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2016 UGANDA DEMOHRAPHIC AND HEALTH SURVEY

FORMATTING DATE: 16 June 2016
ENGLISH LANGUAGE: 10 June 2016

UGANDA DEMOGRAPHIC AND HEALTH SURVEY

UGANDA BUREAU OF STATISTICS

IDENTIFICATION

EA NAME _______

NAME OF HOUSEHOLD HEAD _________

CLSUTER NUMBER _________

HOUSEHOLD NUMBER _________

NAME AND LINE NUMBER OF MAN ________

CHECK HOUSEHOLD QUESTIONNAIRE SL13: MAN SELECTED FOR DV MODULE?

(1=YES, 2=NO) _______

INTERVIEW VISIT

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*

NEXT VISIT:
DATE
TIME

FINAL VISIT
DAY
MONTH
YEAR
INT. NO.
RESULT*

DATE
TIME

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT*

NEXT VISIT:
DATE
TIME

FINAL VISIT
DAY
MONTH
YEAR

INT. NO.
RESULT*

LANGUAGE OF QUESTIONNAIRE**

LANGUAGE OF INTERVIEW**

NATICE LANGUAGE OF RESPONDENT**

TRANSLATOR USED

YES 1
NO 2

**LANGUAGE CODES:

ENGLISH 01
LUGANDA 02
LUO 03
LUGBARA 04
ATESO 05
NGAKARIMOJONG 06
RUNYANKOLE/RUKIGA 07
RUNYORO/RUTORO 08
LUSOGA 09
OTHER (SPECIFY) 96

SUPERVISOR
NAME
NUMBER

CAPI MANAGER
NAME
NUMBER

INTRODUCTION AND CONSENT

Hello. My name is __________________________________. I am working with Uganda Bureau of Statistics. We are conducting a survey about health and other topics all over Uganda. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take 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.

In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.

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

SIGNATURE OF INTERVIEWER ______________ DATE _____________________

RESPONDENT AGREES TO BE INTERVIEWED 1 (CONTINUE)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME

HOURS______
MINUTES______

102) How long have you been living continuously in (NAME OF CURRECT CITY, TOWN OR VILLAGE OF RESIDENCE)?

IF LESS THAN ONE YEAR, RECORD '00' YEARS.

YEARS _____
ALWAYS 95 (GO TO 105)
VISITOR 98 (GO TO 105)

103) Just before you moved here, did you live in a city, in a town, or in a rural area?

CITY 1
TOWN 2
RURAL AREA 3

104) Before you moved here, which district did you live in?

DISTRICT CODE _____
OUTSIDE OF UGANDA 996

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 level of school you attended: primary, 'O' level, 'A' level, tertiary or university?

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

109) What is the highest [CLASS/YEAR] you completed at that level?
IF COMPLETED LESS THA ONE YEAR AT THAT LEVEL, RECORD '00'.

[CLASS/YEAR] _______

110) CHECK 108:

PRIMARY OR "O" OR "A" LEVEL (CONTINUE)
HIGHER (GO TO 113)

111) Now I would like you to read this sentence to me.

SHOW CARD TO RESPONDENT.
OF 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 PART OF THE SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) ______4
BLIND/VISUALLY IMPAIRED 5

112) CHECK 111

CODE '2','3' OR '4' CIRCLED (CONTINUE)
CODE '1' OR '5' CIRCLED (GO TO 114)

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

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

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

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

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

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEL 2
NOT AT ALL 3

116) Do you own a mobile telephone?

YES 1
NO 2 (GO TO 118)

117) Do you use your mobile phone for any financial transactions?

YES 1
NO 2

118) Do you have an account in a bank or other financial institution that you yourself use?

YES 1
NO 2

119) Have you ever used the internet?

YES 1
NO 2 (GO TO 122)

120) In the last 12 months, have you used the internet?

IF NECESSAERY, PROVE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.

YES 1
NO 2 (GO TO 122)

121) During the last one month, how often did you use the internet: almost every day, at least once a week, less than once a week, or not at all?

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

122) What is your religion?

NO RELIGION 10
ANGLICAN 11
CATHOLIC 12
MUSLIM 13
SEVENTH DAY ADVENTIST 14
ORTHODOX 15
PENTECOSAL/BORN AGAIN/EVANGELICAL 16
BAHA'I 17
BAPTIST 18
JEWISH 19
PRESBYERIAN 20
MAMMON 21
HINDU 22
BUDDHIST 23
JEHOVAH'S WITNESS 24
SALVATION ARMY 25
TRADITIONAL 26
OTHER (SPECIFU) 96

123) What is your tribe?

TRIBE CODE ____
OTHER (SPECIFY) 996

124) In the last 12 months, how many times have you been away from home for more than one month at a time?

NUMBER OF TIMES ___
NONE 00 (GO TO 201)

125) In the last 12 months, have you been away from home for more than one month at a time?

YES 1
NO 2

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

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

203) a) How many sons live with you? b) and how many daughters live with you?
IF NONE, RECORD '00'.

a) SONS AT HOME ____
b) DAUGHTERS AT HOME ____

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

YES 1
NO 2 (GO TO 206)

205) a) How many sons are alive but do not live with you?
b) And how many daughters are alive but do not live with you?

IF NONE, RECORD '00'.

a) SONS ELSEWHERE ___
b) DAUGHTERS ELSEWHERE ____

206) Have you ever given birth to a bit or girl who was born alive but later died?

