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DEMOGRAPHIC AND HEALTH SURVEY - TANZANIA 1999 - MAN'S QUESTIONNAIRE

IDENTIFICATION

REGION_____

DISTRICT_____

WARD______

E.A. NUMBER_______

TRCHS CLUSTER NUMBER_____

HOUSEHOLD NUMBER_____

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

DAR ES SALAAM 1
SMALL CITY* 2
TOWN 3
RURAL/VILLAGE 4

*(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 MAN _____

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE____
INTERVIEWER'S NAME___
RESULT___

RESULT____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) __________7

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 men and children. We would very much appreciate your participation in this survey. I would like to ask you about your health. 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: _______

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END SURVEY)

101. RECORD THE TIME.

HOUR_____
MINUTES_____
MORNING 1
AFTERNOON 2
EVENING, NIGHT 3

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?

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

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

YEARS____

ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)

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

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

105. In what month and year were you born?

MONTH____
DON'T KNOW MONTH 98
YEAR____
DON'T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS ___

107. Have you ever attended school?

YES 1
NO 2 (GO TO 111)

108. What is the highest formal school you completed?

LESS THAN ONE 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 96

110. CHECK 108:

STANDARD 8 OR LESS (GO TO 111)
FORM 1 OR HIGHER (GO TO 114)

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

CANNOT READ AT ALL 1 (GO TO 115)
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD, REFUSED, OTHER 4

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?

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

115. 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

116. 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

117. What is your religion?

MOSLEM 1
CATHOLIC 2
PROTESTANT 3
NONE 4
OTHER 6

118. Do you have any children? I mean your own children, not ones you may have adopted or are caring for but are not your own biological children.

YES 1
NO 2 (GO TO 301)

119. How many sons do you have?
And how many daughters do you have?
IF NONE, RECORD '00'.

SONS ___
DAUGHTERS ___

120. So you have TOTAL ___ children. Is that correct?

TOTAL ___

NOTE: THERE IS NO SECTION 2 IN THE MAN'S QUESTIONNAIRE

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)?

01. FEMALE STERILIZATION, TUBAL LIGATION, TL. Women can have an operation to avoid having any more children.
YES 1
NO 2
02. MALE STERILIZATION, VASECTOMY. Men can have an operation to avoid having any more children.
YES 1
NO 2
03. PILL Women can take a pill every day.
YES 1
NO 2
04. IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05. INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
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 several years.
YES 1
NO 2
07. CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08. FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09. DIAPHRAGM, FOAM, OR JELLY Women can place a sponge, suppository, diaphragm, jelly or foam in their vagina before intercourse.
YES 1
NO 2
10. LACTATIONAL AMENORRHOEA METHOD (LAM) Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2
11. RHYTHM OR CALENDAR METHOD 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.
YES 1
NO 2
12. WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
13. Have you heard of any other ways or methods that women or men can use to avoid pregnancy? LIST UP TO TWO METHODS.
(SPECIFY) ________
YES 1
NO 2

302. Have you ever used (METHOD)?

01. FEMALE STERILIZATION, TUBAL LIGATION, TL. Women can have an operation to avoid having any more children: Have you ever had a partner who had an operation to avoid any more children?
YES 1
NO 2
02. MALE STERILIZATION, VASECTOMY. 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
03. PILL Women can take a pill every day.
YES 1
NO 2
04. IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05. INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
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 several years.
YES 1
NO 2
07. CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08. FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09. DIAPHRAGM, FOAM, OR JELLY Women can place a sponge, suppository, diaphragm, jelly or foam in their vagina before intercourse.
YES 1
NO 2
10. LACTATIONAL AMENORRHOEA METHOD (LAM) Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2
11. RHYTHM OR CALENDAR METHOD 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.
YES 1
NO 2
12. WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
13. Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2

303. CHECK 302:

NOT A SINGLE "YES" (NEVER USED) (GO TO 304)
AT LEAST ONE "YES" (EVER USED) (GO TO 310)

