Data Cart

Your data extract

0 variables
0 samples
View Cart

2005 ZIMBABWE DEMOGRAPHIC AND HEALTH SURVEY MEN'S QUESTIONNAIRE

CENTRAL STATISTICAL OFFICE

IDENTIFICATION

PROVINCE

DISTRICT

NAME OF HOUSEHOLD HEAD

CLUSTER NUMBER

HOUSEHOLD NUMBER

HARRARE = 1
SMALL CITY = 2
TOWN = 3
RURAL = 4

NAME AND LINE NUMBER OF MAN

INTERVIEWER VISITS

FIRST VISIT

DATE
INTERVIEWER NAME
RESULT

NEXT VISIT:
DATE
TIME

SECOND VISIT

DATE
INTERVIEWER NAME
RESULT

NEXT VISIT:
DATE
TIME

THIRD VISIT

DATE
INTERVIEWER NAME
RESULT

NEXT VISIT:
DATE
TIME

FINAL VISIT

DAY
MONTH
YEAR
ID NUMBER
RESULT

TOTAL NUMBER OF VISITS ____

*RESULT CODES:

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

LANGUAGE OF QUESTIONNAIRE:

SHONA 1
NEDEBELE 2
ENGLISH 3

LANGUAGE USED FOR INTERVIEW

SHONA A
NDEBELE B
ENGLISH C
OTHER X

TRANSLATOR USED?

YES 1
NO 2

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 the Central Statistical Office. We are conducting a national survey about the health of men, women, and children. We would very much appreciate your participation in this survey. I would like to ask you some questions related to health. This information will help the government to plan health services. The survey usually takes about 30 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

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

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

Signature of the interviewer:
Date:

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

101) RECORD THE TIME.

Hours
Minutes

102) How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?

IF LESS THAN ONE MONTH, RECORD '00' MONTHS.

MONTHS ________ 1
YEARS _________ 2
ALWAYS 95 (GO TO 104)
VISITOR 96 (GO TO 104)

103) Just before you moved here, where did you live? RECORD NAME AND CODE TYPE OF AREA.

PROBE: Is that a city, town, communal land or resettlement area?

NAME OF PLACE ________
CITY 1
TOWN 2
COMMUNAL LAND 3
RESETTLEMENT AREA 4
OTHER RURAL AREA 5
ABROAD 6

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 AWAY ________
NONE 00 (GO TO 106)

105) 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 105 AND/OR 106 IF INCONSISTANT.

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 1
SECONDARY 2
HIGHER 5
DON'T KNOW 8

110) What is the highest grade (number of years) you completed at that level?

GRADE ________

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 (SPECIFY LANGUAGE) ________ 4
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

118) What is your religion?

TRADITIONAL 01
ROMAN CATHOLIC 02
PROTESTANT 03
PENTECOSTAL 04
APOSTOLIC SECT 05
OTHER CHRISTIAN 06
MUSLIM 07
NONE 08 (GO TO 120)
OTHER (SPECIFY) ________ 96

119) How often have you attended religious services in the past month?

RECORD '00' IF DID NOT ATTEND DURING MONTH.

NUMBER OF TIMES ________
DON'T KNOW/NOT SURE 98

120) Have you done any work in the last seven days?

YES 1 (GO TO 123)
NO 2

121) 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 123)
NO 2

122) Have you done any work in the last 12 months?

YES 1
NO 2 (GO TO 201)

123) What is your occupation, that is, what kind of work do you mainly do?

124) CHECK 123:

WORKS IN AGRICULTURE (GO TO 125)
DOES NOT WORK IN AGRICULTURE (GO TO 126)

125) 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 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4

126) Are you paid in cash or kind for the work you do, or are you not paid at all?

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

SECTION 2. REPRODUCTION

201) Now I would like to ask about any children you have had during your life. I am interested only in the children that are biologically yours. Have you ever fathered any children with any woman?

YES 1
NO 2 (GO TO 206)
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
NO 2 (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 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 (GO TO 208)
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 213)

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

YES 1 (GO TO 212)
NO 2

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

NUMBER OF WOMEN ________

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

AGE IN YEARS ________

213) Are you the primary care giver for any children?

YES 1
NO 2 (GO TO 301)

214) Are any of these children for whom you are the primary caregiver under the age of 18?

YES 1
NO 2 (GO TO 301)

215) Now I would like to ask you about the children who are under the age of 18 and for whom you are the primary caregiver. Have you made arrangements for someone to care for these children in the event that you fall sick or are unable to care for them?

YES 1
NO 2
UNSURE 8

SECTION 3. CONTRACEPTION

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.

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302 IF APPLICABLE.

301) Which ways or methods have you heard about?

FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?

METHOD 01 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO METHOD 02)
METHOD 02 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1 (GO TO question 302 METHOD 02)
NO 2 (GO TO METHOD 03)
METHOD 03 PILL Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2 (GO TO METHOD 04)
METHOD 04 IUD (LOOP) Women can have a loop or coil placed inside them by a doctor or nurse.
YES 1
NO 2 (GO TO METHOD 05)
METHOD 05 INJECTION Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2 (GO TO METHOD 06)
METHOD 06 IMPLANT Women can have several 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 (GO TO METHOD 07)
METHOD 07 MALE CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1 (GO TO question 302 METHOD 07)
NO 2 (GO TO METHOD 08)
METHOD 08 FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1 (GO TO question 302 METHOD 08)
NO 2 (GO TO METHOD 09)
METHOD 09 LACTATIONAL AMENORRHEA METHOD (LAM)
YES 1
NO 2 (GO TO METHOD 10)
METHOD 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 (GO TO question 302 METHOD 12)
NO 2 (GO TO METHOD 11)
METHOD 11 WITHDRAWAL Men can be careful and pull out before climax.
YES 1 (GO TO question 302 METHOD 13)
NO 2 (GO TO METHOD 12)
METHOD 12 EMERGENCY CONTRACEPTION (MORNING AFTER PILL/POSTINO 2) Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.
YES 1
NO 2 (GO TO METHOD 113)
METHOD 15 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)?

METHOD 02 MALE STERILIZATION
Have you ever had an operation to avoid having any more children?
YES 1
NO 2
METHOD 07 MALE CONDOM
YES 1
NO 2
METHOD 08 FEMALE CONDOM
YES 1
NO 2
METHOD 10 RHYTHM METHOD
YES 1
NO 2
METHOD 11 WITHDRAWL
YES 1
NO 2

303) CHECK 302 (02):

MAN NOT STERILIZED (GO TO 304)
MAN STERILIZED (GO TO 305A)

304) Are you currently doing something or using any method with any partner to delay or avoid pregnancy?