IF NO, PROVE: Any baby who cried, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?

YES 1
NO 2 (GO TO 208)

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

a) BOYS DEAD ___
b) GIRLS DEAD ____

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

TOTAL BIRTHS ____

209) CHECK 208:

HAS HAD MORE THAN ONE CHILD (CONTINUE)
HAS HAD ONLY ONE CHILD (GO TO 211)
HS NOT HAD ANY CHILDREN (GO TO 301)

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

YES 1
NO 2

211) CHECK 208:

HAS HAD MORE THAN ONE CHILD
a) How old were you when your first child was born?

HAS HAD ONLY ONE CHILD
b) How old were you when your child was born?

AGO IN YEARS _____

212) CHECK 203 AND 205:

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

213) CHECK 203 AND 205:

MOREN THAN ONE LIVING CHILD
a) How old is your youngest child?
ONLY ONE LIVING CHILD
b) How old is your child?

AGE IN YEARS _____

214) CHECK 213:

(YOUNEST) CHILD IS AGE 0-2 YEARS (CONTINUE)
(YOUNGES) CHILD IS AGE 3 YEARS OR OLDER (GO TO 301)

215) CHECK 203 AND 205:

MORE THAN ONE LIVING CHILD
a) What is the name of your youngest child?

ONLY ONE LIVING CHILD
b) What is the name of your child?

(NAME OF (YOUNGEST) CHILD) __________

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

YES 1
NO 2 (GO TO 218)
DON'T KNOW 8 (GO TO 218)

217) Were you ever present during any of those antenatal check-ups?

PRESENT 1
NOT PRESENT 2

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

HOSPITAL/HEALTH PACILITY 1
OTHER 2

219) When a child has diarrhea, how much should he or she be given to drink: more than usual, about the same as usual, less than usual, or nothing to drink at all?

MOREN 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 of methods that a couple can use to delay or avoid a pregnancy. Have you ever heard of (METHODS)?

01) Female Sterilization
PROBE: Women can have an operation to avoid having any more children.

YES 1
NO 2

02) Male Sterilization
PROBE: Men can have an operation to avoid having any more children.

YES 1
NO 2

03) IUD.
PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse which can prevent pregnancy for one or more years.

YES 1
NO 2

04) Injectables.
PROBE: Women can have an injection by a health provider that stops them form becoming pregnant for one or more months.

YES 1
NO 2

05) Implants.
PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.

YES 1
NO 2

06) Pill.
PROBE: Women can take a pill every day to avoid becoming pregnant.

YES 1
NO 2

07) Condom.
PROBE: Men can put a rubber sheath on their penis before sexual.

YES 1
NO 2

08) Female Condom.
PROBE: Women can place a sheath in their vagina before sexual intercourse.

YES 1
NO2

09) Emergency Contraception.
PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.

YES 1
NO 2

10) Standard Days Method/Moon Beads
PROBE: A woman used a string of colored beads to know the days she can get pregnant. On the days she can get pregnant, she uses a condom or does not have sexual intercourse.

YES 1
NO 2

11) Lactational Amenorrhea Method (LAM)
PROBE: Up to six months after childbirth, before the menstrual period has returned, women use a method requiring frequent breastfeeding day and night.

YES 1
NO 2

12) Rhythm Method.
PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.

YES 1
NO 2

13) Withdrawal
PROBE: Men can be careful and pull out before climax.

YES 1
NO 2

14) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?

YES, MEDERN METHOD (SPECIFY) ______A
YES, TRADITIONAL METHOD (SPECIFY) _______B
NO Y

302) In the last few months have you:

a) Heard about family planning on the radio?
YES 1
NO 2
b) Seen anything about family planning on the television?
YES 1
NO 2
c) Read about family planning in a newspaper or magazine?
YES 1
NO 2
d) Received a voice or text message about family planning on a mobile phone?
YES 1
NO 2

303) In the last few months, have you discussed family planning with a health worker or health professional?

YES 1
NO 2

304) 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 when she has sexual relations?

YES 1
NO 2 (GO TO 306)
DON'T KNOW 8 (GO TO 306)

305) 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

306) After the birth of a child, can a woman become pregnant before her menstrual period has returned?

YES 1
NO 2
DON'T KNOW 8

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

a) Contraception is a woman's concern and a man should not have to worry about it.
AGREE 1
DISAGREE 2
DK 8
b) Women who use contraception may become promiscuous.
AGREE 1
DISAGREE 2
DK 8


SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

401) are you currently married or living together with a woman as if married?

YES, CURRENTLY MARRIED 1
YES, LIVING WITH A WOMAN 2 (GO TO 404)
NO, NOT IN UNION 3 (GO TO 402)

401A) What kind of marriage are you in?

CIVIL MARRIAGE A (GO TO 404)
CUSTONARY MARRIAGE B (GO TO 404)
RELIGIOUS MARRIAGE C (GO TO 404)

402) Have you even been married or lived together with a woman as if married?

YESM 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 other wives or do you live with other women as if married?

YES (MORE THAN ONE WIFE) 1
NO (ONLY ONE WIFE) 2 (GO TO 407)

406) Altogether, how many wives or live-in partners do you have?

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS ____

407) CHECK 405:

ONE WIFE/PARTNER
a) Please tell me the name of (your wife/the woman you are living with as if married)
MORE THAN ONE WIFE/PARTNER
b) Please tell me the name of each of your wives or 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 MAN IS NOT LISTED IN THE HOUSEHOLD RECORD'00'

408) ASK 408 FOR EACH PERSON.