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

YES 1
NO 2 (GO TO 328)

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

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

YES 1
NO 2 (GO TO 328)

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

FEMALE STERILIZATION A
MALE STERILIZATION B
PILL C (GO TO 319)
IUD D (GO TO 319)
INJECTIONS E (GO TO 319)
IMPLANTS F (GO TO 319)
CONDOM G (GO TO 318)
FEMALE CONDOM H (GO TO 319)
DIAPHRAGM/FOAM/JELLY I (GO TO 319)
LACT. AMEN. METHOD J (GO TO 319)
PERIODIC ABSTINENCE K (GO TO 319)
WITHDRAWAL L (GO TO 319)
OTHER____________ (SPECIFY) X (GO TO 319)

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.

NAME OF PLACE________
GOVERNMENT/PUBLIC SECTOR
REGIONAL/CONSULTANT HOSP 11
DISTRICT HOSPITAL 12
GOVT. HEALTH CENTER 13
DISPENSARY/PARASTATAL FACILITY 14
VILLAGE HEALTH POST 15
PRIVATE MEDICAL SECTOR
RELIGIOUS ORGANIZATION FACILITY/MISSION HOSP 21
PRIVATE DOCTOR/CLINIC/HOSP 22
OTHER PRIVATE MEDICAL (SPECIFY)________________ 26
OTHER (SPECIFY)_______________ 96
DON'T KNOW 98

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

MONTH___(GO TO 333)
YEAR___ (GO TO 333)

318. What brand of condoms did you use the last time?

BRAND NAME__________
DOES NOT KNOW 98

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

MONTHS___
8 YEARS OR LONGER 96

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.

NAME OF PLACE________
GOVERNMENT/PUBLIC SECTOR
REGIONAL/CONSULTANT HOSP 11(GO TO 333)
DISTRICT HOSPITAL 12 (GO TO 333)
GOVT. HEALTH CENTER 13 (GO TO 333)
DISPENSARY/PARASTATAL FACILITY 14 (GO TO 333)
VILLAGE HEALTH POST/WORKER 15 (GO TO 333)
PRIVATE MEDICAL SECTOR
RELIGIOUS ORGANIZATION FACILITY/MISSION HOSP 21 (GO TO 333)
PRIVATE DOCTOR/CLINIC/HOSP 22 (GO TO 333)
PHARMACY/MEDICAL STORE 23 (GO TO 333)
CBD WORKER 24 (GO TO 333)
OTHER PRIVATE SECTOR
SHOP/KIOSK 31 (GO TO 333)
CHURCH 32 (GO TO 333)
FRIEND/RELATIVE/NEIGHBOR 33 (GO TO 333)
HEALTH EDUCATION/BAR GIRLS 34 (GO TO 333)
OTHER (SPECIFY) _______________96 (GO TO 333)
DON'T KNOW 98 (GO TO 333)

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

YES 1
NO 2 (GO TO 333)

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.

NAME OF PLACE_____
GOVERNMENT/PUBLIC SECTOR
REGIONAL/CONSULTANT HOSP 11
DISTRICT HOSPITAL 12
GOVT. HEALTH CENTER 13
DISPENSARY/PARASTATAL FACILITY 14
VILLAGE HEALTH POST/WORKER 15
PRIVATE MEDICAL SECTOR
RELIGIOUS ORGANIZATION FACILITY/MISSION HOSP 21
PRIVATE DOCTOR/CLINIC/HOSP 22
PHARMACY/MEDICAL STORE 23 (GO TO 330)
CBD WORKER 24
OTHER PRIVATE SECTOR
SHOP/KIOSK 31
CHURCH 32
FRIEND/RELATIVE/NEIGHBOR 33
HEALTH EDUCATION/BAR GIRLS 34
OTHER (SPECIFY) _______________96
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 401)
DOES NOT KNOW 8 (GO to 401)