YES 1
NO 2 (GO TO 306)

305) Which method are you or your partner using to delay or avoid pregnancy? Any other method (with any partner)?

CIRCLE ALL MENTIONED.

FEMALE STERILIZATION A
MALE STERILIZATION B
PILL C
IUD D
INJECTABLES E
IMPLANT F
CONDOM G
FEMALE CONDOM H
DIAPHRAGM I
FOAM/JELLY J
LACTATIONAL AMEN. METHOD K
RHYTHM METHOD L
WITHDRAWL M
OTHER (SPECIFY) ________ X

305A) CIRCLE 'B' FOR MALE STERILIZATION.

FEMALE STERILIZATION A
MALE STERILIZATION B
PILL C
IUD D
INJECTABLES E
IMPLANT F
CONDOM G
FEMALE CONDOM H
DIAPHRAGM I
FOAM/JELLY J
LACTATIONAL AMEN. METHOD K
RHYTHM METHOD L
WITHDRAWL M
OTHER (SPECIFY) ________ X

306) In the last few months have you heard about family planning: On the radio? On the television? In a newspaper or magazine?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2

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

YES 1
NO 2

308) 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 (GO TO 310)
DON'T KNOW 8 (GO TO 310)

309) 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 2 PERIODS 4
OTHER (SPECIFY) ________ 6
DON'T KNOW 8

310) Do you think that a woman who is breastfeeding her baby can become pregnant?

YES 1
NO 2
DEPENDS 3
DON'T KNOW 8

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

a) Contraception is a women's business and a man should not have to worry about it.
b) Women who use contraception may become promiscuous.
c) A woman is the one who gets pregnant so she should be the one to use contraception.

CONTRACEPTION WOMAN'S BUSINESS
AGREE 1
DISAGREE 2
DON'T KNOW 8
WOMAN MAY BECOME PROMISCUOUS
AGREE 1
DISAGREE 2
DON'T KNOW 8
WOMAN SHOULD BE ONE TO USE
AGREE 1
DISAGREE 2
DON'T KNOW 8

312) CHECK 301 (07) KNOWS MALE CONDOM

YES (GO TO 313)
NO (GO TO 314)

313) If a male condom is used correctly, do you think that it protects against pregnancy most of the time, only sometimes, or not at all?

MOST OF THE TIME 1
SOMETIMES 2
DOES NOT PROTECT 3
DON'T KNOW/UNSURE 8

314) CHECK 301 (08) KNOWS FEMALE CONDOM

YES (GO TO 315)
NO (GO TO 401)

315) If a female condom is used correctly, do you think that it protects against pregnancy most of the time, only sometimes, or not at all?

MOST OF THE TIME 1
SOMETIMES 2
DOES NOT PROTECT 3
DON'T KNOW/UNSURE 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 (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 do you have more than one woman with whom you are living as if married?

YES 1
NO 2 (GO TO 410)
DON'T KNOW 8 (GO TO 410)

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

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS ________
DON'T KNOW 98

407) CHECK 405:

RECORD THE NAME(S) AND THE LINE NUMBER(S) FROM THE HOUSEHOLD QUESTIONNAIRE FOR THE WIFE (WIVES) AND LIVE-IN PARTNER(S).

IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

ASK 408 FOR EACH PERSON.

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 each woman you are living with as if married).
NAME ________
LINE NUMBER ________

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 411B)

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 411B)

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

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

411B) 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 ________ (GO TO 413)
DON'T KNOW YEAR 9998

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 need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues. How old were you when you had sexual intercourse for the very first time?

NEVER HAD SEXUAL INTERCOURSE 00
AGE IN YEARS ________ (GO TO 416)
FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE/PARTNER 95 (GO TO 416)

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

YES 1 (GO TO 440)
NO 2 (GO TO 440)
DON'T KNOW/UNSURE 8 (GO TO 440)

416) CHECK 107:

15-24 YEARS OLD (GO TO 417)
25-49 YEARS OLD (GO TO 421)

417) The first time you had sexual intercourse, was a condom used?

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

418) How old was the person you first had sexual intercourse with?

AGE OF PARTNER ________ 421
DON'T KNOW 98

419) Was this person older than you, younger than you, or about the same age as you?

OLDER 1
YOUNGER 2 (GO TO 421)
ABOUT THE SAME AGE 3 (GO TO 421)
DON'T KNOW/DON'T REMEMBER 8 (GO TO 421)

420) Would you say this person was ten or more years older than you or less than ten years older than you?

TEN OR MORE YEARS OLDER 1
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3

421) 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 ________ (GO TO 423)
WEEKS AGO 2 ________ (GO TO 423)
MONTHS AGO 3________ (GO TO 423)
YEARS AGO 4 ________ (GO TO 435)

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

DAYS 1 ________
WEEKS 2 ________
MONTHS 3 ________

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

YES 1
NO 2 (GO TO 425)

423A) What was the main reason you used a condom on that occasion?

PREVENT STI/HIV 1
PREVENT PREGNANCY 2
PREVENT BOTH 3
PARTNER INSISTED 4
OTHER (SPECIFY) 6 ________

424) Did you use a condom every time you had sexual intercourse with this person in the last 12 months?

YES 1
NO 2

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

IF BOYFRIEND: Were you living together as if married?

IF YES, CIRCLE '02'
IF NO, CIRCLE '03'

WIFE 01 (GO TO 431)
LIVE-IN PARTNER 02 (GO TO 431)
GIRLFRIEND NOT LIVING WITH RESPONDENT 03
CASUAL AQUAINTANCE 04
COMMERCIAL SEX WORKER 05
OTHER (SPECIFY) ________ 95

426) For how long (have you had/did you have) a sexual relationship with this person?

IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.

DAYS 1 ________
MONTHS 2 ________
YEARS 3 ________

427) CHECK 107:

15-24 (GO TO 428)
25-49 (GO TO 431)

428) How old is this person?

AGE OF PARTNER ________ (GO TO 431)
DON'T KNOW 98

429) Is this person older than you, younger than you, or about the same age?

OLDER 1
YOUNGER 2 (GO TO 431)
SAME AGE 3 (GO TO 431)
DON'T KNOW 8 (GO TO 431)

430) Would you say this person is ten or more years older than you or less than ten years older than you?

TEN OR MORE YEARS OLDER 1
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3

431) The last time you had sexual intercourse with this person, did you or this person drink alcohol?

