IDENTIFICATION

REGION_______

DISTRICT_________

WARD________

ENUMERATION AREA_______

NAME OF HEAD OF HOUSEHOLD______

TDHS NUMBER______

HOUSEHOLD NUMBER______

LARGE CITY/SMALL CITY/TOWN/COUNTRYSIDE

LARGE CITIES ARE : DAR ES SALAAM, MWANZA, MBEYA AND TANGA. SMALL CITIES ARE: MOROGORO, DODOMA, MOSHI, IRINGA, SHINYANGA, SINGIDA, SONGEA ,MTWARA, TABORA, MUSOMA, SUMBAWANGA, BUKOBA, KIGOMA NA MJINI MAGHARIBI . MIJI MINGINE NI MIJI MIDOGO

NAME AND LINE NUMBER OF MAN_______

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER NAME
RESULT*

RESULT

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE
TIME

TOTAL NUMBER OF VISITS

SURPERVISOR
NAME ___________

FIELD EDITOR
NAME ___________

OFFICE EDITOR

KEYED BY

INFORMED CONSENT

Hello. My name is ______. I am working with the National Bureau of Statistics. We are conducting a survey about health all over Tanzania. The information we collect will help the government to plan health services.
Your household was selected for the survey. The survey usually takes about 30 to 60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.

Do you have any questions? May I begin the interview now?

Signature of interviewer:______
Date:_____

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME.

104. In the last 12 months, on how many separate occasions have you traveled away from your home community and slept away?

105. In the last 12 months, have you been away from your home community for more than one month at a time?

106. In what month and year were you born?

107. How old were you at your last birthday?
COMPARE AND CORRECT 106 AND/OR 107 IF INCONSISTENT.

108. Have you ever attended school?

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

110. What is the highest grade you completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL RECORD '00'.

111. CHECK 109:

112. Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT. IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

114. CHECK 112:

115. Do you read a newspaper or magazine at least once a week, less than once a week or not at all?

116. Do you listen to the radio at least once a week, less than once a week or not at all?

117. Do you watch television at least once a week, less than once a week or not at all?

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, even if they are not legally yours or do not have your last name. Have you ever fathered any children with any woman?

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

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

204. Do you have any sons or daughters that you have fathered who are alive but do not live with you?

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, RECORD '00'.

206. Have you ever fathered a son or a daughter who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

207. How many boys have died? And 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:

210. Did all of the children you have fathered have the same biological mother?

211. In all, how many women have you fathered children with?

212. How old were you when your (first) child was born?

213. CHECK 203 AND 205:

214. How many years old is your (youngest) child?

215. CHECK 214:

216. What is the name of your (youngest) child?
WRITE NAME OF (YOUNGEST) CHILD

217. When (NAME)'s mother was pregnant with (NAME), did she have any antenatal check-ups?

218. Were you ever present during any of those antenatal check-ups?

219. Was (NAME) born in a hospital or health facility?

221. When a child has diarrhea, how much should he or she be given to drink: more than usual, the same amount as usual, less than usual, or should he or she not be given anything to drink at all?

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. Have you ever heard of (METHOD)?
PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD. CIRCLE CODE '1' IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED.

303. In the last few months have you:

Heard about family planning on the radio?
Seen about family planning on the television?
Read about family planning in a newspaper or magazine?

305. Now I would like to ask you about a woman's risk of pregnancy. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?

306. Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?

308. I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.

a) Contraception is women's business and a man should not have to worry about it.
b) Women who use contraception may become promiscuous.

309. CHECK 301 (07):
KNOWS MALE CONDOM

310. Do you know of a place where a person can get condoms?

311. Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE
IF UNABLE TO DETERMINE IS PUBLIC OR PRIVATE MEDICAL SECTOR , WRITE THE NAME OF THE PLACE.