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

FAMILY PLANNING 1
SOMETHING ELSE 2
DOES NOT KNOW 8

335. How did you learn about the Green Star?

BILLBOARDS A
POSTERS B
LEAFLETS C
RADIO D
CLINIC SIGN E
SERVICE PROVIDER F
OTHER (SPECIFY) ________X

SECTION 4. HEALTH

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

SHE HAS A FEVER A
SWOLLEN HANDS AND FEET B
SHE IS BLEEDING TOO MUCH C
OTHER_____ X
OTHER_____ Y
DOES NOT KNOW Z

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

MONTHS_____
OTHER_____ 96
DOES NOT KNOW 98

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

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

YES, CURRENTLY MARRIED 1 (GO TO 505)
YES, LIVING WITH A WOMAN 2 (GO TO 505)
NO, NOT IN UNION 3

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

YES, FORMALLY MARRIED 1
YES, LIVED WITH A WOMAN 2 (GO TO 507)
NO 3 (GO TO 514)

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

WIDOWED 1 (GO TO 507)
DIVORCED 2 (GO TO 507)
SEPARATED 3 (GO TO 507)

505. Is your wife/partner living with you now or is she staying elsewhere?

LIVING WITH HIM 1
STAYING ELSEWHERE 2

506. RECORD THE WIFE'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF SHE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.
IF THERE ARE TWO WIVES IN THE HOUSEHOLD, RECORD THE NAME AND LINE NUMBER OF BOTH.

NAME_____
LINE NO._____

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

ONCE 1
MORE THAN ONCE 2

508. CHECK 507:

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

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

MONTH___
DON'T KNOW MONTH 98
YEAR___ (GO TO 514)
DON'T KNOW YEAR 9998

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

AGE____

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)?

NEVER 00 (GO TO 524)
AGE IN YEARS___
FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE/PARTNER 96

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

DAYS AGO 1_____
WEEKS AGO 2_____
MONTHS AGO 3_____
YEARS AGO 4_____ (GO TO 524)

516. The last time you had sexual intercourse, did you use a condom?

YES 1
NO 2

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

WIFE/COHABITATING PARTNER 1 (GO TO 519)
GIRLFRIEND/FIANCEE 2
OTHER FRIEND 3
CASUAL ACQUAINTANCE 4
COMMERCIAL SEX CUSTOMER 5
RELATIVE 6
OTHER_________ (SPECIFY) 7

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

DAYS 1___
WEEKS 2___
MONTHS 3___
YEARS 4___

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

YES 1
NO 2 (GO TO 524)

520. The last time you had sexual intercourse with another woman, did you use a condom?

YES 1
NO 2

521. What is your relationship to this other woman?
IF 'GIRLFRIEND' OR 'FIANCEE', ASK: Was your girlfriend/fianc??e living with you when you last had sex?
IF YES, RECORD '1'. IF NO, RECORD '2'.

WIFE/COHABITATING PARTNER 1 (GO TO 523)
GIRLFRIEND/FIANCEE 2
OTHER FRIEND 3
CASUAL ACQUAINTANCE 4
COMMERCIAL SEX CUSTOMER 5
RELATIVE 6
OTHER_________ (SPECIFY) 7

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

DAYS 1___
WEEKS 2___
MONTHS 3___
YEARS 4___

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

NUMBER OF PARTNERS____

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

YES 1
NO 2 (GO TO 601)

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.

NAME OF PLACE______
GOVERNMENT/PUBLIC SECTOR
REGIONAL/CONSULTANT HOSP 11
DISTRICT HOSPITAL 12
GOVT. HEALTH CENTER 13
DISPENSARY/PARASTATAL FACILITY 14
VILLAGE HEALTH POST/WORKER 15
PRIVATE MEDICAL SECTOR
RELIGIOUS ORGANIZATION FACILITY/MISSION HOSP 21
PRIVATE DOCTOR/CLINIC/HOSP 22
PHARMACY/MEDICAL STORE 23
CBD WORKER 24
OTHER PRIVATE SECTOR
SHOP/KIOSK 31
CHURCH 32
FRIEND/RELATIVE/NEIGHBOR 33
HEALTH EDUCATION/BAR GIRLS 34
OTHER (SPECIFY) _______________96
DON'T KNOW 98

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

YES 1
NO 2
DOES NOT KNOW 8

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?

