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UGANDA BUREAU OF STATISTICS

UGANDA DEMOGRAPHIC AND HEALTH SURVEY
MAN'S QUESTIONNAIRE -ENGLISH

IDENTIFICATION

REGION

DISTRICT

COUNTY

SUBCOUNTY/TOWN

PARISH/LC2 NAME

EA NAME

UDHS NUMBER

NAME OF HOUSEHOLD HEAD_______________________________________

HOUSEHOLD NUMBER

NAME AND LINE NUMBER OF MAN

MAN SELECTED FOR QUESTIONS ON DOMESTIC VIOLENCE (SECTION 9) (YES=1, NO=2)

INTERVIEWER VISITS:

FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT*

NEXT VISIT:
DATE
TIME

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT*

NEXT VISIT:
DATE
TIME

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT*

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT

TOTAL NUMBER OF VISITS

*RESULT CODES:

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER 7 (SPECIFY)

LANGUAGE OF THE QUESTIONNAIRE 7

LANGUAGE USED IN THE INTERVIEW

NATIVE LANGUAGE OF RESPONDENT

TRANSLATOR USED (NOT AT ALL=1; SOMETIMES=2; ALL THE TIME=3)

LANGUAGE USED:

ATESO-KARAMOJONG 1
LUGANDA 2
LUGBARA 3
LUO 4
RUNYANKOLE-RUKIGA 5
RUNYORO-RUTORO 6
ENGLISH 7
OTHER 8

SUPERVISOR
NAME
DATE

FIELD EDITOR
NAME
DATE

OFFICE EDITOR

KEYED BY

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is ________________________________ and I am working with UGANDA BUREAU OF STATISTICS. We are conducting a national survey to ask men and women about various health issues. We would very much appreciate your participation in this survey. This information will help the government to plan health services. The survey usually takes about 60 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

At this time, do you 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 (END INTERVIEW)

101. RECORD THE TIME.

HOUR___
MINUTES___

102. 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 104)
VISITOR 96 (GO TO 104)

103. Just before you moved here, did you live in a city, in a town, or in the countryside?

CITY 1
TOWN 2
COUNTRYSIDE 3

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

NUMBER OF TRIPS____
NONE 00 (GO TO 106)

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

YES 1
NO 2

106. In what month and year were you born?

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

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

AGE IN COMPLETED YEARS____

108. Have you ever attended school?

YES 1
NO 2 (GO TO 112)

109. What is the highest level of school you attended: primary, '0' level, 'A' level, or university or tertiary?

PRIMARY 1
'O' LEVEL 2
'A' LEVEL 3
TERTIARY 4
UNIVERSITY 5

110. What is the highest (class/year) you completed at that level?

CLASS/YEAR___

111. CHECK 109:

PRIMARY (GO TO 112)
SECONDARY OR HIGHER (GO TO 115)

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?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE 4 (SPECIFY LANGUAGE)
BLIND/VISUALLY IMPAIRED 5

113. Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)?

YES 1
NO 2


114. CHECK 112:

CODE '2', '3' OR '4' CIRCLED (GO TO 115)
CODE '1' OR '5' CIRCLED (GO TO 116)


115. 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

116. 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

117. 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

117A. In which level and grade do you think children should start to be taught in English?

PREPRMARY 0
GRADE___
PRIMARY 1
GRADE___
O LEVEL 2
GRADE___
A LEVEL 3
GRADE___
TERTIARY 4
GRADE___
UNIVERSITY 5
GRADE___

118 What is your religion?

CATHOLIC 1
PROTESTANT 2
MUSLIM 3
PENTECOSTAL 4
SDA 5
OTHERS 6

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?

YES 1
NO 2
DON'T KNOW 8 (GO TO 206)

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

YES 1
NO2 (GO TO 204)

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

SONS AT HOME___
DAUGHTERS AT HOME___

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

YES 1
NO 2 (GO TO 206)

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

SONS ELSEWHERE___
DAUGHTERS ELSEWHERE___

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?

YES 1
NO 2
DON'T KNOW 8 (GO TO 208)

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

BOYS DEAD____
GIRLS DEAD____

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

TOTAL CHILDREN____

209. CHECK 208:

HAS HAD MORE THAN ONE CHILD (GO TO 210)
HAS HAD ONLY ONE CHILD (GO TO 212)
HAS NOT HAD ANY CHILDREN (GO TO 301)

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

YES 1 (GO TO 212)
NO 2

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

NUMBER OF WOMEN____

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

AGE IN YEARS___

213. CHECK 203 AND 205:

AT LEAST ONE LIVING CHILD (GO TO 214)
NO LIVING CHILDREN (GO TO 301)

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

AGE IN YEARS____

215. CHECK 214:

(YOUNGEST) CHILD IS AGE 0-3 YEARS (GO TO 216)
OTHER (GO TO 301)

216. What is the name of your (youngest) child?

WRITE NAME OF (YOUNGEST) CHILD

(NAME OF (YOUNGEST) CHILD)_____

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

YES 1
NO 2 (GO TO 219)
DON'T KNOW 3 (GO TO 219)

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

PRESENT 1
NOT PRESENT 2

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

HOSPITAL/HEALTH FACILITY 1 (GO TO 221)
OTHER 2

220. What was the main reason why (NAME)'s mother did not deliver in a hospital or health facility?

COST TOO MUCH 01
FACILITY CLOSED 02
TOO FAR/NO TRANSPORTATION 03
DON'T TRUST FACILITY/POOR QUALITY SERVICE 04
NO FEMALE PROVIDER 05
NOT THE FIRST CHILD 06
CHILD'S MOTHER DID NOT THINK IT WAS NECESSARY 07
HE DID NOT THINK IT WAS NECESSARY 08
FAMILY DID NOT THINK IT WAS NECESSARY 09
OTHER (SPECIFY) 96
DON"T KNOW 98

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?

