CENTRAL STATISTICS ORGANIZATION AND MINISTRY OF PUBLIC HEALTH

IDENTIFICATION

PROVINCE

DISTRICT

VILLAGE/NAHIA

CONTROLLER AREA

CLUSTER NUMBER

TYPE OF LOCATION

STRUCTURE/BUILDING NUMBER/GATE NUMBER

HOUSEHOLD NUMBER

NAME OF HOUSEHOLD HEAD

NAME AND LINE NUMBER OF MAN

INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT

NEXT VISIT
DATE
TIME

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT

NEXT VISIT
DATE
TIME

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT

FINAL VISIT
DAY
MONTH
YEAR
INT. NO.
RESULT

TOTAL NUMBER OF VISITS

LANGUAGE OF INTERVIEW

NATIVE LANGUAGE OF RESPONDENT

TRANSLATOR USED?

SUPERVISOR
NAME

FIELD EDITOR
NAME

OFFICE EDITOR
NAME

KEYED BY
NAME

SECTION 1. RESPONDENT'S BACKGROUND

INFORMED CONSENT

As-salamu alaykum. My name is _______________________________________. I am working with Central Statistics Organization. We are conducting a survey about health all over Afghanistan, which is conducted with the joint effort of the Ministry of Public Health and Central Statistics Organization. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 20 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 questions? May I begin the interview now?

SIGNATURE OF INTERVIEWER:________________________
DATE:__________

101. RECORD THE TIME.

102. In what month and year were you born?

103. How old were you at your last birthday?
COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT.

104. Have you ever attended school?

104A. What type of school have you attended?

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

106. What is the highest grade you completed?

IF COMPLETED LESS THAN GRADE ONE, RECORD '00'.

107. CHECK 105

108. 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?

109. CHECK 108:

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

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

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

113. To which ethnic group do you belong?

SECTION 2. REPRODUCTION

201. Now I would like to ask about any children you have had during your life. I am interested in all of the children that are biologically yours, even if they are not legally yours or do not have your last name.

Have you ever fathered any children with any woman?

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

203. How many sons live with you?

And how many daughters live with you?

IF NONE, RECORD '00'.

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

205. How many sons are alive but do not live with you?

And how many daughters are alive but do not live with you?

IF NONE, RECORD '00'.

206. Have you ever fathered a son or a daughter who was born alive but later died?

IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

207. How many boys have died?

And how many girls have died?

IF NONE, RECORD '00'.

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

209. CHECK 208:

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

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

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

213. CHECK 203 AND 205:

214. How old is your (youngest) child?

215. CHECK 214:

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

WRITE NAME OF (YOUNGEST) CHILD

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

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

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

220. 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?

SECTION 3. CONTRACEPTION

301. Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.

Have you ever heard of (METHOD)?

302. In the last few months have you:

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

304. Now I would liek 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?

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

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

307. CHECK 301 (07): KNOWS MALE CONDOM

308. Do you know where a person can get male condoms?

309. Where is that? Any other place?

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

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

SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

401. What is your current marital status: are you married, widowed, divorced, or separated?

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

405. Do you have other wives?

406. Altogether, how many wives do you have?

407. CHECK 405:

ONE WIFE: Please tell me the name of your wife.
MORE THAN ONE WIFE: Please tell me the name of each of your wives.

RECORD THE NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE.

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

408. How old was (NAME) on her last birthday? ASK 408 FOR EACH PERSON.

409. CHECK 407:

410. Have you been married only once or more than once?

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

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

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

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

414. Now I would like to ask some questions about sexual activity in order to gain a better understanding of some important life issues.

How old were you when you had sexual intercourse for the very first time?

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

416. When was the last time you had sexual intercourse?

IF LESS THAN 12 MONTHS, ANSER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS.
IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUS BE RECORDED IN YEARS.

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

436. What is the brand name of the condom used at the time?

IF BRAND NOT KNOWN, ASK TO SEE THE PACKAGE.

437. From where did you obtain the condom the last time?

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

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

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.

SECTION 5. FERTILITY PREFERENCES

501. CHECK 401:

502. CHECK 439:

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

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

505. 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?

506. CHECK 407:

507. CHECK 503:

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

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

(GO TO 509)

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

509. CHECK 203 AND 205:

HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?

NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be?

PROBE FOR A NUMERIC RESPONSE.

510. 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 if it's a boy or a girl?

SECTION 6. EMPLOYMENT AND GENDER ROLES

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

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

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

604. What is you 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?

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

607. CHECK 401:

608. CHECK 606:

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

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

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

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

613. Do you own any land either alone or jointly with someone else?

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

SECTION 7. HIV/AIDS

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

702. Can people reduce their chance of getting HIV by having just one uninfected sex partner who has no other sex partners?

703. Can people get HIV from mosquito bites?

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

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

706. Can people get HIV becasue of witchcraft or other supernatural means?

707. Is it possible for a health-looking person to have HIV?

708. Can HIV be transmitted from a mother to her baby:

709. CHECK 708:

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?

710A. From where did you hear or get information about HIV/AIDS? Any other source?

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

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

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

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

715. Where was the test done?

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

(GO TO 718)

716. Do you know of a place where people can go to get tested for HIV?

717. Where is that? Any other place?

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

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

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

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

721. In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in a school?

722. Should children age 12-14 be taught about using a condom to avoid getting AIDS?

723. CHECK 701:

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

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

724. CHECK 414:

725. CHECK 723: HEARD ABOUT SEXUALLY TRANSMITTED INFECTIONS?

726. 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?

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

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

729. CHECK 726, 727, AND 728:

730. The last time you had (PROBLEM FROM 726/727/728), did you seek any kind of advice or treatment?

731. Where did you go? Any other place?

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

732. If a wife know 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?

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

SECTION 8. OTHER HEALTH ISSUES

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

802. How old were you when you got circumcised?

803. Who did the circumcision?

804. Where was it done?

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-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

806. Among these injections, how many were administered by a doctor, a nurse, a pharmacisit, 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-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

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?

808. Do you currently smoke cigarettes?

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

810. Do you currently smoke or use any (other) type of tobacco?

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

811A. Do you currently use drugs?

811B. What type of drugs do you currently use? RECORD ALL MENTIONED.

811C. Have you ever heard of an illness called tuberculosis or TB?

811D. How does tuberculosis spread from one person to another?

PROBE: Any other ways? [CIRCLE ALL MENTIONED]

811E. Can tuberculosis be cured?

811F. Have you ever been told by a doctor or nurse that you have/had tuberculosis?

811G. Have you ever heard of an illness called Hepatitis?

811H. Is there anything a person can do to avoid getting Hepatitis?

811I. What can a person do to avoid getting Hepatitis?

PROBE: Any other ways? [CIRCLE ALL MENTIONED]

811J. Have you ever been told by a doctor or nurse that you have/had Hepatitis?

811K. What type of Hepatitis were you diagnosed with?

811L. Are you currently suffering from Hepatitis?

811M. What type of Hepatitis are you currently suffering from?

812. Are you covered by any health insurance?

813. What type of health insurance are you covered by? RECORD ALL MENTIONED.

814. RECORD THE TIME.