YES 1
NO 2
DOES NOT KNOW 8

SECTION 6. FERTILITY PREFERENCES

601. CHECK 310:
USING A METHOD?

NOT ASKED (GO TO 607)
NOT CURRENTLY USING (GO TO 607)
CURRENTLY USING (GO TO 614)

607. Why are you not using a method of family planning?

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SUBFECUND/INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
WIFE/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
HEALTH CONCERNS O
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COST TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NATURAL PROCESS T
OTHER_________ (SPECIFY) X
DON'T KNOW Z

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

YES 1 (GO TO 614)
NO 2
DOES NOT KNOW 8

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

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SUBFECUND/INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
WIFE/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
HEALTH CONCERNS O
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COST TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NATURAL PROCESS T
OTHER_________ (SPECIFY) X
DON'T KNOW Z

614. CHECK 118:

HAS 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?

HAS NO 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

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

APPROVE 1
DISAPPROVE 2
DON'T KNOW/UNSURE 3

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?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2
POSTER
YES 1
NO 2
LEAFLET OR PAMPHLET
YES 1
NO 2
BILLBOARDS
YES 1
NO 2
COMMUNITY EVENTS
YES 1
NO 2
LIVE DRAMA
YES 1
NO 2
DOCTOR OR A NURSE
YES 1
NO 2

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?

ZINDUKA
YES, SPONTANEOUS 1
YES, PROBED 2
NO 3
TWENDE NA WAKATI
YES, SPONTANEOUS 1
YES, PROBED 2
NO 3
GEUZA MWENDO
YES, SPONTANEOUS 1
YES, PROBED 2
NO 3
UKIMWI KIFO
YES, SPONTANEOUS 1
YES, PROBED 2
NO 3
SEMA NAYE
YES, SPONTANEOUS 1
YES, PROBED 2
NO 3
VIJANA WETU
YES, SPONTANEOUS 1
YES, PROBED 2
NO 3

618A. CHECK 618:

LISTENED TO ZINDUKA (GO TO 618B)
DID NOT LISTEN TO ZINDUKA (GO TO 618E)

618B. How often do you listen to Zinduka?

TWICE A WEEK 1
ONCE A WEEK 2
ONCE OR TWICE A MONTH 3
RARELY 4
DOES NOT KNOW 8

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

YES 1
NO 2 (GO TO 618E)
DOES NOT KNOW 8(GO TO 618E)

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

TALKED TO PARTNER A
TALKED TO HEALTH WORKER B
TALKED TO SOMEONE ELSE C
WENT TO CLINIC FOR FAM. PLAN D
BEGAN USING MODERN METHOD E
BEGAN USING CONDOMS F
OTHER______(SPECIFY) X

618E. CHECK 618:

LISTENED TO TWENDE (GO TO 618F)
DID NOT LISTEN TO TWENDE (GO TO 618I)

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

TWICE A WEEK 1
ONCE A WEEK 2
ONCE OR TWICE A MONTH 3
RARELY 4
DOES NOT KNOW 8

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

YES 1
NO 2 (GO TO 618I)
DOES NOT KNOW (GO TO 618I)

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

TALKED TO PARTNER A
TALKED TO HEALTH WORKER B
TALKED TO SOMEONE ELSE C
WENT TO CLINIC FOR FAM. PLAN D
BEGAN USING MODERN METHOD E
BEGAN USING CONDOMS F
OTHER______(SPECIFY) X

618I. CHECK 618:

LISTENED TO VIJANA WETU (GO TO 618J)
DID NOT LISTEN TO VIJANA WETU (GO TO 619)