MORE THAN USUAL 1
ABOUT THE SAME 2
LESS THAN USUAL 3
NOTHING TO DRINK 4
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?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK:
Have you ever heard of (METHOD)?

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 METHODS 02, 07, 10,
AND 11, ASK 302 IF 301 HAS CODE 1 CIRCLED.

01 FEMALE STERILIZATION Women can have an operation to avoid having any more children
YES 1
NO 2
02 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2
03 PILL Women can take a pill every day to avoid becoming pregnant.
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 INJECTABLES Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
06 IMPLANTS Women can have several small rods placed in the arm by a doctor or nurse which can prevent pregnancy for one or more 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 LACTATIONAL AMENORRHEA METHOD (LAM)
YES 1
NO 2
10 RHYTHM 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
11 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
12 EMERGENCY CONTRACEPTION As an emergency measure after sexual intercourse, women can take special pills at any time within 5 days to prevent pregnancy.
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 (SPECIFY)
NO 2

302 Have you ever used (METHOD)?

02 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
07 CONDOM Men can put a rubber sheath on their penis
before sexual intercourse
YES 1
NO 2
10 RHYTHM 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
11 WITHDRAWAL Men can be careful and pull out before climax
YES 1
NO 2

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

a) On the radio?
YES 1
NO 2
b) On the television?
YES 1
NO 2
c) In a newspaper or magazine?
YES 1
NO 2
d) In a video or film?
YES 1
NO 2

304 In the last few months, have you discussed the practice of family planning with a health worker or health professional?

YES 1
NO 2


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?

YES 1
NO 2
DON'T KNOW 8 (GO TO 307)

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

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) 6
DON'T KNOW 8

307. Do you think that a woman who is breastfeeding her baby can become pregnant?

YES 1
NO 2
DEPENDS 3
DON'T KNOW 8

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.
AGREE 1
DISAGREE 2
DON'T KNOW 8
b) Women who use contraception may have sex with many men.

AGREE 1
DISAGREE 2
DON'T KNOW 8

309. CHECK 301 (07): KNOWS MALE CONDOM

YES (GO TO 310)
NO (GO TO 401)

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

YES 1
NO 2 (GO TO 401)

311. Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER
OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
FAMILY PLANNING CLINIC C
OUTREACH SERVICES D
GOVERNMENT COMMUNITY BASED DISTRIBUTOR E
OTHER PUBLIC (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY/DRUG SHOP H
PRIVATE DOCTOR/NURSE/ MIDWIFE I
OUTREACH SERVICES J
NGO COMMUNITY BASED DISTRIBUTOR K
OTHER PRIVATE MEDICAL (SPECIFY) L
OTHER SOURCE
SHOP M
RELIGIOUS INSTITUTION N
FRIENDS/RELATIVES O
STREET VENDOR P
LODGE Q
OTHER (SPECIFY) X


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

YES 1
NO 2

SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

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

YES, CURRENTLY MARRIED 1 (GO TO 404)
YES, LIVING WITH A WOMAN 2 (GO TO 404)
NO, NOT IN UNION 3

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

YES, FORMERLY MARRIED 1
YES, LIVED WITH A WOMAN 2
NO 3 (GO TO 413)

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

WIDOWED 1 (GO TO 410)
DIVORCED 2 (GO TO 410)
SEPARATED 3 (GO TO 410)


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

LIVING WITH HIM 1
STAYING ELSEWHERE 2

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

YES 1
NO 2 (GO TO 407)

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

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS___


407. CHECK 405:

ONE WIFE/ PARTNER:

Please tell me the name of your wife (the woman you are living with as if married).

NAME____
LINE NUMBER____

MORE THAN ONE WIFE/PARTNER

Please tell me the name of each of your current wives (and/or of each woman you
are living with as if married).

NAME____
LINE NUMBER____

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?

AGE

409. CHECK 407:

ONE WIFE/ PARTNER (GO TO 410)
MORE THAN ONE WIFE/ PARTNER (GO TO 411A)

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

ONLY ONCE 1
MORE THAN ONCE 2 (GO TO 411A)

411. In what month and year did you start living with your wife (partner)?

MONTH____
DON'T KNOW MONTH 98
YEAR
DON'T KNOW YEAR 9998 (GO TO 413)

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

MONTH____
DON'T KNOW MONTH 98
YEAR
DON'T KNOW YEAR 9998 (GO TO 413)

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

AGE

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?

NEVER HAD SEXUAL INTERCOURSE 00
AGE IN YEARS___
FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE/PARTNER 95 (GO TO 417)


415. CHECK 107: AGE OF RESPONDENT

AGE 15-24
AGE 25-54 (GO TO 501)

416. Do you intend to wait until you get married to have sexual intercourse for the first time?

YES 1 (GO TO 501)
NO 2 (GO TO 501)
DON'T KNOW/UNSURE 8 (GO TO 501)


417. CHECK 107: AGE OF RESPONDENT

AGE 15-24 (GO TO 418)
AGE 25-54 (GO TO 419)

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

YES 1
NO 2
DON'T KNOW/DON'T REMEMBER 8

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.