312. If you wanted to, could you yourself get a condom?

313. CHECK 301 (08):
KNOWS FEMALE CONDOM

314. Do you know of a place where a person can get female condoms?

315. Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE
IF UNABLE TO DETERMINE IS PUBLIC OR PRIVATE MEDICAL SECTOR , WRITE THE NAME OF THE PLACE.

316. If you wanted to, could you yourself get a female condom?

SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

401. Are you currently married or living together with a woman as if married?

402. Have you ever been married or lived together with a woman as if married?

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

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

405. Do you have more than one wife or woman you live with as if married?

406. Altogether, how many wives do you have or other partners you are living with as if married?

407. CHECK 405:

ONE WIFE/ PARTNER: Please tell me the name of your wife (the woman you are living with as if married).

MORE THAN ONE WIFE/PARTNER: Please tell me the name of each of your wives or of each woman you are living with as if married.

RECORD THE NAME AND THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE AND LIVE-IN PARTNER.
IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.
ASK 408 FOR EACH PERSON.

408. How old was (NAME) on her last birthday?

409. CHECK 407:

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

411. In what month and year did you start living with your (wife/partner)?
411A. Now I would like to ask about your first (wife/partner).
In what month and year did you start living with her?

412. How old were you when you first started living with her?

413. CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

414. Now I would like to ask you some questions about sexual activity in order to gain a better understanding of some important life issues. How old were you when you had sexual intercourse for the very first time?

417. CHECK 107:

418. The first time you had sexual intercourse, was a condom used?

419. When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

420. Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question. (GO TO 422)

421. When was the last time you had sexual intercourse with this person?

422. The last time you had sexual intercourse (with this second/third person), was a condom used?

423. Was a condom used every time you had sexual intercourse with this person in the last 12 months?

424. What was your relationship to this (second/third) person with whom you had sexual intercourse?
IF GIRLFRIEND: Were you living together as if married?
IF YES, CIRCLE '2'. IF NO, CIRCLE '3'.

424A. CHECK 410:

424B. CHECK 414:

425. How long ago did you first have sexual intercourse with this (second/third) person?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD 'O1' DAYS.

425A. How many times during the last 12 months did you have sexual intercourse with this person: once, twice, or more?

428. Apart from [this person/these two people], have you had sexual intercourse with any other in the last 12 months?

429. In total, with how many different people have you had sexual intercourse in the last 12 months?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95.'

430. CHECK 424 (ALL COLUMNS):

431. CHECK 424 AND 422 (ALL COLUMNS):

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

432A. Have you ever paid anyone in exchange for having sexual intercourse?

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

434. Was a condom used during sexual intercourse every time you paid someone in exchange for having sexual intercourse in the last 12 months?

435. In total, with how many different people have you had sexual intercourse in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95.'

436. CHECK 422, MOST RECENT PARTNER (FIRST COLUMN):

437. You told me that a condom was used the last time you had sex. What is the brand name of the condom used at that time?
IF YOU DON'T KNOW BRAND, ASK TO SEE THE PACKAGE.

438. From where did you obtain the condom the last time?
PROBE TO IDENTIFY TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

440. The last time you had sex did you or your partner use any method (other than a condom) to avoid or prevent a pregnancy?

441. What method did you or your partner use?
PROBE: Did you or your partner use any other method to prevent pregnancy?
RECORD ALL MENTIONED.

SECTION 5. FERTILITY PREFERENCES

501. CHECK 401:

502. CHECK 441:

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

504. CHECK 503:

NO WIFE/PARTNER PREGNANT OR DON'T KNOW: 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?

WIFE(WIVES)/PARTNER(S) PREGNANT: Now I have some questions about the future.
After the child(ren) you and your (wife(wives)/partner(s)) are expecting now, would you like to have another child, or would you prefer not to have any more children?

505. CHECK 405:

506. CHECK 503:

WIFE/PARTNER NOT PREGNANT OR DON'T KNOW: How long would you like to wait from now before the birth of (a/another) child?

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?

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

508. CHECK 203 AND 205:

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.

509. How many of these children would you like to be boys, how many would you like to be girls and for how many would the sex not matter?