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

TWICE A WEEK 1
ONCE A WEEK 2
ONCE OR TWICE A MONTH 3
RARELY 4
DOES NOT KNOW 8

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

YES 1
NO 2 (GO TO 619)
DOES NOT KNOW (GO TO 619)

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

TALKED TO PARTNER A
TALKED TO HEALTH WORKER B
TALKED TO SOMEONE ELSE C
WENT TO CLINIC FOR FAM. PLAN D
BEGAN USING MODERN METHOD E
BEGAN USING CONDOMS F
OTHER______(SPECIFY) X

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

YES 1
NO 2 (GO TO 621)
DOES NOT KNOW (GO TO 621)

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

RADIO A
TELEVISION B
NEWSPAPER OR MAGAZINE C
POSTER D
LEAFLET OR PAMPHLET E
BILLBOARD F
COMMUNITY EVENT G
LIVE DRAMA H
SALES REPRESENTATIVE I
OTHER X

621. CHECK 501:

YES, CURRENTLY MARRIED (GO TO 622)
YES, LIVING WITH A WOMAN (GO TO 622)
NO, NOT IN UNION (GO TO 701)

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

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

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

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

SECTION 7. WORK

701. Are you currently working?

YES 1 (GO TO 704)
NO 2

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

YES 1
NO 2 (GO TO 801)

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

OCCUPATION____________

705. CHECK 704:

WORKS IN AGRICULTURE (GO TO 706)
DOES NOT WORK IN AGRICULTURE (GO TO 707)

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?

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

707. 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

708. 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

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

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4

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?

YES 1
NO 2 (GO TO 821)

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

YES 1
NO 2 (GO TO 809)
DON'T KNOW 8 (GO TO 809)

803. What can a person do?
Anything else?
RECORD ALL 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
INJECT DRUGS INTRAVENOUSLY H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID KISSING K
AVOID MOSQUITO BITES L
SEEK PROTECTION FROM TRADITIONAL HEALER M
AVOID SHARING RAZORS/BLADES N
OTHER__________ W
OTHER__________ X
DON'T KNOW Z

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 814)
DON'T KNOW 8 (GO TO 814)

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?

PREGNANCY
YES 1
NO 2
DON'T KNOW 8
DURING DELIVERY
YES 1
NO 2
DON'T KNOW 8
BREASTFEEDING
YES 1
NO 2
DON'T KNOW 8

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

SMALL 1
MODERATE 2 (GO TO 816)
GREAT 3 (GOT TO 816)
NO RISK AT ALL 4
DOES NOT KNOW 8 (GO TO 817)
HAS AIDS 6 (GO TO 817)

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

NO SEXUAL INTERCOURSE A (GO TO 817)
PARTNER HAS NO OTHER MEN B (GO TO 817)
SLEEPS ONLY WITH ONE PARTNER C (GO TO 817)
USES CONDOMS D (GO TO 817)
OTHER__________(SPECIFY) X (GO TO 817)

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

HAS MULTIPLE PARTNERS A
PARTNER HAS OTHER MEN B
DOES NOT USE CONDOMS C
HAD INJECTION, BLOOD TRANSFUS D
OTHER__________(SPECIFY) X

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

YES 1 (GO TO 821)
NO 2
DOES NOT KNOW/NOT SURE 8

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

YES 1
NO 2 (GO TO 820)
DOES NOT KNOW/NOT SURE 8 (GO TO 820)

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

DOES NOT KNOW WHERE TO GO A
COSTS TOO MUCH B
AFRAID TO GET RESULTS C
DOES NOT HAVE TIME TO GO D
OTHER__________(SPECIFY) X

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

YES 1
NO 2

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

PILL, ORAL CONTRACEPTIVE 1
CONDOM 2
OTHER__________(SPECIFY) 6
DOES NOT KNOW ANY METHODS 8

822. RECORD THE TIME.

HOUR___
MINUTES___
MORNING 1
AFTERNOON 2
EVENING, NIGHT 3

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:______