NAME____
LINE NUMBER
How old was (NAME) on her last birthday?

AGE ____

409) CHECK 407:

ONE/WIFE/PARTNER (CONTINUE)
MORE THAN ONE WIFE/PARTNER (GO TO 411)

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

MORE THAN ONCE 1
ONLY ONCE 2

411) CHECK 405 AND 410:

BOTH ARE CODE '2'
a) In what month and year did you start living with your (wife/partner)?

OTHER
b) Now I would like to ask 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 413)
DON'T KNOW YEAR 9998

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

AGE _____

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

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

NEVER HAD SEXUAL INTERCOURSE 00 (GO TO 501)
AGE IN YEARS _____

415) I would like to ask you about your recent sexual activity. 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 RECORD IN YEARS.

DAYS AGO 1______ (GO TO 417)
WEEKS AGO 2_______(GO TO 417)
MONTHS AGO 3 ________(GO TO 417)
YEARS AGO 4__________(GO TO 427)

416) When was the last time you had sexual intercourse with this person?

DAYS AGO 1 ______
WEEKS AGO 2________
MONTHS AGO 3_______

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

YES 1
NO 2 (GO TO 419)

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

YES 1
NO 2

419) What was your relationship to this person with whom you had sexual intercourse?

IF GIRLFRIEND: Were you living together as if married?

IF YES, RECORD '2'.
IF NO, RECORD '3'.

WIFE 1
LIVE-IN PARTNER 2
FIRLFRIEND NOT LIVING WITH RESPONDENT 3
CAUAL ACQUAINTANCE 4
CLIENT/SEX WORKER 5
OTHER (SPECIFY) ______6

420) How long ago did you first have sexual intercourse with this person?

DAYS AGO 1 ____
WEEKS AGO 2______
MONTHS AGO 3______
YEARS AGO 4_______

421) How many times during the last 12 months did you have sexual intercourse with this person?

IF NON-NUMBERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF TIMES IS 95 OR MORE, RECORD '95'

NUMBER OF TIMES ______

422) How old is this person?

AGE OF PARTNER ______
DON'T KNOW 98

423) Apart from this person, have you had sexual intercourse with any other person in the last 12 months?

YES 1 (GO BACK TO 416 IN NEXT COLUMN)
NO 2 (SKIP TO 425)

424) In total, with how many different people have you had sexual intercourse in the last 12 months?

IF NON-NUMBERIC ANSWER, PROVE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OT MORE, RECORD '95'.

NUMBER OF PARTNERS LAST 12 MONTHS ____
DON'T KNOW 98

425) CHECK 419 (ALL COLUMNS):

AT LEAT ONE PARTNER IS A SEX WORKER (CONTINUE)
NO PARTNERS ARE SEX WORKERS (GO TO 427)

426) CHECK 419 AND 417 (ALL COLUMN)

CONCOM USED WITH EVERY SEX WORKER (GO TO 430)
OTHER (GO TO 431)

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

YES 1 (GO TO 429)
NO 2

428) Have you ever paid anyone in exchange for having sexual intercourse?

YES 1 (GO TO 431)
NO 2 (GO TO 431)

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

YES 1
NO 2 (GO TO 431)

430) 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
NO 2
DON'T KNOW 8

431) In the past 12 months have you given any gifts or other goods in order to have sex or to become sexually involved with anyone?

YES 1(GO TO 433)
NO 2

432) Have you ever given any gifts or other goods in order to have sex or to become sexually involved with anyone?

YES 1
NO 2

433) In total, with how many different people have you had sexual intercourse in your lifetime?

IF NON-NUMBERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, RECORD '95'.

NUMBER OF PARTNERS IN LIFETIME ____
DON'T KNOW 98

434) CHECK 417: MOST RECENT PARTNER (FIRST COLUMN)

CONDOM USED (CONTINUE)
NOT ASKED (GO TO 438)
NO CONDOM USED (GO TO 438)

435) 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 PROBE NOT KNOWN, ASK TO SEE THE PACKAGE.

PROTECTOR 01
CONDOM O 02
ENGABU 03
TRUST 04
LIFE GUARD 05
GOVT BRAND 06
NO BRAND 07
OTHER (SPECIFY) ______96
DON'T KNOW 98

436) From where did you obtain the condom the last time?

PROBE TO IDENTIFU TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)

PUBLIC SECTOR
GOVERNMENT HPSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
COMMUNITY HEALTH WORKER/VHI 15
OTHER PUBLIC SECTOR (SPECIFY) ___________________________16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPUTAL/CLINIC 21
PHARMACY/DRUG SHOP 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
COMMUNITY HEALTH WORKER 25
OTHER PRIVATE MEDICAL SETOR (SPECIFY) ________26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
OTHER (SPECIFY)_________________________96
DON'T KNOW 98

437) 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 (GO TO 439)
NO 2 (GO TO 440)
DON'T KNOW 8 (GO TO 440)

438) The last time you had sex did you or your partner use any method to avoid or prevent a pregnancy?

YES 1
NO 2 (GO TO 440)
DON'T KNOW (GO TO 440)

439) What method did you or your partner use?