DAYS AGO 1____
WEEKS AGO 2____
MONTHS AGO 3____
YEARS AGO 4____ (GO TO 435)

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. SKIP TO 422

421. When was the last time you had sexual intercourse with this person?
[Exclude Last Sexual Partner]

DAYS 1___
WEEKS 2___
MONTHS 3___

422. The last time you had sexual intercourse with this person, was a condom used?

YES 1
NO 2 (GO TO 424)

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

YES 1
NO 2

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 '02'.IF NO, CIRCLE '03'.

WIFE 1 (GO TO 426)
LIVE-IN PARTNER 2 (GO TO 426)
GIRLFRIEND NOT LIVING WITH RESPONDENT 3
CASUAL ACQUAINTANCE 4
PROSTITUTE 5
OTHER (SPECIFY) 6

425. For how long (have you had/did you have) a sexual relationship with this (second/third) person?
IF ONLY HAD SEXUAL MONTHS RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.

DAYS 1____
MONTHS 2___
YEARS 3___

426. The last time you had sexual intercourse with this (second/third) person, did you or this person drink alcohol?

YES 1
NO 2 (GO TO 428)


427. Were you or your partner drunk at that time?
IF YES: Who was drunk?

RESPONDENT ONLY 1
PARTNER ONLY 2
RESPONDENT AND PARTNER BOTH 3
NEITHER 4

428 Apart from [this person/these two people], have you had sexual intercourse with any other) person in the last 12 months?
[Last Sexual Partner and Second-To-Last Sexual Partner]

YES 1 (GO BACK TO 421 IN NEXT COLUMN)
NO 2 (GO TO 430)

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.'

NUMBER OF PARTNERS____
DON'T KNOW 98

430. CHECK 424 (ALL COLUMNS):

AT LEAST ONE PARTNER IS PROSTITUTE (GO TO 431)
NO PARTNERS ARE PROSTITUTES (GO TO 432)

431. CHECK 424 AND 422 (ALL COLUMNS):

CONDOM USED WITH EVERY PROSTITUTE (GO TO 434)
OTHER (GO TO 435)

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

YES 1
NO 2 (GO TO 434A)

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

YES 1
NO 2 (GO TO 435)

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

YES 1 (GO TO 435)
NO 2 (GO TO 435)
DON'T KNOW 8 (GO TO 435)

434A. In the past 12 months, did you ever give or receive money, gifts or favours in exchange for sex?

YES 1
NO 2

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.'

NUMBER OF PARTNERS IN LIFETIME___
DON'T KNOW 98

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

NO CONDOM USED (GO TO 442)
CONDOM USED (GO TO 437)
NO CODE CIRCLED (GO TO 501)


437. You told me that a condom was used the last time you had sex. May I see the package of condoms you were using at that time?
RECORD NAME OF BRAND IF PACKAGE SEEN.

PACKAGE SEEN 1 (GO TO 439)
BRAND NAME (SPECIFY) (GO TO 439)
DOES NOT HAVE/NOT SEEN 2 (GO TO 439)

438. Do you know the brand name of the condom used at that time?
RECORD NAME OF BRAND.

BRAND NAME (SPECIFY)
DON'T KNOW 98


439. How many condoms did you get the last time?

NUMBER OF CONDOMS___
DON'T KNOW 998

440. The last time you obtained the condoms, how much did you pay in total, including the cost of the condom(s) and any consultation you may have had?

COST____
FREE 999995
DON'T KNOW 999998

441. From where did you obtain the condom the last time?
PROBE TO IDENTIFY TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)____
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVT. HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
OUTREACH 14
GOVERNMENT COMMUNITY BASED DISTRIBUTOR 15
OTHER PUBLIC (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY/DRUG SHOP 22
PRIVATE DOCTOR/NURSE/ MIDWIFE 23
OUTREACH 24
NGO COMMUNITY BASED DISTRIBUTOR 25
OTHER PRIVATE MEDICAL (SPECIFY) 26

OTHER SOURCE
SHOP 31
RELIGIOUS INSTITUTION 32
FRIENDS/RELATIVES 33
STREET VENDOR 34
LODGE 35
OTHER (SPECIFY) 36

442. CHECK 302 (02): RESPONDENT EVER STERILIZED

NO (GO TO 443)
YES (GO TO 501)

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

YES 1
NO 2 (GO TO 501)
DON'T KNOW 8 (GO TO 501)

444 What method did you or your partner use?

PROBE: Did you use any other method to prevent pregnancy?

RECORD ALL MENTIONED.