YES 1
NO 2 (GO TO 433)

432) 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

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

YES 1 (go back to 422 in next column)
NO 2 (GO TO 435)

434) 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 LAST 12 MONTHS ________
DON'T KNOW 98

435) CHECK 425:

NO PARTNERS ARE COMMERCIAL SEX WORKERS (GO TO 436)
AT LEAST ONE PARTNER A COMMERCIAL SEX WORKER (GO TO 438)

436) In the last 12 months, did you pay anyone in exchange for sex?

YES 1
NO 2 (GO TO 439)

437) The last time you paid someone in exchange for sex, was a condom used?

YES 1
NO 2 (GO TO 439)

438) Was a condom used during every time you paid someone in exchange for sex in the last 12 months?

YES 1
NO 2
DON'T KNOW 8

439) 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

440) CHECK 107:

15-24 YEARS OLD (GO TO 441)
25-49 YEARS OLD (GO TO 444)

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

PRIVACY OBTAINED: Now I would like to ask about another important issue. The questions are very personal. However, your answers are very crucial for helping to understand the condition of men in Zimbabwe. I assure you that your answers are completely confidential and will not be told to anyone.

PRIVACY NOT POSSIBLE (GO TO 444)

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

YES 1
NO 2 (GO TO 444)
REFUSED TO ANSWER/ NO RESPONSE 3 (GO TO 444)

443) Were you physically forced?

YES 1
NO 2
REFUSED TO ANSWER/NO RESPONSE 3

444) CHECK 423, MOST RECENT PARTNER (FIRST COLUMN):

YES, CONDOM USED (GO TO 445)
NO CONDOM USED/Q. 423 NOT ASKED (GO TO 454)

445) The last time you had intercourse you told me you used a condom. Did you or your partner obtain the condom?

MAN HIMSELF 1
PARTNER 2
SOMEONE ELSE 3

446) What brand of condoms did you use at that time?

MALE CONDOMS
CHOICE ASSORTED 1
DUREX 2
ECSTASY 3
PROTECTA 4
PUBLIC SECTOR DIS. (BLUE CONDOM OR KAREX) 5
ROUGH RIDER 6
OTHER (SPECIFY) ________ 7
MALE CONDOM, DON'T KNOW 8
FEMALE CONDOMS
CARE 9
OTHER (SPECIFY) ________ 10
FEMALE CONDOM, DON'T KNOW 12

447) How many condoms did you get the last time?

NUMBER OF CONDOMS ________
DON'T KNOW 998

448) How much did the condoms cost?

COST ________
FREE 995
DON'T KNOW 998

449) 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.

RECORD ALL SOURCES MENTIONED.

(NAME OF PLACES) ________
PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC 11
RURAL/MUNICIPAL CLINIC 12
RURAL HEALTH CENTER 13
ZNFPC CLINIC 14
MOH MOBILE CLINIC 15
ZNFPC CBD/DEPOT HOLDER 16
OTHER PUBLIC (SPECIFY) ________ 17
MISSION FACILITY 21
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
CBD 34
OTHER PRIVATE MEDICAL (SPECIFY) ________ 36
RETAL OUTLET
GENERAL DEALER 41
SUPERMARKET 42
TUCK SHOP 43
SERVICE STATION 44
OTHER RETAIL (SPECIFY) ________ 45
OTHER PRIVATE SOURCE
CHURCH 46
FRIEND/RELATIVE 47
OTHER (SPECIFY) ________ 48
DON'T KNOW/NOT SURE 98

450) CHECK 302 (02) USING MALE STERILIZATION

NO (GO TO 451)
YES (GO TO 453)

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

YES 1
NO 2 (GO TO 453)
DON'T KNOW 8 (GO TO 453)

452) What method did you (your partner) use?

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

FEMALE STERILIZATION A
PILL C
IUD D
INJECTION E
IMPLANT F
MALE CONDOM G
FEMALE CONDOM H
DIAPHRAGM I
FOAM/JELLY J
LACTATIONAL AMEN. METHOD K
RHYTHM METHOD L
WITHDRAWL M
OTHER (SPECIFY) ________ X

453) CHECK 423 COLUMN 1 (CONDOM USE WITH LAST SEXUAL PARTNER)

NO (GO TO 454)
YES (GO TO 458)

454) CHECK 301 (07) KNOWS MALE CONDOM

YES (GO TO 455)
NO (GO TO 458)

455) Do you know of a place where a person can get male condoms?

YES 1
NO 2 (GO TO 458)

456) Where is that? Any other place?

PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND CIRCLE THE APPROPRIATE CODE(S).

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
RECORD ALL SOURCES MENTIONED.

(NAME OF PLACE(S)) ________
PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
RURAL/MUNICIPAL CLINIC B
RURAL HEALTH CENTER C
ZNFPC CLINIC D
MOH MOBILE CLINIC E
ZNFPC CBD/DEPOT HOLDER F
OTHER PUBLIC (SPECIFY) ________ G
MISSION FACILITY H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC I
PHARMACY J
PRIVATE DOCTOR K
CBD L
OTHER PRIVATE MEDICAL (SPECIFY) ________ M
RETAL OUTLET
GENERAL DEALER N
SUPERMARKET O
TUCK SHOP P
SERVICE STATION Q
OTHER RETAIL (SPECIFY) ________ R
OTHER PRIVATE SOURCE
CHURCH S
FRIEND/RELATIVE T
OTHER (SPECIFY) ________ X

457) If you wanted to, could you yourself get a condom?

YE 1
NO 2

458) Do you know of a place where a person can get female condoms?

YES 1
NO 2 (GO TO 461)

459) Where is that? Any other place?

PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND CIRCLE THE APPROPRIATE CODE(S).

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

RECORD ALL SOURCES MENTIONED.

(NAME OF PLACE(S)) ________
PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
RURAL/MUNICIPAL CLINIC B
RURAL HEALTH CENTER C
ZNFPC CLINIC D
MOH MOBILE CLINIC E
ZNFPC CBD/DEPOT HOLDER F
OTHER PUBLIC (SPECIFY) ________ G
MISSION FACILITY H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC I
PHARMACY J
PRIVATE DOCTOR K
CBD L
OTHER PRIVATE MEDICAL (SPECIFY) ________ M
RETAL OUTLET
GENERAL DEALER N
SUPERMARKET O
TUCK SHOP P
SERVICE STATION Q
OTHER RETAIL (SPECIFY) ________ R
OTHER PRIVATE SOURCE
CHURCH S
FRIEND/RELATIVE T
OTHER (SPECIFY) ________ X

460) If you wanted to, could you yourself get a female condom?