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

FEMALE STERILIZATION A
MALE STERILIZATION B
IUD C
INJECTABLES D
IMPLANTS E
PILL F
CONDOM G
GEMALE CONDOM H
EMERGENCY SONTRACEPTION I
STANDARD DAYS METHOD/MOON BEADS J
LACTATIONAL AMENORRHEA METHOD K
RHYTHM METHOD L
WITHDRAWAL M
OTHER MODERN METHOD X
OTHER TRADITIONAL METHOD Y

440) Do you know of a place where you can obtain a method of family planning?

YES 1
NO 2

SECTION 5, FRTTILITY PREDERENCES

501) CHECK 401:

CURRENTLY MARRIED OR LIVING WITH A PARTNER (CONTINUE)
NOT CURRENTLY MARRIED AND NOT LIVIG WITH A PARTNER (GO TO 514)

502) CHECK 439:

MAN NOT STERILIZED (CONTINUE)
NOT ASKED (CONTINUE)
MAN STERILIZED (GO TO 514)

503) CHECK 407:

ONE WIFE/PARTNER (CONTINUE)
MORE THAN ONE WIFE/PARTNER (GO TO 509)

504) Is your (wife/partner) currently pregnant?

YES 1
NO 2 (GO TO 507)
DON'T KNOW 8 (GO TO 507)

505) Now I have some questions about the future. After the child you and your (wife/partner) are expecting now, would you like to have any more children?

HAVE ANOTHER CHILD 1
NO MORE 2 (GO TO 514)
UNDERCIDED/DON'T KNOW 8 (GO TO 514)

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

MONTH 1______(GO TO 514)
YEARS 2________ (GO TO 514)
SOON/NOW 993 (GO TO 514)
OTHER (SPECIFY)________996 (GO TO 514)
DON'T KNOW 998 (GO TO 514)

507) CHECK 208:

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

HAS NOT FATHERED CHILDREN
b) Now I have some questions about the future. Would you like to have a child, or would you prefer not to have any children?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 514)
SAYS COUPLE CAN'T GET PREGNANT 3 (GO TO 514)
WIFE/PARTNER STERILIZED 4 (GO TO 514)
UNDECIDED/DON'T KNOW 8 (GO TO 514)

508) CHECK 208:

HAS FATHERED CHILDREN
a) How long would you like to wait form now before the birth of another child?

HAS NOT FATHERED CHILDREN
b) How long would you like to wait from now before the birth of a child?

MONTHS 1____ (GO TO 514)
YEARS 2________ (GO TO 514)
SOON/NOW 994 (GO TO 514)
SAYS COUPLE CAN'T GET PREGNANT 994 (GO TO 514)
OTHER (SPECIFY)_______996 (GO TO 514)
DON'T KNOW 998 (GO TO 514)

509) Are any of your (wives/partners) currently pregnant?

YES 1
NO 2 (GO TO 512)
DON'T KNOW 8 (GO TO 512)

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

HAVE ANOTHER CHILD 1
NO MORE 2 (GO TO 514)
UNDECIDED/DON'T KNOW 8 (GO TO 514)

511) 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 514)
YEAS 2______ (GO TO 514)
SOON/NOW 993 (GO TO 514)
OTHER (SPECIFY)________996 (GO TO 514)
DON'T KNOW 998 (GO TO 514)

512) CHECK 208:

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

HAS NOT FATHERED CHILDREN
b) Now I have some questions about the future. Would you like to have a child, or would you prefer not to have any children?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 514)
SAYS COUPLE CAN'T GET PREGNANT 3 (GO TO 514)
(WIFE/WIVES/PARTNER(S)) STERILIZED 4 (GO TO 514)
UNDECIDED/DON'T KNOW 8 (GO TO 514)

513) CHECK 208:

HAS FATHERED CHILDREN
a) How long would you like to wait form now before the birth of another child?

HAS NOT FATHERED CHILDREN
b) How long would you like to wait from now before the birth of a child?

MONTHS 1____
YEARS 2________
SOON/NOW 994
SAYS COUPLE CAN'T GET PREGNANT 994
OTHER (SPECIFY)_______996
DON'T KNOW 998

514) CHECK 203 AND 205:

HAS LIVING CHILDREN
a) 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
b) If you could choose exactly the number of children to have in your whole life, how many would that be?

PROBE FOR A NUMBERIC RESPONSE.

NONE 00 (GO TO 601)
NUMBER ____
OTHER (SPECIFY) ______96 (GO TO 601)

515) How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter of it's a boy or a girl?

NUMBER
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 607)

604) What is your occupation? That is, what kind of work do you mainly do?

_____________________________________________________________________________________________________________________________________________________

605) 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

606) 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

607) CHECK 401:

CURRENTLY MARRIED OR LIVING WITH A PARTNER (CONTINUE)
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (GO TO 612)

608) CHECK 606:

CODE '1' OR '2' CIRCLED (CONTINUE)
OTHER (GO TO 610)

609) Who usually decides how the money you earn will be used: you, your(wife/partner), or you and your (wife/partner) jointly?

RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
OTHER (SPECIFY) _______6

610) Who usually makes decisions about health care for yourself: you, your (wife/partner), you and your (wife/partner) jointly, or someone else?

RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6

611) Who usually makes decisions about making major household purchases?

RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6

612) Do you own this or any other house either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4 (GO TO 615)

613) Do you have a title deed for any house you own?

YES 1
NO 2 (GO TO 615)
DON'T KNOW 8 (GO TO 615)

614) Is your name on the title deed?

YES 1
NO 2
DON'T KNOW 8

615) Do you own any agricultural or non-agricultural land either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4 (GO TO 618)

616) Do you have a title deed for any land you own?