FEMALE STERILIZATION A
PILL B
IUD C
INJECTABLES D
IMPLANTS E
FEMALE CONDOM F
DIAPHRAGM G
FOAM/JELLY H
RHYTHM METHOD I
WITHDRAWAL J
OTHER (SPECIFY) X

SECTION 5. FERTILITY PREFERENCES

501. CHECK 407:

ONE OR MORE WIVES/PARTNERS (GO TO 502)
QUESTION NOT ASKED (GO TO 508)

502. CHECK 302:

MAN NOT STERILIZED (GO TO 503)
MAN STERILIZED (GO TO 508)


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

YES 1
NO 2
DON'T KNOW 8

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?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 508)
COUPLE CAN'T GET PREGNANT 3 (GO TO 508)
WIFE (WIVES)/PARTNER(S) STERILIZED 4 (GO TO 508)
UNDECIDED/DON'T KNOW 8 (GO TO 508)

WIFE(WIVES)/ PARTNER(S) PREGNANT

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

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 508)
COUPLE CAN'T GET PREGNANT 3 (GO TO 508)
WIFE (WIVES)/PARTNER(S) STERILIZED 4 (GO TO 508)
UNDECIDED/DON'T KNOW 8 (GO TO 508)

505. CHECK 407:

ONE WIFE/ PARTNER (GO TO 506)
MORE THAN ONE WIFE/PARTNER (GO TO 507)

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?

MONTHS 1 (GO TO 508)
YEARS 2 (GO TO 508)
SOON/NOW 993 (GO TO 508)
COUPLE CAN'T GET PREGNANT 994 (GO TO 508)
OTHER (SPECIFY) 996 (GO TO 508)
DON'T KNOW 998 (GO TO 508)

WIFE/PARTNER PREGNANT:

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

MONTHS 1 (GO TO 508)
YEARS 2 (GO TO 508)
SOON/NOW 993 (GO TO 508)
COUPLE CAN'T GET PREGNANT 994 (GO TO 508)
OTHER (SPECIFY) 996 (GO TO 508)
DON'T KNOW 998 (GO TO 508)

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

MONTHS 1
YEARS 2
SOON/NOW 993
HE/ALL HIS WIVES/PARTNERS CAN'T GET PREGNANT 994
OTHER (SPECIFY) 996
DON'T KNOW 998

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?

NONE 00 (GO TO 601)
NUMBER___
OTHER (SPECIFY) 96 (GO TO 601)

NO LIVING CHILDREN

If you could choose exactly the number of children to have in your whole life, how many would that be?

NONE 00 (GO TO 601)
NUMBER___
OTHER (SPECIFY) 96 (GO TO 601)

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?

BOYS____
GIRLS____
EITHER___
OTHER (SPECIFY) 96

SECTION 6. EMPLOYMENT AND GENDER ROLES

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

YES 1 (GO TO 604)
NO 2

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?

YES 1 (GO TO 604)
NO 2

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

YES 1
NO 2 (GO TO 613)

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

OCCUPATION___

605. CHECK 604:

WORKS IN AGRICULTURE (GO TO 606)
DOES NOT WORK IN AGRICULTURE (GO TO 607)

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

OWN LAND 01
FAMILY LAND 02
RENTED/BORROWED LAND 03
SOMEONE ELSE'S LAND 04
COMMUNAL LAND 05
PUBLIC LAND 06

607. 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

608. 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

609. 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

610. CHECK 407:

ONE OR MORE WIVES/PARTNERS (GO TO 611)
QUESTION NOT ASKED (GO TO 613)

611. CHECK 609:

CODE 1 OR 2 CIRCLED (GO TO 612)
OTHER (GO TO 613)

612. Who 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?

RESPONDENT 1
WIFE(WIVES)/PARTNER(S) 2
RESPONDENT AND WIFE (WIVES)/ PARTNER(S) JOINTLY 3
OTHER (SPECIFY) 4

613. In a couple, who do you think should have the greater say in each of the following decisions: the husband, the wife or both equally:

a) making large household purchases?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
b) making small daily household purchases?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
c) deciding when to visit the wife's family or relatives?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
d) deciding what to do with the money she earns for her work?

HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
e) deciding how many children to have?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8

614. I will now read you some statements about pregnancy. Please tell me if you agree or disagree with them.

a) Childbearing is a woman's concern and there is no need for the father to get involved.
AGREE 1
DISAGREE 2
DON'T KNOW 8
b) It is crucial for the mother's and child's health that a woman have assistance from a doctor or nurse at delivery.
AGREE 1
DISAGREE 2
DON'T KNOW 8

615. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

a) If she goes out without telling him?
YES 1
NO 2
DON'T KNOW 8
b) If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
c) If she argues with him?
YES 1
NO 2
DON'T KNOW 8
d) If she refuses to have sex with him?
YES 1
NO 2
DON'T KNOW 8
e) If she burns the food?
YES 1
NO 2
DON'T KNOW 8

616. Do you think that if a woman refuses to have sex with her husband when he wants her to, he has the right to???

a) Get angry and reprimand her?
YES 1
NO 2
DON'T KNOW/DEPENDS 8
b) Refuse to give her money or other means of support?
YES 1
NO 2
DON'T KNOW/DEPENDS 8
c) Use force and have sex with her even if she doesn't want to?
YES 1
NO 2
DON'T KNOW/DEPENDS 8
d) Go ahead and have sex with another woman?
YES 1
NO 2
DON'T KNOW/DEPENDS 8

SECTION 7. HIV/AIDS

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

YES 1
NO 2 (GO TO 733)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

706. Can people reduce their chance of getting the AIDS virus by not having sexual intercourse at all?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

a) During pregnancy?
YES 1
NO 2
DON'T KNOW 8
b) During delivery?
YES 1
NO 2
DON'T KNOW 8
c) By breastfeeding?
YES 1
NO 2
DON'T KNOW 8

710. CHECK 709:

AT LEAST ONE 'YES' (GO TO 711)
OTHER (GO TO 712)

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?