YES 1
NO 2

461) Now I would like to ask you a few questions regarding relationships between men and women.
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 family, friends 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 and when to have them?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8

462) Sometimes a husband is annoyed or angered by things that his wife/partner 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/DEPENDS 8
b) If she neglects the children?
YES 1
NO 2
DON'T KNOW/DEPENDS 8
c) If she argues with him?
YES 1
NO 2
DON'T KNOW/DEPENDS 8
d) If she refuses to have sex with him?
YES 1
NO 2
DON'T KNOW/DEPENDS 8
e) If she burns the food?
YES 1
NO 2
DON'T KNOW/DEPENDS 8

463) When a wife knows her husband has a disease that can be transmitted through sexual contact, is she justified in asking that they use a condom?

YES 1
NO 2
DON'T KNOW 8

464) Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband if...

a) She is tired and not in the mood?
YES 1
NO 2
DON'T KNOW/DEPENDS 8
b) She has recently given birth?
YES 1
NO 2
DON'T KNOW/DEPENDS 8
c) She knows her husband has sex with other women?
YES 1
NO 2
DON'T KNOW/DEPENDS 8
d) She knows her husband has a sexually transmitted disease?
YES 1
NO 2
DON'T KNOW/DEPENDS 8

465) 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 financial 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 and have sex with another woman?
YES 1
NO 2
DON'T KNOW/DEPENDS 8

SECTION 5. FERTILITY PREFERENCES

501) CHECK 405:

HAS ONE OR MORE WIVES/PARTNERS (GO TO 502)
QUESTION SKIPPED (GO TO 601)

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

YES 1
NO 2
UNSURE 3

503) CHECK 502:

YES, WIFE/WIVES PREGNANT: Now I have some questions about the future. After the child(ren) your wife/wives/partner(s) is/are expecting now, would you like to have another child or would you prefer not to have any more children at all?
HAVE A/ANOTHER CHILD 1
NO MORE/NONE 2 (GO TO 505)
WIFE/WIVES INFECUND/STERILIZED 3 (GO TO 505)
UNDECIDED/DON'T KNOW 8 (GO TO 505)
NO WIFE/PARTNER PREGNANT OR UNSURE: Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children at all?
HAVE A/ANOTHER CHILD 1
NO MORE/NONE 2 (GO TO 505)
WIFE/WIVES INFECUND/STERILIZED 3 (GO TO 505)
UNDECIDED/DON'T KNOW 8 (GO TO 505)

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

MONTHS ________ 1
YEARS ________ 2
SOON/NOW 993
AFTER MARRIAGE 995
OTHER (SPECIFY) ________ 996
DON'T KNOW 998

505) CHECK 203 AND 205:

HAS CHILDREN LIVING: 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 CHILDREN LIVING: 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)

506) 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?

NUMBER
BOYS__
GIRLS__
EITHER__
OTHER (SPECIFY) ________

SECTION 6. PARTICIPATION IN HEALTH CARE

601) CHECK 209:

HAS HAD ONE OR MORE CHILDREN (GO TO 602)
HAS NOT HAD ANY CHILDREN (GO TO 701)

602) Please tell me the name and sex of your child (who was born most recently).

(NAME OF CHILD) ________
BOY 1
GIRL 2

603) In what month and year was (NAME OF CHILD) born?

MONTH ________
YEAR ________
DON'T KNOW 998

604) Is (NAME OF CHILD) still living?

YES 1 (GO TO 606)
NO 2
DON'T KNOW 8 (GO TO 606)

605) How old was (NAME OF CHILD) when he/she died?

IF '1 YEAR', PROBE: How many months old was (NAME)?

RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS ________ 1
WEEKS ________ 2
MONTHS ________ 3
YEARS ________ 4
DON'T KNOW 998

606) What is the name of (NAME OF CHILD)'s mother?

WRITE THE CHILD'S MOTHER'S NAME AND HER LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE.

IF MOTHER IS NOT LISTED IN THE HOUSEHOLD SCHEDULE RECORD '00'.

NAME OF CHILD'S MOTHER ________
LINE NUMBER IN HHD. QUESTIONNAIRE ________

607) CHECK 603:

CHILD BORN IN 2000 OR LATER (GO TO 608)
CHILD BORN IN 1999 OR EARLIER (GO TO 701)

609) What is your relationship with (NAME OF CHILD)'s mother?

CURRENT SPOUSE 01
FORMER SPOUSE 02
CURRENT LIVE-IN PARTNER 03
FORMER LIVE-IN PARTNER 04
REGULAR SEXUAL PARTNER 05
WOMAN IS GIRLFRIEND/FIANCEE 06
OCCASIONAL SEXUAL PARTNER 07
FRIEND/ACQUAINTANCE 08
OTHER (SPECIFY) ________ 96

610) ASK QUESTIONS 610A-612 FIRST FOR PREGNANCY, THEN FOR DELIVERY, AND THEN FOR THE SIX WEEKS AFTER DELIVERY. ALL QUESTIONS REFER TO THE LAST BIRTH..

Now, think back to the time when (NAME OF CHILD'S MOTHER) was pregnant with (NAME OF CHILD).

PREGNANCY
610A: Did (NAME OF CHILD'S MOTHER) receive any antenatal care from a doctor or any health care provider when she was pregnant with (NAME OF CHILD)?
YES 1
NO 2 (GO TO 612)
DON'T KNOW 8 (GO TO 610b in next column)
DELIVERY
610B: Did a doctor or any health care provider assist with the delivery of (NAME OF CHILD)?
YES 1
NO 2 (GO TO 612)
DON'T KNOW 8 (GO TO 610C in next column)
SIX WEEKS AFTER DELIVERY
610C: Did (NAME OF CHILD'S MOTHER) receive any care for herself from a doctor or any health provider during the six weeks after this delivery?
YES 1
NO 2 (GO TO 612)
DON'T KNOW 8 (GO TO 613)

611) Who mainly provided the money or goods or services to pay for this care?