509A. If you wanted to get information on family planning, who would you like to talk to most:

509B. Is it acceptable to you for information on family planning to be provided:

On the radio?
On the television?
In a newspaper or magazine?

509C. In the last six months have you heard about family planning:

a) On the radio?
b) On the television?
c) In a newspaper or magazine?
d) From a poster?
e) From billboards?
f) At community events?
g) From live drama?
h) From a doctor or nurse?
i) From a community health worker?

509D. In the past six months, what drama series have you listened to on the radio?
CIRCLE THE SERIES MENTIONED SPONTANEOUSLY. FOR SERIES NOT MENTIONED, ASK: In the last 6 months, have you listened to:

a) Zinduka?
b) Twende na Wakati?
c) Other?

509E. CHECK 509D:

509F. How often do you listen to Zinduka?

509G. As a result of listening to Zinduka, did you do anything or take any action related to family planning?

509H. What did you do as a result of listening to Zinduka?
RECORD ALL MENTIONED.

509I. CHECK 509D:

509J. How often do you listen to Twenda na Wakati?

SECTION 6. EMPLOYMENT AND GENDER ROLES

601. Have you done any work in the last seven days?

602. Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, or any other such reason?

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

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

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

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

610. CHECK 401:

611. CHECK 609:

612. Who usually decides how the money you earn will be used: mainly you, mainly your (wife (wives)/partner(s)), or you and your (wife (wives)/partner(s)) jointly?

613A. Who usually makes decisions about health care for yourself: you, your wife/partner, you and your wife/partner jointly, or someone else?

613B. Who usually makes decisions about making major household purchases?

615. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

If she goes out without telling him?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she burns the food?

616. As far as you know, did your father ever beat your mother?

SECTION 7. HIV/AIDS

701. Now I would like to talk about something else. Have you ever heard of an illness called AIDS?

702. Can people reduce their chances of getting the AIDS virus by having just one uninfected sex partner who has no other sex partners?

703. Can people get the AIDS virus from mosquito bites?

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

705. Can people get the AIDS virus by sharing food with a person who has AIDS?

707. Can people get the AIDS virus because of witchcraft or other supernatural means?

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

709. Can the virus that causes AIDS be transmitted from a mother to her baby:

During pregnancy?
During delivery?
By breastfeeding?

710. CHECK 709:

711. Are there any special drugs that a doctor or a nurse can give to a woman infected with the AIDS virus to reduce the risk of transmission to the baby?

712A. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

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

714. When was the last time you were tested?

715. 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?

716. I don't want to know the results, but did you get the results of the test?

717. Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

718. Do you know of a place where people can go to get tested for the AIDS virus?

719. Where is that? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

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

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

722. If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?

723. 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?

733. CHECK 701:

HEARD ABOUT AIDS: Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

NOT HEARD ABOUT AIDS: Have you heard about infections that can be transmitted through sexual contact?

734. CHECK 414:

735. CHECK 733:
HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

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

737. Sometimes men experience an abnormal discharge from their penis. During the last 12 months, have you had an abnormal discharge from your penis?

738. 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?

739. CHECK 736, 737, AND 738:

740. The last time you had (PROBLEM FROM 945/946/947), did you seek any kind of advice or treatment?

741. Where did you go?
Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

742. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in refusing to have sex with him?

743. 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?

SECTION 8. OTHER HEALTH ISSUES

801. Some men are circumcised. Are you circumcised?

802. How old were you when circumcision occurred?

803. Who did the circumcision?

804. Where did you go to be circumcised?

805. Are there any benefits to being circumcised?

805A. What are the benefits? Any other?

806. Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

807. Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

810. Do you currently smoke cigarettes?

811. In the last 24 hours, how many cigarettes did you smoke?

812. Do you currently smoke or use any other type of tobacco?

813. What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.

814. Are you covered by any health insurance?

815. What type of health insurance?
RECORD ALL MENTIONED.

820. 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: _________