YES 1
NO 2
DON'T KNOW 8

712. Have you heard about any drugs that people infected with the AIDS virus can get from a doctor or a nurse to help them live longer?

YES 1
NO 2 (GO TO 712F)
DON'T KNOW 8 (GO TO 712F)


712A. In the past six months, have you seen or heard anything about drug treatments for AIDS

a) On the radio?
YES 1
NO 2
b) On the television?
YES 1
NO 2
c) In a newspaper or magazine?
YES 1
NO 2
d) On a sign or pamphlet?
YES 1
NO 2
e) In a video or film?
YES 1
NO 2

712B. What drugs do you know about?

ANTI-RETROVIRAL DRUGS (ARV's) A
SEPTRINE B (GO TO 712F)
OTHER DRUGS (SPECIFY) X (GO TO 712F)
DON'T KNOW Z (GO TO 712F)

712C. Do you know of a place to get ARVs?

YES 1
NO 2 (GO TO 712E)

712D Where is this place? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
OUTREACH D
GOVERNMENT COMMUNITY BASED WORKER E
OTHER PUBLIC (SPECIFY) F
PRIVATE/NGO MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY/DRUG SHOP H
PRIVATE DOCTOR/NURSE/ MIDWIFE I
OUTREACH J
TASO K
AIDS INFORMATION CENTER L
OTHER PRIVATE/NGO MEDICAL (SPECIFY)
OTHER (SPECIFY) X

712E. Now I'd like to ask you some questions about the drug treatment (ART) that is available to people with AIDS virus. For each statement I read, please tell me if you agree or disagree
with it

a) ART is not a cure for the AIDS virus.
AGREE 1
DISAGREE 2
DON'T KNOW 8
b) A person receiving ART cannot transmit the virus to others.
AGREE 1
DISAGREE 2
DON'T KNOW 8
c) Once ART is started, a patient must continue treatment for the rest of his/her life.

AGREE 1
DISAGREE 2
DON'T KNOW 8
d) People who know they are HIV positive should wait until they feel sick to see a doctor or nurse about ART.
AGREE 1
DISAGREE 2
DON'T KNOW 8
e) Failing to follow ART as directed can make the AIDS virus become stronger and even harder to control.
AGREE 1
DISAGREE 2
DON'T KNOW 8

712F. 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 know if you have the AIDS virus?

YES 1
NO 2 (GO TO 718)


714. When was the last time you were tested?

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

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?

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

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

YES 1
NO 2

717. Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE____
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 720)
GOVT. HEALTH CENTER 12 (GO TO 720)
STAND-ALONE VCT CENTER 13 (GO TO 720)
FAMILY PLANNING CLINIC 14 (GO TO 720)
OUTREACH 15 (GO TO 720)
GOVERNMENT COMMUNITY BASED WORKER 16 (GO TO 720)
OTHER PUBLIC (SPECIFY) 17 (GO TO 720)
PRIVATE/NGO MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (GO TO 720)
STAND-ALONE VCT CENTER 22 (GO TO 720)
PHARMACY/DRUG SHOP 23 (GO TO 720)
PRIVATE DOCTOR/NURSE/ MIDWIFE 24 (GO TO 720)
OUTREACH 25 (GO TO 720)
TASO 26 (GO TO 720)
AIDS INFORMATION CENTER 27 (GO TO 720)
OTHER PRIVATE/NGO MEDICAL (SPECIFY) 28 (GO TO 720)
OTHER (SPECIFY) 96 (GO TO 720)

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

YES 1
NO 2 (GO TO 720)

719. Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
OUTREACH E
GOVERNMENT COMMUNITY BASED WORKER F
OTHER PUBLIC (SPECIFY) G
PRIVATE/NGO MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC H
STAND-ALONE VCT CENTER I
PHARMACY/DRUG SHOP J
PRIVATE DOCTOR/NURSE/ MIDWIFE K
OUTREACH L
TASO M
AIDS INFORMATION CENTER N
OTHER PRIVATE/NGO MEDICAL (SPECIFY) O
OTHER (SPECIFY) X


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

YES 1
NO 2
DON'T KNOW 8

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

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8


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?

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

722A. Should a child with the AIDS virus go to school?

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8


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?

SHOULD BE ALLOWED 1
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8

724. Do you personally know someone who has been denied health services in the last 12 months because he or she has or is suspected to have the AIDS virus?

YES 1
NO 2
DON'T KNOW ANYONE WITH AIDS 8 (GO TO 733)

725. Do you personally know someone who has been denied involvement in social events, religious services, or community events in the last 12 months because he or she has or is suspected to have the AIDS virus?

YES 1
NO 2

726. Do you personally know someone who has been verbally abused or teased in the last 12 months because he or she has or is suspected to have the AIDS virus?

YES 1
NO 2

727. CHECK 724, 725, AND 726:

AT LEAST ONE 'YES' (GO TO 733)
OTHER (GO TO 728)


728. Do you personally know someone who has or is suspected to have the AIDS virus?

YES 1
NO 2

729. Do you agree or disagree with the following statement: People with the AIDS virus should be ashamed of themselves.

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

730. Do you agree or disagree with the following statement: People with the AIDS virus should be blamed for bringing the disease into the community.