YES 1
NO 2 (GO TO 618)
DON'T KNOW 8 (GO TO 618)

617) Is your name on the title deed?

YES 1
NO 2
DON'T KNOW 8

618) 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


SECTION 7. HIV/AIDS

701) Now I would like to talk about something else. Have you ever heard of HIS OR AIDS?

YES 1
NO 2 (GO TO 727)

702) HIV is the virus that can lead to AIDS. Can people reduce their chance of getting HIV 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 HIV from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

704) Can people reduce their chance of getting HIV by using a condom every time they have sex?

YES 1
NO 2
DON'T KNOW 8

705) Can people get HIV by sharing food with a person who has HIV?

YES 1
NO 2
DON'T KNOW 8

706) Can people get HIV because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

707) Is it possible for a healthy-looking person to have HIV?

YES 1
NO 2
DON'T KNOW 8

708) Can HIV be transmitted form 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

709) CHECK 708:

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

710) Are there any special drugs that a doctor or a nurse can give to a woman infected with HIV to reduce the risk of transmission to the baby?

YES 1
NO 2
DON'T KNOW 8

711) CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERT EFFORT TO ENSURE PRIVACY.

712) I don't want to know the results, but have you ever been tested for HIV?

YES 1
NO 2 (GO TO 716)

713) How many months ago was your most recent HIV test?

MONTHS AGO _______
TWO OR MORE YEARS 95

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

YES 1
NO 2

715) Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE ___________________________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL11 (GO TO 718)
GOVERNMENT HEALTH CENTER12 (GO TO 718)
FAMILY PLANNING CLINIC 13 (GO TO 718)
OUTREACH/MOBILE CLINIC 14 (GO TO 718)
FIELDWORKER/VHT 15 (GO TO 718)
OTHER PUBLIC SECTOR (SPECIFY) ______16 (GO TO 718)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (GO TO 718)
PHARMACY/DRUG SHOP 22 (GO TO 718)
PRIVATE DOCTOR 23 (GO TO 718)
MOBILE CLINIC 24 (GO TO 718)
COMMUNITY HEALTH WORKER 25 (GO TO 718)
OTHER PRIVATE MEDICAL SECOR (SPECIFY) ____26 (GO TO 718)
OTHER SOURCE
HOME 31(GO TO 718)
WORKPLACE 32 (GO TO 718)
SHOP 33 (GO TO 718)
OTHER (SPECIFY) _____96 (GO TO 718)

716) Do you know of a place where people can go to get an HIV test?

YES 1
NO 2 (GO TO 718)

717) Where is that?
Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIBATE SECTOR, WRITE THE NAME OF THE PALCE.

(NAME OF PLACE) ___________
PUBLIC SETOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE VCT SERICES D
COMMUNITY HEALTH WORKER/VH E
OTHER PUBLIC SECTOR (SPECIFY)_______F
PRIVATE MEDICAL SECTOR
PRIVATE GISOURAK/CLINIC/PRIVATE DOCTOR G
PHARMACY/DRUG SHOP H
MEBILE VCT SERVICES I
COMMUNITY HEALTH WORKER J
OTHER PRIVAT MEDICAL SECTOR (SPECIFY) _____K
OTHER (SPECIFY) ______X

718) Have you heard of test kits people can use to text themselves for HIV?

YES 1
NO 2 (GO TO 720)

719) Have you ever tested yourself for HIV using a self-test kit?

YES 1
NO 2

720) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?

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

721) Do you think children living with HIV should be allowed to attend school with children who do not have HIV?

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

722) Do you think people hesitate to take an HIV test because they are afraid of how other people will react of the test result is positive for HIV?

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

723) Do people talk badly about people living with HIV, or who are thought to be living with HIV?

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

724) Do people living with HIV, or thought to be living with HIV, lose the respect of other people?

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

725) Do you agree or disagree with the following statement: I would be ashamed if someone in my family had HIV.

AGREE 1
DISAGREE 2
DON'T KNOW/NOT SURE/DEPENDS

726) Do you fear that you could get HIV if you come into contact with the saliva of a person living with HIV?

YES 1
NO 2
SAYS SHE HAS HIV 3
DON'T KNOW/ NOT SURE/DEPENDS 8

727) CHECK 701:

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

YES 1
NO 2

NOT HEARD ABOUT HIV OR AIDS
b) Have you heard about inductions that can be transmitted through sexual contact?

YES 1
NO 2

728) CHECK 414:

HAS HAD SEXUAL INTERCOURSE (CONTINUE)
NEVER HAD SEXUAL INTERCOURSE (GO TO 736)

729) CHECK 727: HEARD ABOUT OTHER SUEXUALLY TRANSMITTED INFERCTIONS?

YES (CONTINUE)
NO (GO TO 731)

730) 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

731) Sometimes women experience a bad-smelling abnormal genital discharge. During the last 12 months, have you had a bad-smelling abnormal genital discharge?

YES 1
NO 2
DON'T KNOW 8

732) Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

YES 1
NO 2
DON'T KNOW 8

733) CHECK 730,731 AND 732:

HAS HAD AN INFECTION (ANY 'YES') (CONTINUE)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 736)

734) The last time you had (problem from 730/731/732), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 736)

735) Where did you go? Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIBATE SECTOR, WRITE THE NAME OF THE PALCE.