PREGNANCY
FREE 01 (GO TO 610B IN NEXT COLUMN)
INSURANCE 02 (GO TO 610B IN NEXT COLUMN)
RESPONDENT 03 (GO TO 610B IN NEXT COLUMN)
CHILD'S MOTHER 04 (GO TO 610B IN NEXT COLUMN)
RESPONDENT AND CHILD'S MOTHER 04 (GO TO 610B IN NEXT COLUMN)
RESPONDENT'S FAMILY 06 (GO TO 610B IN NEXT COLUMN)
CHILD'S MOTHER'S FAMILY 07 (GO TO 610B IN NEXT COLUMN)
OTHER (SPECIFY) ________ 96 (GO TO 610B IN NEXT COLUMN)
DELIVERY
FREE 01 (GO TO 610C IN NEXT COLUMN)
INSURANCE 02 (GO TO 610C IN NEXT COLUMN)
RESPONDENT 03 (GO TO 610C IN NEXT COLUMN)
CHILD'S MOTHER 04 (GO TO 610C IN NEXT COLUMN)
RESPONDENT AND CHILD'S MOTHER 04 (GO TO 610C IN NEXT COLUMN)
RESPONDENT'S FAMILY 06 (GO TO 610C IN NEXT COLUMN)
CHILD'S MOTHER'S FAMILY 07 (GO TO 610C IN NEXT COLUMN)
OTHER (SPECIFY) ________ 96 (GO TO 610C IN NEXT COLUMN)
SIX WEEKS AFTER DELIVERY
FREE 01 (GO TO 613)
INSURANCE 02 (GO TO 613)
RESPONDENT 03 (GO TO 613)
CHILD'S MOTHER 04 (GO TO 613)
RESPONDENT AND CHILD'S MOTHER 04 (GO TO 613)
RESPONDENT'S FAMILY 06 (GO TO 613)
CHILD'S MOTHER'S FAMILY 07 (GO TO 613)
OTHER (SPECIFY) ________ 96 (GO TO 613)

612) What was the main reason (NAME OF CHILD'S MOTHER) did not receive any advice or care from a doctor or other health care provider during (pregnancy/delivery/the six weeks after delivery?)

PREGNANCY
NOT NECESSARY 01 (GO TO 610B in next column)
NOT CUSTOMARY 02 (GO TO 610B in next column)
RESPONDENT DIDN'T ALLOW 03 (GO TO 610B in next column)
TOO COSTLY 04 (GO TO 610B in next column)
TOO FAR/NO TRANSPORT 05 (GO TO 610B in next column)
POOR SERVICE 06 (GO TO 610B in next column)
LACK OF KNOWLEDGE 07 (GO TO 610B in next column)
OTHER (SPECIFY) ________ 96 (GO TO 610B in next column)
DELIVERY
NOT NECESSARY 01 (GO TO 610C in next column)
NOT CUSTOMARY 02 (GO TO 610C in next column)
RESPONDENT DIDN'T ALLOW 03 (GO TO 610C in next column)
TOO COSTLY 04 (GO TO 610C in next column)
TOO FAR/NO TRANSPORT 05 (GO TO 610C in next column)
POOR SERVICE 06 (GO TO 610C in next column)
LACK OF KNOWLEDGE 07 (GO TO 610C in next column)
OTHER (SPECIFY) ________ 96 (GO TO 610C in next column)
SIX WEEKS AFTER DELIVERY
NOT NECESSARY 01 (GO TO 613)
NOT CUSTOMARY 02 (GO TO 613)
RESPONDENT DIDN'T ALLOW 03 (GO TO 613)
TOO COSTLY 04 (GO TO 613)
TOO FAR/NO TRANSPORT 05 (GO TO 613)
POOR SERVICE 06 (GO TO 613)
LACK OF KNOWLEDGE 07 (GO TO 613)
OTHER (SPECIFY) ________ 96 (GO TO 613)

613) At any time while (NAME OF CHILD'S MOTHER) was pregnant with (NAME OF CHILD), did you yourself talk with a doctor or any other health care provider about the health of the mother or of the pregnancy?

YES 1
NO 2

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 801)

702) Can people reduce their chances of getting HIV by just having one sex partner who is not infected and who has no other 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 chances 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 AIDS?

YES 1
NO 2
DON'T KNOW 8

706) Can people reduce their chance of getting HIV by abstaining from sexual intercourse?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

708) Is there anything(else) a person can do to avoid or reduce the chances of getting HIV or AIDS?

YES 1
NO 2 (GO TO 710)
DON'T KNOW 8 (GO TO 710)

709) What can a person do? Anything else?

RECORD ALL WAYS MENTIONNED.

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING RAZORS/BLADES K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM TRADITIONAL PRACTIITIONER N
OTHER (SPECIFY) ________ W
OTHER (SPECIFY) ________ X
DON'T KNOW Z

710) Do you think your risk of getting infected with HIV is low, medium or high, or do you have no risk at all?

LOW 1
MEDIUM 2
HIGH 3
NO RISK 4
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

712) Can HIV be transmitted from a mother to her baby: During pregnancy? During delivery? By breastfeeding?

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

713) CHECK 712:

AT LEAST ONE 'YES' (GO TO 714)
OTHER (GO TO 715)

714) Are there any special medications that a doctor or 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

715) Is there any special medication that people infected with HIV can get from a doctor or nurse?

YES 1
NO 2
DON'T KNOW 8

716) Have you ever been tested to see if you have HIV?

YES 1
NO 2 (GO TO 723)

717) 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

718) 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

719) Did you get the results of the test?

YES 1
NO 2

720) Where was the test done?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE SOURCE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) ________
PUBLIC SECTOR
CENTRAL HOSPITAL 11
PROVINCIAL HOSPITAL 12
DISTRICT/RURAL HOSPITAL 13
RURAL HEALTH CENTER 14
MUNICIPLE CLINIC 15
OTHER PUBLIC (SPECIFY) ________ 16
MISSION FACILITY 21
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
NEW START CENTER 32
OTHER PRIVATE VCT CENTER (SPECIFY) ________ 33
OTHER PRIVATE DOCTOR (SPECIFY) ________ 36
OTHER (SPECIFY) _________ 96

721) CHECK 719: GOT THE RESULTS OF HIV TEST

YES (GO TO 722)
NO (GO TO 726)

722) Did you tell your wife/partner the result of your test?

YES 1 (GO TO 726)
NO 2 (GO TO 726)
HAD NO WIFE/PARTNER 3 (GO TO 726)

723) What is the main reason you have not been tested for HIV?

CAN'T AFFORD IT 01
DON'T KNOW WHERE TO GO 02 (GO TO 936)
TESTING SITE DIFFICULT TO GET TO 03
AFRAID OF TEST RESULT 04
FATALISTIC/NOTHING CAN BE DONE 05
CONCERNED ABOUT CONFIDENTIALITY 06
NO RISK/NOT SEXUALLY ACTIVE 07
OTHER (SPECIFY) ________ 96
DON'T KNOW 98
724) Do you know of a place where people can GO TO get tested for HIV?

YES 1
NO 2 (GO TO 729)

725) Where is that? Any other places?