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8


733. CHECK 701:

HEARD ABOUT AIDS:

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

YES 1
NO 2

NOT HEARD ABOUT AIDS:

Have you heard about infections that can be transmitted through sexual contact?

YES 1
NO 2

734. CHECK 414:

HAS HAD SEXUAL INTERCOURSE (GO TO 735)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 742)


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

YES (GO TO 736)
NO (GO TO 737)

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?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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?

YES 1
NO 2
DON'T KNOW 8

739 CHECK 736, 737, AND 738:

HAS HAD AN INFECTION (ANY 'YES') (GO TO 740)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 742)


740. The last time you had (PROBLEM FROM 736/737/738), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 742)

741 Where did you go? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
OUTREACH E
GOVERNMENT COMMUNITY BASED WORKER F
OTHER PUBLIC (SPECIFY) G

PRIVATE/NGO MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
STAND-ALONE VCT CENTER I
PHARMACY/DRUG SHOP J
PRIVATE DOCTOR/NURSE/ MIDWIFE K
OUTREACH L
TASO M
AIDS INFORMATION CENTER N
OTHER PRIVATE/NGO MEDICAL (SPECIFY) O
OTHER SOURCE
SHOP N
OTHER (SPECIFY) X


742. Husbands and wives do not always agree on everything. If a wife knows that her husband has a disease that she can get during sexual intercourse, is she justified in refusing to have sex with him?

YES 1
NO 2
DON'T KNOW 8


744. Is a wife justified in refusing to have sex with her husband when she is tired or not in the mood?

YES 1
NO 2
DON'T KNOW 8

745. Is a wife justified in refusing to have sex with her husband when she knows her husband has sex with other women?

YES 1
NO 2
DON'T KNOW 8


747. Do you think that most young men you know wait until they are married to have sexual intercourse?

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

751 Do you think that most married men you know have sex only with their wives?

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8


753. Do you think that most young women you know wait until they are married to have sexual intercourse?

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

757. Do you think that most married women you know have sex only with their husbands?

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

SECTION 8. OTHER HEALTH ISSUES

801 Have you ever heard of an illness called tuberculosis or TB?

YES 1
NO 2 (GO TO 805)

802. How does tuberculosis spread from one person to another? PROBE: Any other ways?
RECORD ALL MENTIONED.

THROUGH THE AIR WHEN COUGHING OR SNEEZING A
THROUGH SHARING UTENSILS B
THROUGH TOUCHING A PERSON WITH TB C
THROUGH FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER (SPECIFY) X
DON???T KNOW X

803. Can tuberculosis be cured?

YES 1
NO 2
DON'T KNOW 8

804. If a member of your family got tuberculosis, would you want it to remain a secret or not?

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/ DEPENDS 8


805 Some men are circumcised. Are you circumcised?

YES 1
NO 2
DON'T KNOW 8

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.

NUMBER OF INJECTIONS____
NONE 00 (GO TO 810)

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.

NUMBER OF INJECTIONS____
NONE 00 (GO TO 810)

808. The last time you had an injection given to you by a health worker, where did you go to get the injection?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE____
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
OTHER PUBLIC (SPECIFY) 16

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/ PRIVATE DOCTOR 21
DENTAL CLINIC/OFFICE 22
PHARMACY/DRUG SHOP 23
OFFICE OR HOME OF NURSE/ HEALTH WORKER 24
OTHER PRIVATE MEDICAL (SPECIFY) 26
OTHER PLACE
AT HOME 31
OTHER (SPECIFY) 96

809 Did the person who gave you that injection take the syringe and needle from a new, unopened package?

YES 1
NO 2
DON'T KNOW 8

810. Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 812)

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

CIGARETTES____

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

YES 1
NO 2 (GO TO 816)

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

PIPE A
CHEWING TOBACCO B
SNUFF C
OTHER (SPECIFY) X

816. CHECK 214:

(YOUNGEST) CHILD IS AGE 0-17 (GO TO 817)
OTHER (GO TO 818)

817. Now I would like to ask you about your own child(ren) who (is/are) under the age of 18.
Have you made arrangements for someone to care for (him/her/them) in the event that you fall sick or are unable to care for (him/her/them)?

YES 1
NO 2
UNSURE 8

818. (Besides your own child/children), are you the primary caregiver for any children under the age of 18?

YES 1
NO 2 (GO TO 900)

819. Have you made arrangements for someone to care for (this child/these children) in the event that you fall sick or are unable to care for (him/her/them)?

YES 1
NO 2
UNSURE 8

SECTION 9. DOMESTIC VIOLENCE

900. CHECK FRONT COVER: MAN SELECTED FOR THIS SECTION?

MAN SELECTED FOR THIS SECTION (GO TO 901)
MAN NOT SELECTED (GO TO 935)

901. CHECK FOR PRESENCE OF OTHERS:

DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.

PRIVACY OBTAINED 1
PRIVACY NOT POSSIBLE 2 (GO TO 934)

READ TO THE RESPONDENT
Now I would like to ask you questions about some other important aspects of a man's life. I know that some of these questions are very personal. However, your answers are crucial for helping to understand the condition of men in UGANDA. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else will know that you were asked these questions.