(NAME OF PLACE) ___________
PUBLIC SETOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE VCT SERICES D
COMMUNITY HEALTH WORKER/VH E
OTHER PUBLIC SECTOR (SPECIFY)_______F
PRIVATE MEDICAL SECTOR
PRIVATE GISOURAK/CLINIC/PRIVATE DOCTOR G
PHARMACY/DRUG SHOP H
MEBILE VCT SERVICES I
COMMUNITY HEALTH WORKER J
OTHER PRIVAT MEDICAL SECTOR (SPECIFY) _____K
OTHER SOURCE
SHOP L
OTHER (SPECIFY) ______X

736) 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?

YES 1
NO 2
DON'T KNOW 8

737) Is a wife justified in refusing to have sex with her husband when she know she has sex with other women?

YES 1
NO 2
DON'T KNOW 8


SECTION 8, OTHER HEALTH ISSUES

801) Some men are circumcised, that is, the foreskin is completely removed from the penis. Are you circumcised?

YES 1
NO 2 (GO TO 805)
DON'T KNOW 8 (GO TO 805)

802) How old were you when you got circumcised?

AGE IN COMPLETED YEARS _______
DURING CHILDHOOD (less than 5 YEARS) 95
DON'T KNOW 98

803) Who did the circumcision?

RELIGIOUS PERSON/TRADITIONAL PRACTITIONER/FAMILY/FRIEND 1
HEALTH WORKER/PROFESSIONAL 2
OTHER 3
DON'T KNOW 8

804) Where was it done?

HEALTH FACILITY 1
HOME OF A HEALTH WORKER/PROFESSIONAL 2
CIRCUMCISIONDONE AT HIME 3
RITUAL SITE 4
OTHER HIME/PLACE 5
DON'T KNOW 8

805) 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 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMBERIC ANSWER, PROVE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS _______
NONE 00 (GO TO 808)

806) 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 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMBERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS _____
NONE 00 (GO TO 808)

807) The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

YES 1
NO 2
DON'T KNOW 8

808) Do you currently smoke cigarettes every day, some days, or not at all?

EVERY DAY 1
SOME DAYS 2 (GO TO 811)
NOT AT ALL 3 (GO TO 810)

809) In the past, have you smoked tobacco every day?

YES 1 (GO TO 812)
NO 2 (GO TO 812)

810) In the past, have you ever smoked tobacco every day, some days, or not at all?

EVERY DAY 1 (GO TO 813)
SOME DAYS 2 (GO TO 813)
NOT AT ALL 3 (GO TO 813)

811) On average, how many of the following products do you currently smoke each day? Also, let me know if you use the product, but not every day.

a) Manufactured cigarettes?
NUMBER DAILY ____ (GO TO 813)
b) Hand-rolled cigarettes?
NUMBER DAILY ____(GO TO 813)
d) Pipes full of tobacco?
NUMBER DAILY ____(GO TO 813)
e) Cigars, cheroots, or cigarillos?
NUMBER DAILY ____(GO TO 813)
f) Number of water pipe/Shisha sessions?
NUMBER DAILY ____(GO TO 813)
g) Any others? (SPECIFY)_____________
NUMBER DAILY ____(GO TO 813)

812) On average, how many of the following products do you currently smoke each week? Also, let me know if you use the product, but not every week.

IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY WEEK, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.

a) Manufactured cigarettes?
NUMBER WEEKLY ____
b) Hand-rolled cigarettes?
NUMBER WEEKLY ____
d) Pipes full of tobacco?
NUMBER WEEKLY ____
e) Cigars, cheroots, or cigarillos?
NUMBER WEEKLY ____
f) Number of water pipe/Shisha sessions?
NUMBER WEEKLY _________
g) Any others? (SPECIFY)_____________
NUMBER WEEKLY ____

813) Do you currently use smokeless tobacco every day, some days, or not at all?

EVERY DAY 1
SOME DAYS 2 (GO TO 815)
NOT AT ALL 3 (GO TO 815A)

814) On average, how many times a day do you use the following products? Also, let me know if you use the product, but not every day.

IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY DAY, RECORD '888', IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.

a) Snuff, by mouth?
TIMES DAILY ________ (GO TO 815A)
b) Snuff, by nose?
TIMES DAILY ________ (GO TO 815A)
c) Chewing tobacco?
TIMES DAILY ________ (GO TO 815A)
e) Any others? (SPECIFY) _______
TIMES DAILY ________ (GO TO 815A)

815) On average, how many times a week do you use the following products? Also, let me know if you use the product, but not every week.

IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY WEEK, RECORD '888', IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.

a) Snuff, by mouth?
TIMES WEEKLY _______
b) Snuff, by nose?
TIMES WEEKLY _______
c) Chewing tobacco?
TIMES WEEKLY _______
e) Any others? (SPECIFY) _______
TIMES WEEKLY _______

815A)Are you covered by any health insurance?

YES 1
NO 2 (GO TO DV00)

816) Are you covered by any health insurance?

YES 1
NO 2 (GO TO 817A)

817) What type of health insurance are you covered by?

RECORD ALL MENTIONED.

MUTUAL HEALTH ORGANIZATION/COMMUNITY-BASED HEALTH INSURANCE A (GO TO DV00)
HEALTH INSURANCE THROUGH EMPLOYER B (GO TO DV00)
SOCIAL SECURITY C (GO TO DV00)
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D (GO TO DV00)
OTHER (SPECIFY) _______X (GO TO DV00)

817A) Would you consider joining a health insurance scheme to pay for your health care?