RECORD ALL SOURCES MENTIONED

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE SOURCE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE (S)) ________
PUBLIC SECTOR
CENTRAL HOSPITAL A
PROVINCIAL HOSPITAL B
DISTRICT/RURAL HOSPITAL C
RURAL HEALTH CENTER D
MUNICIPLE CLINIC E
OTHER PUBLIC (SPECIFY) ________ F
MISSION FACILITY G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
NEW START CENTER I
OTHER PRIVATE VCT CENTER (SPECIFY) ________ J
OTHER PRIVATE DOCTOR (SPECIFY) ________ K
OTHER (SPECIFY) _________ X

726) CHECK 401: CURRENT MARITAL STATUS

CURRENTLY MARRIED/LIVING WITH A WOMAN (GO TO 727)
NO (GO TO 729)

727) Did your wife/partner ever have a test for HIV?

YES 1
NO 2 (GO TO 729)
DON'T KNOW 8 (GO TO 729)

728) Did she tell you the result of her test?

YES 1
NO 2

729) 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 8

730) If a member of your family got infected with HIV, would you want others to know about it?

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

731) If a relative of yours became sick with HIV, 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

732) If a female teacher has HIV 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

732A) If a male teacher has HIV but is not sick, should he be allowed to continue teaching in the school?

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

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

YES 1
NO 2
DON'T KNOW ANYONE WITH AIDS 8 (GO TO 738)

734) 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 is suspected to have HIV or AIDS?

YES 1
NO 2

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

YES 1
NO 2

736) CHECK 733, 734, 735:

OTHER (GO TO 737)
AT LEAST ONE 'YES' (GO TO 738)

737) Do you personally know someone who is suspected to have HIV or AIDS?

YES 1
NO 2

738) Do you agree or disagree with the following statement: People with HIV should be ashamed of themselves.

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

739) Do you agree or disagree with the following statement: People with HIV should be blamed for bringing the disease into the community.

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

740) Do you agree or disagree with the following statement: In a marriage, it is possible for one partner to be infected with HIV and other person not be infected.

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

741) Should children age 12-14 be taught about using a condom to avoid HIV infection?

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

742) Should children age 12-14 be taught to wait until they get married to have sexual intercourse in order to avoid HIV infection?

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

SECTION 8. OTHER HEALTH ISSUES

801) Some men are circumcised. Are you circumcised?

YES 1
NO 2

802) CHECK 701:

HAS HEARD ABOUT AIDS: Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?
YES 1
NO 2 (GO TO 806)
NOT HEARD ABOUT AIDS: Have you heard about infections that can be transmitted through sexual contact?
YES 1
NO 2 (GO TO 806)

803) CHECK 419:

HAS HAD SEXUAL INTERCOURSE (GO TO 804)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 811)

804) CHECK 802:

KNOWS STI (GO TO 805)
DOES NOT KNOW STI (GO TO 806)

805) 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

806) 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

807) Sometimes men have a sore or ulcer on or near their penis. During the last 12 months, have you had a sore or ulcer on or near your penis?

YES 1
NO 2
DON'T KNOW 8

808) CHECK 805, 806, 807:

AT LEAST ONE 'YES' (GO TO 809)
OTHER (GO TO 811)

809) The last time you had (PROBLEM(S) FROM 805, 806, 807), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 811)

810) Where did you go? Any other places?

RECORD ALL SOURCES MENTIONED.

PUBLIC SECTOR
CENTRAL HOSPITAL A
PROVINCIAL HOSPITAL B
DISTRICT/RURAL HOSPITAL C
RURAL HEALTH CENTER D
RURAL/MUNICIPAL CLINIC E
OTHER PUBLIC (SPECIFY) ________ F
MISSION FACILITY G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
PHARMACY I
OTHER PRIVATE MEDICAL (SPECIFY) _______ J
OTHER SOURCE
SHOP M
RELATIVE/FRIEND N
TRADITIONAL HEALER O
OTHER (SPECIFY) ________ X

811) CHECK 701 AND 802:

KNOWS ABOUT AIDS AND/OR OTHER STI (GO TO 812)
DOES NOT KNOW (GO TO 816)

812) CHECK 301(07) KNOWS MALE CONDOM:

YES (GO TO 813)
NO (GO TO 814)

813) Some people use male condoms to prevent sexually transmitted diseases. If a male condom is used correctly, do you think that it protects against these diseases most of the time, only sometimes, or not at all?

MOST OF THE TIME 1
SOMETIMES 2
DOES NOT PROTECT 3
DON'T KNOW/UNSURE 8

814) CHECK 301 (08) KNOWS FEMALE CONDOM

YES (GO TO 815)
NO (GO TO 816)

815) Some people use female condoms to prevent sexually transmitted diseases. If a female condom is used correctly, do you think that it protects against these diseases most of the time, only sometimes, or not at all?

MOST OF THE TIME 1
SOMETIMES 2
DOES NOT PROTECT 3
DON'T KNOW/UNSURE 8

816) Now I would like to ask you some questions about any injections you have had in the last six months. Have you had an injection for any reason in the last six months?

IF YES: How many injections have you had?

IF NUMBER OF INJECTIONS IS GREATER THAN 94, OR DAILY FOR 3 MONTHS OR MORE, RECORD '95'.

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ________
NONE 00 (GO TO 820)

817) 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 94, OR DAILY FOR 3 MONTHS OR MORE, RECORD '95'.

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ________
NONE 00 (GO TO 820)

818) The last time you had an injection given to you by a health worker, where did you GO TO get the injection?

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC 11
RURAL/MUNICIPAL CLINIC 12
RURAL HEALTH CENTER 13
ZNFPC CLINIC 14
MOH MOBILE CLINIC 15
ZNFPC CBD/DEPOT 16
OTHER PUBLIC (SPECIFY) ________ 17
MISSION FACILITY 21
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC
PHARMACY 31
PRIVATE DOCTOR 32
CBD 33
OTHER PRIVATE DOCTOR (SPECIFY) ________ 34
RETAIL OUTLET
GENERAL DEALER 35
SUPERMARKET
TUCK SHOP
SERVICE STATION 96
OTHER RETAIL (SPECIFY) ________
OTHER PRIVATE SOURCE
CHURCH
FRIEND/RELATIVE
OTHER (SPECIFY) ________

819) 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

820) Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 822)

821) In the last 24 hours, how many cigarettes did you smoke?

CIGARETTES ________

822) Do you currently smoke or use any other type of tobacco?

YES 1
NO 2 (GO TO 824)

823) What (other) type of tobacco do you currently smoke or use?