902. CHECK 401 AND 402:

CURRENTLY MARRIED/LIVING WITH A WOMAN (GO TO 903)
FORMERLY MARRIED/LIVED WITH A WOMAN (READ IN PAST TENSE) (GO TO 903)
NEVER MARRIED/NEVER LIVED WITH A WOMAN (GO TO 914)

903. First, I am going to ask you about some situations which happen to some men. Please tell me if these apply to your relationship with your (last) wife/partner?

a) She (is/was) jealous or angry if you (talk/talked) to other women?
YES 1
NO 2
DON'T KNOW 8

b) She frequently (accuses/accused) you of being unfaithful?
YES 1
NO 2
DON'T KNOW 8

c) She (does/did) not permit you to meet your male friends?
YES 1
NO 2
DON'T KNOW 8

d) She (tries/tried) to limit your contact with your family?
YES 1
NO 2
DON'T KNOW 8

e) She (insists/insisted) on knowing where you (are/were) at all times?
YES 1
NO 2
DON'T KNOW 8

f) She (does/did) not trust you with any money?
YES 1
NO 2
DON'T KNOW 8



904. Now if you will permit me, I need to ask some more questions about your relationship with your (last) wife/partner. If we should come to any question that you do not want to answer, just let me know and we will go on to the next question.

(Does/did) your (last) wife/partner ever:

a) say or do something to humiliate you in front of others?
YES 1
NO 2 (GO TO 904b)

How often did this happen during the last 12 months: often, only sometimes, or not at all?
[ASK ONLY IF RESPONDENT IS NOT A WIDOWER]

OFTEN 1
SOMETIMES 2
NOT AT ALL 3
b) threaten to hurt or harm you or someone close to you?
YES 1
NO 2 (GO TO 904c)

How often did this happen during the last 12 months: often, only sometimes, or not at all?
[ASK ONLY IF RESPONDENT IS NOT A WIDOWER]

OFTEN 1
SOMETIMES 2
NOT AT ALL 3
c) insult you or make you feel bad about yourself?
YES 1
NO 2 (GO TO 905)

905. (Does/did) your (last) wife/partner ever do any of the following things to you:

a) push you, shake you, or throw something at you?
YES 1
NO 2 (GO TO 905b)

How often did this happen during the last 12 months: often, only sometimes, or not at all?
[ASK ONLY IF RESPONDENT IS NOT A WIDOWER]

OFTEN 1
SOMETIMES 2
NOT AT ALL 3


b) slap you?

YES 1
NO 2 (GO TO 905c)

How often did this happen during the last 12 months: often, only sometimes, or not at all?
[ASK ONLY IF RESPONDENT IS NOT A WIDOWER]

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

c) twist your arm or pull your hair?

YES 1
NO 2 (GO TO 905d)

How often did this happen during the last 12 months: often, only sometimes, or not at all?
[ASK ONLY IF RESPONDENT IS NOT A WIDOWER]

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

d) punch you with her fist or with something that could hurt you?

YES 1
NO 2 (GO TO 905e)

How often did this happen during the last 12 months: often, only sometimes, or not at all?
[ASK ONLY IF RESPONDENT IS NOT A WIDOWER]

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

e) kick you, drag you or beat you up?

YES 1
NO 2 (GO TO 905f)

How often did this happen during the last 12 months: often, only sometimes, or not at all?
[ASK ONLY IF RESPONDENT IS NOT A WIDOWER]

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

f) try to choke you or burn you on purpose?

YES 1
NO 2 (GO TO 905g)

How often did this happen during the last 12 months: often, only sometimes, or not at all?
[ASK ONLY IF RESPONDENT IS NOT A WIDOWER]

OFTEN 1
SOMETIMES 2
NOT AT ALL 3


g) threaten or attack you with a knife, gun, or any other weapon?

YES 1
NO 2 (GO TO 905h)

How often did this happen during the last 12 months: often, only sometimes, or not at all?
[ASK ONLY IF RESPONDENT IS NOT A WIDOWER]

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

h) physically force you to have sexual intercourse with her even when you did not want to?

YES 1
NO 2 (GO TO 905i)

How often did this happen during the last 12 months: often, only sometimes, or not at all?
[ASK ONLY IF RESPONDENT IS NOT A WIDOWER]

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

i) force you to perform any sexual acts you did not want to?

YES 1
NO 2 (GO TO 906)

How often did this happen during the last 12 months: often, only sometimes, or not at all?
[ASK ONLY IF RESPONDENT IS NOT A WIDOWER]

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

906. CHECK 905A (a-i):

AT LEAST ONE 'YES'
NOT A SINGLE 'YES' (GO TO 90

907. How long after you first got married to/started living with your (last) wife/partner did (this/any of these things) first happen?
IF LESS THAN ONE YEAR, RECORD '00'.

NUMBER OF YEARS
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95


908. Did the following ever happen as a result of what your (last) wife/partner did to you:

a) You had cuts, bruises or aches?
YES 1
NO 2
b) You had eye injuries, sprains, dislocations, or burns?
YES 1
NO 2
c) You had deep wounds, broken bones, broken teeth, or any other serious injury?
YES 1
NO 2

909. Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) wife/partner at times when she was not already beating or physically hurting you?