YES 1
NO 2
DON'T KNOW 8


DOMESTIC VIOLENCE MODULE

DV00) CHECK COVER PAGE: MAN SELECTED FOR DV MODELE?

MAN SELECTED FOR THIS SECTION (CONTINUE)
MAN NOT SELEXTED (GO TO 818)

DV01) CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

PRIVACY OVTAINED 1 (CONTINUE)
PRIVACY NOT POSSIBLE 2 (GO TO 818)

DC01A) READ TO THE RESPONENT:
Now I would like to ask you questions about some other important aspects of a man's life. You may find some of these questions 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 in your household will know that you were asked these questions. 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.

DV02) CHECK 401 AND 402:

CURRENTLY MARRIED/LIVING WITH A WOMAN (CONTINUE)
FORMERLY MARRIED/LIVED WITH A WOMAN (READ IN PAST TENSE AND USE 'LAST' WITH 'WIFE/PARTNER') (CONTINUE)
NEVER MARRIED/NEVER LIVED WITH A WOMEN (GO TO DV16)

DV 03) First, I am going to ask you about some situations which happen to some men. Please tell me of 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
DK 8

b) She frequently (accuses/accused) you of being unfaithful?

YES 1
NO 2
DK 8

c) She (does/did) not permit you to meet your male friends?

YES 1
NO 2
DK 8

d) She (tries/tried) to limit your contact with your family?

YES 1
NO 2
DK 8

e) She (insists/insisted) on knowing where you (are/were) at all times?

YES 1
NO 2
DK 8

DV04) Now I need to ask some more questions about your relationship with your (last) (wife/partner).
A. Did your (last) (wife/partner) ever:

a) say or do something to humiliate you in front of other?
YES 1
NO 2
b) threaten to hurt or harm you or someone you care about?
YES 1
NO 2
c) insult you or make you feel bad about yourself?
YES 1
NO 2

B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) say or do something to humiliate you in front of other?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) threaten to hurt or harm you or someone you care about?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) insult you or make you feel bad about yourself?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

DV05) A. 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
b) slap you?
YES 1
NO 2
c) twist your arm or pull your hair?
YES1
NO 2
d) punch you with his fist or with something that could hurt you?
YES 1
NO 2
e) kick you, drag you, or beat you up?
YES 1
NO 2
f) try to choke you or burn you on purpose?
YES 1
NO 2
g) threaten or attack you with a knife, gun, or other weapon?
YES 1
NO 2
h) physically force you to have sexual intercourse with him when you did not want to?
YES 1
NO 2
i) physically force you to perform any other sexual acts you did not want to?
YES 1
NO 2
j) force you with threats or in any other way to perform sexual acts you did not want to?
YES 1
NO 2

B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) push you, shake you, or throw something at you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) slap you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
d) punch you with his fist or with something that could hurt you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
e) kick you, drag you, or beat you up?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
f) try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
g) threaten or attack you with a knife, gun, or other weapon?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
h) physically force you to have sexual intercourse with him when you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
i) physically force you to perform any other sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
j) force you with threats or in any other way to perform sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

DV06) CHECK DV05(a-j):

AT LEAST ONE 'YES' (CONTINUE)
NOT A SINGLE 'YES' (GO TO DV09)

DV07) How long after you first (got married/started living together) 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

DV08) 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 bums?
YES 1
NO 2
c) You had deep wounds, broken bones, broken teeth, or any other serious injury?
YES 1
NO 2

DV09) Have you even hit, slapped, kicked, or done anything else to physically hurt your(last) (wife/partner) at times when he was not already beating or physically hurting you?

YES 1
NO 2 (GO TO DV11)

DV10) In the last 12 months, how often have you done this to your (last) (wife/partner) : often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 2

DV11) Does (did) your (last)(wife/partner) drink alcohol?

YES 1
NO 2 (GO TO DV13)

DV12) How often does (did) she get drunk?

OFTEN 1
SOMETIMES 2
NEVER 2

DV13) Are (Were) you afraid of your (last) (wife/partner): most of the time, sometimes, or never?

MOST OF THE TIME AFRAID 1
SOMETIMES AFRAID 2
NEVER AFRAD 3

DV14) CHECK 409:

MERRIED MORE THAN ONCE (CONTINUE)
MARRIED ONLY ONCE (GO TO DV16)

DV15) A. So far we have been talking about the behavior of your (current/last) (wife/partner). Now I want to ask you about the behavior of any previous (wife/partner)

a) Did any previous (wife/partner) ever hit, slap, kick or do anything else to hurt you physically?
YES 1 (GO TO B)
NO 2
b) Did any previous (wife/partner) physically force you to have intercourse or perform any other sexual acts against your will?
YES 1( GO TO B)
NO 2

B. How long ago did this last happen?

0-11 MONTHS AGO 1
12+MONTHS AGO 2
DON'T REMEMBER 3

DV16) CHECK 401 AND 402:

EVER MARRIED/EVER LIVED WITH A WOMAN:
a) From the time you were 15 years old has anyone other than (your/any) (wife/partner) hit you slapped you, kicked you, or done anything else to hurt you physically?

YES 1
NO 2 (GO TO DV22)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO DV22)

NEVER MARRIED/NEVER LIVED WITH A WOMAN
b) From the time you were 15 years old has anyone hit you, slapped you, kicked you, or done anything else to hurt you physically?