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

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

YES 1
NO 2 (GO TO 901)

825) 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 Z

826) Can tuberculosis be cured?

YES 1
NO 2
DON'T KNOW 8

827) If a member of your family got tuberculosis, would you want others to know about it?

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

SECTION 9. ADULT MORTALITY

901) Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother, including those who are living with you, those living elsewhere and those who have died.

How many children did your mother give birth to, including you?

NUMBER OF BIRTHS TO NATURAL MOTHER ________

902) CHECK 901:

TWO OR MORE BIRTHS (GO TO 903)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 914)

903) How many of these births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS _________

904) What was the name given to your oldest (next oldest) brother or sister?

905) Is (NAME) male or female?

MALE 1
FEMALE 2

906) Is (NAME) still alive?

YES 1
NO 2 (GO TO 908)
DON'T KNOW 8

907) How old is (NAME)?

__

908) How many years ago did (NAME) die?

__

909) How old was (NAME) when he/she died? (IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO NEXT CHILD)

__

910) Was (NAME) pregnant when she died?

YES 1 (GO TO 913)
NO 2

911) Did (NAME) die during childbirth?

YES 1 (GO TO 913)
NO 2

912) Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2

913) Was (NAME)'s death due to an accident or violence?

YES 1
NO 2

IF NO MORE BROTHERS OR SISTERS, GO TO 914.

914) RECORD THE TIME.

HOURS ________
MINUTES ________

SECTION 10. ANAEMIA AND HIV TESTING

ANTHROPOMETRY

CONSENT FOR ANAEMIA AND HIV TESTS FOR NEVER-MARRIED YOUTH AGE 15-17

ASK CONSENT FOR THE ANAEMIA AND HIV TESTS. FOR NEVER-IN UNION RESPONDENTS AGE 15-17, YOU MUST FIRST OBTAIN THE CONSENT OF A PARENT OR OTHER ADULT RESPONSIBLE FOR THE YOUTH AT THE TIME OF YOUR VISIT.

1001) CHECK 105: AGE

AGE 15-17 (GO TO 1002)
AGE 18-49 (GO TO 1007)

1002) CHECK 401 AND 402: RESPONDENT NEVER-EVER MARRIED AND NEVER LIVED TOGETHER WITH A WOMAN.

CODE 3 IN BOTH QUESTIONS 401 AND 402 (GO TO 1003)
CODE 1 OR CODE 2 IN QUESTION 401 OR IN QUESTION 402 (GO TO 1007)

1003) CHECK HOUSEHOLD SCHEDULE (COLUMN 1) AND RECORD LINE NUMBER OF THE PARENT OR OTHER ADULT FROM WHOM CONSENT WILL BE REQUESTED.

IF PARENT OR OTHER RESPONSIBLE ADULT IS NOT A HOUSEHOLD MEMBER, WRITE '00'.

LINE NUMBER OF PARENT/OTHER ADULT ________

1004) READ THE ANAEMIA CONSENT STATEMENT TO THE PARENT OR ADULT RESPONSIBLE FOR THE CHILD.

As part of this survey, we are trying to find out more about anaemia, that is, low blood levels, in men, women, and children.

To know more about this problem in Zimbabwe, we are asking people in this survey all over the country to take a test. For the test, I will take a few drops of blood from (NAME OF ADOLESCENT'S) finger.

The test uses clean and completely safe equipment that is used only once and then thrown away. The blood will be tested with new equipment. The result will be given to (NAME) right after the test is done. We will not tell anyone else the results of the test.

Do you have any questions?

You can say yes or you can say no; it is up to you. If you say yes, it will help the country to develop programs to fight the problem of anaemia.

Do you agree that (NAME) may give blood for the anaemia test?

CIRCLE CODE AND SIGN.

FURTHER DISCUSS ANAEMIA TESTING PROCESS TO PUT RESPONDENT AT EASE.

CONSENT OF PARENT/OTHER ADULT FOR ANAEMIA TEST

CONSENTED (SIGN) ________ 1
REFUSED 2
PARENT/ADULT NOT PRESENT 8

1005) READ THE HIV CONSENT STATEMENT TO THE PARENT OR ADULT RESPONSIBLE FOR THE CHILD.

We are also asking people in this survey to help us find out how big the HIV problem is in Zimbabwe. We would like (NAME OF ADOLSCENT) to take part in the HIV test by allowing us to collect a few more drops of blood from his/her finger.

This blood will be tested later in the laboratory. We will not keep any name with the blood. Because there will be no name with the blood when it is tested, we will not be able to give (NAME) the result of the test and no one will be able to trace the test back to (NAME).

If (NAME) wants to know his/her HIV status, I can tell (NAME) where to GO TO get tested for HIV.

Do you have any questions?

You can say yes or you can say no; it is up to you. If you say yes, it will help the country to develop programs to fight the problem of HIV and AIDS.

Do you agree that (NAME) may give blood for the HIV test?

CIRCLE CODE AND SIGN.

FURTHER DISCUSS ANAEMIA TESTING PROCESS TO PUT RESPONDENT AT EASE.

CONSENT OF PARENT/OTHER ADULT FOR HIV TEST

CONSENT (SIGN) ________ 1
REFUSED 2 (GO TO 1007)
PARENT/ADULT NOT PRESENT 8 (GO TO 1007)

1006) READ THE BLOOD STORAGE CONSENT STATEMENT TO THE PARENT OR ADULT RESPONSIBLE FOR THE CHILD.

Some of the blood that (NAME) gives may be left after the HIV test. We would like to keep that blood at the laboratory to use for other tests later on.

Again, you can say yes or you can say no; it is up to you. If you say yes, it may help the country later on to develop programs to fight HIV/AIDS and other health problems.

Will you agree that we do other tests on (NAME'S) blood later?

CIRCLE CODE AND SIGN.

FURTHER DISCUSS STORAGE PROCESS TO PUT RESPONDENT AT EASE.

CONSENT OF PARENT/OTHER ADULT FOR STORAGE OF BLOOD

CONSENT (SIGN) ________ 1
REFUSED 2

RESPONDENT CONSENT FOR ANAEMIA AND HIV TESTS

ASK CONSENT FOR THE ANEMIA AND HIV TESTS FROM RESPONDENT. FOR NEVER-IN-UNION RESPONDENTS AGE 15-17, ASK FOR CONSENT ONLY IF PARENT OR OTHER ADULT RESPONSIBLE FOR THE YOUTH AT THE TIME OF YOUR VISIT HAS GRANTED CONSENT OR THE PARENT OF OTHER ADULT WAS NOT PRESENT.