YES 1
NO 2 (GO TO 912)

910 CHECK 403:

RESPONDENT IS A WIDOWER
RESPONDENT IS NOT A WIDOWER (GO TO 912)

911. In the last 12 months, how often have you done this to your wife/partner: often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

912. Does (did) your wife/partner drink alcohol?

YES 1
NO 2 (GO TO 914)

913. How often does (did) your wife/partner get drunk: often, only sometimes, or never?

OFTEN 1
SOMETIMES 2
NEVER 3

914 CHECK 401 AND 402:

EVER MARRIED/LIVED WITH A WOMAN

From the time you were 15 years old has anyone other than your (current/last) wife/partner hit, slapped, kicked, or done anything else to hurt you physically?

YES 1
NO 2 (GO TO 920)
REFUSED TO ANSWER/ NO ANSWER 3 (GO TO 920)

NEVER MARRIED/ NEVER WITH A WOMAN LIVED

From the time you were 15 years old has anyone ever hit, slapped, kicked, or done anything else to hurt you physically?

YES 1
NO 2 (GO TO 920)
REFUSED TO ANSWER/ NO ANSWER 3 (GO TO 920)

915. Who has hurt you in this way? Anyone else?
RECORD ALL MENTIONED.

MOTHER/STEP-MOTHER A
FATHER/STEP-FATHER B
SISTER/BROTHER C
DAUGHTER/SON D
OTHER RELATIVE E
FORMER WIFE/PARTNER F
CURRENT GIRLFRIEND G
FORMER GIRLFRIEND H
MOTHER-IN-LAW I
FATHER-IN-LAW J
OTHER IN-LAW K
TEACHER L
EMPLOYER/SOMEONE AT WORK M
POLICE/SOLDIER N
OTHER (SPECIFY) X

916. In the last 12 months, how often have you been hit, slapped, kicked, or physically hurt by this/these person(s): often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

920. CHECK 414: EVER HAD SEX?

HAS EVER HAD SEX (GO TO 921)
NEVER HAD SEX (GO TO 925)

921. The first time you had sexual intercourse, would you say that you had it because you wanted to, or because you were forced to have it against your will?

WANTED TO 1
FORCED TO 2
REFUSED TO ANSWER/NO RESPONSE 3

922 CHECK 401 AND 402:

EVER MARRIED/LIVED WITH A WOMAN:

In the last 12 months, has anyone other than your (current/last) wife/partner forced you to have sexual intercourse against your will?

YES 1
NO 2
REFUSED TO ANSWER/ NO ANSWER 3

NEVER MARRIED/NEVER LIVED WITH A WOMAN:

In the last 12 months has anyone forced you to have sexual intercourse against your will?

YES 1
NO 2
REFUSED TO ANSWER/NO ANSWER 3

923. CHECK 921 AND 922:

921 ='1' OR '3' AND 922 ='2' OR '3' (GO TO 924)
OTHER (GO TO 926)

924. CHECK 905(h) and 905(i):

905(h) IS NOT '1' AND 905(i) IS NOT '1' (GO TO 925)
OTHER (GO TO 928)

925. At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts?

YES 1
NO 2
REFUSED TO ANSWER/ NO ANSWER 3 (GO TO 928)

926. How old were you the first first time you were forced to have sexual intercourse or perform any other sexual acts?

AGE IN COMPLETED YEARS____
DON'T KNOW 98

927. Who was the person who was forcing you at that time?

CURRENT WIFE/PARTNER 01
FORMER WIFE/PARTNER 02
CURRENT/FORMER GIRLFRIEND 03
FATHER 04
STEP FATHER 05
OTHER RELATIVE 06
IN-LAW 07
OWN FRIEND/ACQUAINTANCE 08
FAMILY FRIEND 09
TEACHER 10
EMPLOYER/SOMEONE AT WORK 11
POLICE/SOLDIER 12
PRIEST/RELIGIOUS LEADER 13
STRANGER 14
OTHER (SPECIFY) 96

928 CHECK '905A (a-i), 914, 922 AND 925:

AT LEAST ONE 'YES' (GO TO 929)
NOT A SINGLE 'YES' (GO TO 932)

929. Thinking about what you yourself have experienced amongthe different things we have been talking about, have you ever tried to seek help to stop (the/these) person(s) from doing this to you again?

YES 1
NO 2 (GO TO 932)

930. From whom have you sought help? Anyone else?
RECORD ALL MENTIONED.

OWN FAMILY A
WIFE/PARTNER'S FAMILY B
CURRENT/LAST/LATE
WIFE/PARTNER C
CURRENT/FORMER GIRLFRIEND D
FRIEND E
NEIGHBOR F
RELIGIOUS LEADER G
DOCTOR/MEDICAL PERSONNEL H
POLICE I
LAWYER J
SOCIAL SERVICE ORGANIZATION K
OTHER (SPECIFY) X

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

YES 1
NO 2
UNSURE 8

REASSURE THE RESPONDENT ABOUT THE CONFIDENTIALITY OF HIS ANSWERS.
FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.

933. DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS
TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

WIFE
YES ONCE 1
YES, MORE THAN ONCE 2
NO 3
OTHER FEMALE ADULT
YES ONCE 1
YES, MORE THAN ONCE 2
NO 3
MALE ADULT
YES ONCE 1
YES, MORE THAN ONCE 2
NO 3
CHILD
YES ONCE 1
YES, MORE THAN ONCE 2
NO 3

934. INTERVIEWER'S COMMENTS / EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE

COMMENTS_____

935 RECORD THE TIME.

HOURS____
MINUTES____

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:____