618J. How often do you listen to Vijana Wetu?

618K. As a result of listening to Vijana Wetu, did you do anything or take any action related to family planning?

618L. What did you do as a result of listening to Vijana Wetu?
RECORD ALL MENTIONED.

619. In the last 6 months, have you heard or seen a message about Salama condoms?

620. Where did you hear or see the message about Salama condoms?
DO NOT READ CODES. RECORD ALL MENTIONED.

621. CHECK 501:

622. Now I want to ask you about your husband's/partner's views on family planning.
Do you think that your husband/partner approves or disapproves of couples using a method to avoid pregnancy?

623. How often have you talked to your husband/partner about family planning in the last year?

SECTION 7. WOMAN'S WORK

701. Aside from your own housework, are you currently working?

702. As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. Are you currently doing any of these things or any other work?

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

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

705. CHECK 704:

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

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

708. Do you usually work throughout the year, or do you work seasonally, or only once in a while?

709. Are you paid in cash or kind for this work or are you not paid at all?

SECTION 8: AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES

801. Now I would like to talk about something else. Have you ever heard of the virus HIV or an illness called AIDS?

802. Is there anything a person can do to avoid getting infected with HIV, the virus that causes AIDS?

803. What can a person do?
Anything else?
RECORD ALL MENTIONED.

804. Can people protect themselves from getting the AIDS virus by having just one sex partner who has no other partners?

805. Can a person get the AIDS virus from mosquito bites?

806. Can people protect themselves from getting the AIDS virus by using a condom every time they have sex?

807. Can people protect themselves from getting the AIDS virus by not sharing food with a person who has AIDS?

808. Can people protect themselves from getting the AIDS virus by abstaining completely from sex?

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

811. Do you know someone personally who has the virus that causes AIDS or someone who died from AIDS?

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

813. When can the virus that causes AIDS be transferred from a mother to a child? Can it be transmitted?

During pregnancy?
During delivery?
During breastfeeding?

814. Do you think your chances of getting AIDS are small, moderate, great or no risk at all?

815. Why do you think that you have (NO CHANCE/SMALL CHANCE) of getting AIDS?
Any other reasons?
RECORD ALL MENTIONED.

816. Why do you think that you have a (MODERATE/GREAT) risk of getting AIDS?
Any other reasons?
RECORD ALL MENTIONED.

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

818. Would you like to be tested for the AIDS virus?

819. Why haven't you gotten tested for the AIDS virus?

820. Do you know a place where you could go to get an AIDS test?

821. Do you know any methods that can protect against pregnancy as well as protecting against sexual diseases?

822. RECORD THE TIME.

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:

COMMENTS ON SPECIFIC QUESTIONS:

ANY OTHER COMMENTS:

SUPERVISOR'S OBSERVATIONS
NAME OF SUPERVISOR: _______
DATE: ____

EDITOR'S OBSERVATIONS
NAME OF EDITOR: _____
DATE: ____