YES 1
NO 2 (GO TO DV22)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO DV22)

DV17) 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
CURRECT BOYFRIEND F
FORMER BOYDRIEND G
MOTHE-IN-LAW H
FATHER-IN-LAW I
OTHER IN-LAW J
TEACHER K
EMPLYER/SOMEONE AT WORK L
POLICE/SOLDIER M
OTHER (SPECIFY) ____________X

DV18) In the last 12 months, how often has (this person/have these persons)physically hurt: often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

DV22) CHECK 401 AND 402:

EVER MARRIED/EVER LIVED WITH A WOMAN (CONTINUE)
NEVER MARRIED/NEVER LIVED WITH A WOMAN (GO TO DV22B)

DV22A) Now I want to ask you about things that may have been done to you by someone other than (your/any) (wife/partner). 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 when you did not want to?

YES 1 (GO TO DV23)
NO 2(GO TO DV24A)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO DV24A)

DV22B) 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 when you did not want to?

YES 1
NO 2(GO TO DV26)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO DV26)

DV23) Who was the person who was forcing you the very first time this happened?

CURRENT/FORMER BOTFRIEND 01
FATER/STEP-FATHER 02
BROTHER/STEP-BROTHER 03
OTHER RELATIVE 04
IN-LAW 05
OWN FRIEND/ACQUAINTANCE 06
FAMILY FRIEND 07
EMPLOYER/SOMEONE AT WORK 09
POLICE/SOLDIER 10
PRIEST/RELIGIOUS LEADER 11
STRANGER 12
OTHER (SPECIFY)_______96

DV23A) After being forced to have sexual intercourse or perform sexual acts, have you ever sought help form a doctor or medical personnel?

YES 1
NO 2 (GO TO DV23G)

DV23B) How long after you were forced to have sexual intercourse or perform sexual acts did you seek help?

WITHIN 3 DAYS 1
AFTER 3 DAYS OR MORE 2

DV23C) Were you offered drugs to prevent you from getting HIV after you were forced to have sexual intercourse or perform sexual acts?

YES 1
NO 2

DV23D) Were you offered a test for HIV after you were forced to have sexual intercourse or perform sexual acts?

YES 1
NO 2

DV23G) After being forced to have sexual intercourse or perform sexual acts, have you ever sought:

a) Psychological support?
YES 1
NO 2
b) Legal support?
YES 1
NO 2

DV24) CHECK 401 AND 402:

EVERR MARRIED/EVER LIVED WITH A WOMAN
a) In the last 12 months, has anyone other than (your/any) (wife/partner) physically forced you to have sexual intercourse when you did not want to?

YES 1 (GO TO DV25)
NO 2 (GO TO DV25)

NEVER MARRIED/NEVER LIVED WITH A WOMAN
b) In the last months has anyone physically forced you to have sexual intercourse when you did not want to?

YES 1 (GO TO DV25)
NO 2 (GO TO DV25)

DV24A) CHECK DV05A (h-j) and DV 15A (b)

AT LEAST ONE 'YES' (CONTINUE)
NOT A SINGLE 'YES' (GO TO DV 26)

DV25) CHECK 401 AND 402:

EVER MARRIED/EVER LIVED WITH AWOMAN
a) How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts by anyone, including (your/any) wife/partner?

NEVER MARRIED/NEVER LIVED WITH A WOMAN
b) How old were you the first time you were forced to have sexual intercourse of perform any other sexual acts?

AGO IN COMPLETED YEARS _____
DON'T KNOW 98

DV26) CHECK DV05A(a-j), DV16. DV20. DV22A. AND DV22B:

AT LEAST ONE 'YES' (CONTINUE)
NOT A SINGLE 'YES' (GO TO DV30)

DV27) Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

YES 1
NO 2 (GO TO DV29)

DV28) From whom have you sought help?
Anyone else?
RECORD ALL MENTIONED.

OWN FAMILY A (GO TO DV30)
HUSBAND/PARTNER'S FAMILY B (GO TO DV30)
CURRENT/FORMER HUSBAD/PARTENR C (GO TO DV30)
CURRENT/FORMER BOYFRIEND D (GO TO DV30)
FRIEND E (GO TO DV30)
NEIGHBOR F (GO TO DV30)
RELIGIOUS LEADER G (GO TO DV30)
DOCOTOR/MEDICAL PERSONNEL H (GO TO DV30)
POLICE I (GO TO DV30)
LAWYER J (GO TO DV30)
SOCIAL SERVICE ORGANIZATION K (GO TO DV30)
OTHER (SPECIFY) _______X (GO TO DV30)

DV29) Have you ever told anyone about this?

YES 1
NO 2

DV30) As for as you know, did your father or any other husband or boyfriend your mother had ever hit or beat her?

YES 1
NO 2
DON'T KNOW 8

THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.

DV31) 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

DV32) INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE
_____________________________________________________________________________

818) RECORD THE TIME

HOURS ______
MINUTES________

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTEVIEW

COMMENTS ABOUT INTERVIEW:
_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

COMMENTS ON SPECIFIC QUESTIONS:
____________________________________________________________________________________________________________________________________________________________

ANY OTHER COMMENTS:
____________________________________________________________________________________________________________________________________________________________

SUPERVISOR'S OBSERVATIONS
____________________________________________________________________________________________________________________________________________________________

EDITOR'S OBSERVATIONS
____________________________________________________________________________________________________________________________________________________________