1007) CHECK 1001 AND 1002: RESPONDENT'S AGE AND UNION STATUS

AGE 15-17 AND NEVER-IN-UNION (GO TO 1008)
OTHER (GO TO 1009)

1008) CHECK 1004: PARENTAL/ADULT CONSENT FOR ANEMIA TEST

CONSENT FOR ANAEMIA TEST OBTAINED FROM PARENT/OTHER ADULT RESPONSIBLE FOR ADOLESCENT (GO TO 1009)
PARENT/OTHER ADULT NOT PRESENT (GO TO 1009)
PARENT/OTHER ADULT REFUSED (GO TO 1010)

1009) READ THE ANAEMIA CONSENT STATEMENT TO THE RESPONDENT.

As part of this survey, we are trying to find out more about anaemia, that is, low blood levels in men, women, and children.

To know more about this problem in Zimbabwe, we are asking people in this survey all over the country to take a test. For the test, I will take a few drops of blood from your finger.

The test uses clean and completely safe equipment that is used only once and then thrown away. The blood will be tested with new equipment. The result will be given to you right after the test is done. We will not tell anyone else the results of the test.

Do you have any questions?

You can say yes or you can say no; it is up to you. If you say yes, it will help the country to develop programs to fight the problem of anaemia.

Do you agree to give blood for the anaemia test?

CIRCLE CODE AND SIGN.

FURTHER DISCUSS ANAEMIA TESTING PROCESS TO PUT RESPONDENT AT EASE.

CONSENT (SIGN) ________ 1
REFUSED 2

1010) CHECK 1001 AND 1002: RESPONDENT'S AGE AND UNION STATUS

AGE 15-17 AND NEVER-IN-UNION (GO TO 1011)
OTHER (GO TO 1012)

1011) CHECK 1005: PARENTAL/ADULT CONSENT FOR HIV TEST

CONSENT FOR HIV TEST OBTAINED FROM PARENT/OTHER ADULT RESPONSIBLE FOR ADOLESCENT (GO TO 1012)
PARENT/OTHER ADULT NOT PRESENT (GO TO 1012)
PARENT/OTHER ADULT REFUSED (GO TO 1014)

READ THE HIV CONSENT STATEMENT TO THE RESPONDENT.

We are also asking people in this survey to help us find out how big the HIV problem is in Zimbabwe. We would like you to take part in the HIV test by allowing us to collect a few more drops of blood from your finger.

This blood will be tested later in the laboratory. We will not keep any name with the blood. Because there will be no name with the blood when it is tested, we will not be able to give you the result of the test and no one will be able to trace the test back to you.

If you want to know your HIV status, I can tell you where to GO TO get tested for HIV.

Do you have any questions?

You can say yes or you can say no; it is up to you. If you say yes, it will help the country to develop programs to fight the problem of HIV and AIDS.

Do you agree to give blood for the HIV test?

CIRCLE CODE AND SIGN.

FURTHER DISCUSS HIV TESTING PROCESS TO PUT RESPONDENT AT EASE.

CONSENT (SIGN) ________ 1
REFUSED 2 (GO TO 1014)

1013) READ THE BLOOD STORAGE CONSENT STATEMENT TO THE RESPONDENT.

Some of the blood that you give may be left after the HIV test. We would like to keep that blood at the laboratory to use for other tests later on.

Again, you can say yes or you can say no; it is up to you. If you say yes, it may help the country later to develop programs to fight HIV/AIDS and other health problems.

Will you agree that we do other tests on your blood later?

CIRCLE CODE AND SIGN.

FURTHER DISCUSS BLOOD STORAGE TO PUT RESPONDENT AT EASE.

CONSENT (SIGN) ________ 1
REFUSED 2

1014) May I provide you with an informational brochure about voluntary HIV testing from the nearest facility offering VCT?

PROVIDE BROCHURE TO ALL RESPONDENTS WHO WANT IT.

ACCEPTED 1
REFUSED 2

1015) CHECK 1004, 1005, 1009 AND 1012 AND INDICATE THE TESTS FOR WHICH CONSENT HAS BEEN GRANTED.

IF BOTH REFUSED, COMPLETE QUESTIONS 1017 AND 1019.

CONSENTED TO BOTH 1
ANAEMIA TEST ONLY 2
HIV TEST ONLY 3
BOTH REFUSED 4

1016) FOR ALL RESPONDENTS WHERE CONSENT WAS OBTAINED, FOLLOW INSTRUCTIONS FOR PASTING THE BAR CODE LABELS AND TAKING THE DBS SPECIMEN.

PASTE FIRST LABEL HERE
PASTE SECOND LABEL ON FILTER PAPER
PASTE THIRD LABEL ON BLOOD TRANSMITTAL FORM.

1017) OUTCOME OF HIV TEST.

BLOOD SPECIMEN COLLECTED 1
REFUSED 2
ABSENT 3
TECHNICAL PROBLEM 4
OTHER (SPECIFY) ________ 6

1018) RECORD HEMOGLOBIN LEVEL

G/DL ________

1019) OUTCOME OF ANAEMIA TEST

BLOOD SPECIMEN COLLECTED 1
REFUSED 2 (GO TO 1022)
ABSENT 3 (GO TO 1022)
TECHNICAL PROBLEM 4 (GO TO 1022)
OTHER (SPECIFY) ________ 6 (GO TO 1022)

1020) CHECK 1018: THE CUTOFF POINT IS 9 G/DL.

HEMOGLOBIN LEVEL BELOW THE CUTOFF POINT: GIVE EACH MAN/PARENT/RESPONSIBLE ADULT RESULT OF HEMOGLOBIN MEASUREMENT AND CONTINUE WITH 1021.
HEMOGLOBIN LEVEL AT OR ABOVE CUTOFF: GIVE EACH MAN/PARENT/RESPONSIBLE ADULT RESULT OF HEMOGLOBIN MEASUREMENT AND PROCEED TO 1022.

1021) We detected a low level of hemoglobin in your blood. This indicates that you have developed severe anaemia, which is a serious health problem. We would like to inform the clinic at ________ about your condition. This will assist you in obtaining help.

AGREES TO REFERAL?

YES 1
NO 2

1022) THANK THE RESPONDENT.

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT THE RESPONDENT:

COMMENTS ON SPECIFIC QUESTIONS:

ANY OTHER COMMENTS:

SUPERVISOR'S OBERVATIONS

NAME OF THE SUPERVISOR:
DATE:

EDITOR'S OBSERVATIONS

NAME OF EDITOR:
DATE: