Demographic and health survey (EDSB-V-2017)
Man's Questionnaire
Republic of Benin
Ministry of Planning and Development
National institute of statistics and economic analysis (INSAE)
Department
Commune
Rural 2
Name of head of household
Cluster number
Household number
Name and line number of woman
Household selected for men's survey? (1=Yes, 2=No)
No 2
Interviewer's name
Result*
Final visit
Day
Month
Year 201
Int. number
Result
Next visit
Date
Time
Total no. of visits
2 Not at home
3 Postponed
4 Refused
5 Partly completed
6 Incapacitated
7 Other (specify)
Language of questionnaire 01
Language of interview
Native language of respondent
No 2
Language of questionnaire: French
Language codes:
02 Adja
03 Bariba
04 Fon
05 Dendi
06 Ditamari
07 Yorub
08 Other
Editor
Name
Number
Hello. My name is ___. I am working with the National Institute of Statistics and Economic Analysis (INSAE). We are conducting a survey about health all over Benin. 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 to 30 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?
Signature of interviewer Date
Respondent agrees to be interviewed 1
Respondent does not agree to be interviewed 2-End
Section 1. Respondent's background
No.
Questions and filters
Coding categories
Skip
Minutes
102) How long have you been living continuously in (Name of current city, town or village of residence)?
If less than one year, record 00 years
Always 95-skip to 105
Visitor 96-skip to 105
103) Just before you moved here, did you live in a city, in a town, or in a rural area?
Town 2
Rural area 3
Outside of Benin 4
104) Before you moved here, which (province/region/state) did you live in?
Atacora 02
Atlantique 03
Borgou 04
Collines 05
Couffo 06
Donga 07
Littoral 08
Mono 09
Oueme 10
Plateau 11
Zou 12
Outside of Benin 96
105) In what month and year were you born?
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.
30-64 years 2
106c) During this interview I would like to measure your blood pressure. I will do this three times during the interview. There is no danger to the procedure. We do it to know if a person has high blood pressure. If it isn't treated, high blood pressure can seriously hurt the heart.
I will give you the results of the blood pressure measurement after the interview and explain to you the meaning of the results. If you have high blood pressure, we recommend that you consult a health care facility or see a doctor because we cannot offer any treatment as part of the survey.
Do you have any questions to ask me about blood pressure measurement?
Date
No, respondent doesn't accept 2-skip to 107
106d) Before measuring your blood pressure, I would like to ask you some questions on things that could affect the measurements. Did you do any of the following things in the last 30 minutes:
No 2
No 2
No 2
No 2
106e) Look at the respondent's arm and take the appropriate armband to take blood pressure
106f) Take the blood pressure
Record the systolic and diastolic pressure
If you can't measure the respondent's blood pressure, record the reason.
Diastolic
Refused 994
Technical problems 995
Other 996
107) Have you ever attended school?
No 2- skip to 111
108) What is the highest level of school you attended: primary, secondary 1st cycle, secondary 2nd cycle, or higher?
Secondary 1st cycle 2
Secondary 2nd cycle 3
Higher 4
109) What is the highest grade you completed at this level?
If completed less than one year at that level, record 00.
Higher- skip to 113
111) 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?
Able to read only part of sentence 2
Able to read whole sentence 3
No card with required language (specify language) 4
Blind/visually impaired 5
Code 1 or 5 circled-skip to 114
113) Do you read a newspaper or magazine at least once a week, less than once a week or not at all?
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?
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?
Less than once a week 2
Not at all 3
116) Do you own a mobile telephone?
No 2-skip to 118
117) Do you use your mobile phone for any financial transactions?
No 2
118) Do you have an account in a bank or other financial institution that you yourself use?
No 2
119) Have you ever used the internet?
No 2-skip to 122
120) In the last 12 months, have you used the internet?
If necessary, probe for use from any location, with any device.
No 2-skip 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?
At least once a week 2
Less than once a week 3
Not at all 4
Other traditional 2
Islam 3
Catholic 4
Protestant Methodist 5
Other protestant 6
Celestial 7
Other Christian 8
Other religion 9
Other (specify) 10
Bariba and similar 2
Dendi and similar 3
Fon and similar 4
Yoa and Lokpa and similar 5
Betamaribe and similar 6
Peulh and similar 7
Yoruba and similar 8
Other Beninese (specify) 96
Other nationality (specify) 97
30-64 years 2
123c) Can I measure your blood pressure now?
Date
No, respondent did not accept 2-skip to 201
123d) Take blood pressure.
Record systolic and diastolic pressure.
If you cannot measure the respondent's blood pressure, record the reason.
Diastolic
Refused 994
Technical problems 995
Other 996
Codes for Q 108 and 109: Education
Level attainted
Class successfully achieved
Less than one year in C1=0
C1=1
CP=2
CE1=3
CE2=4
CM1=5
CM2=6
Don't know=8
Less than 1 year in 6th =0
6th=1
5th=2
4th=3
3rd=4
Don't know =8
Less than one year in 2nd=0
2nd=1
1st=2
Final=3
Don't know =8
Less than one year in 1st =0
1st year=1
2nd year=2
3rd year=3
4th year=4
Don't know 8
No.
Questions and filters
Coding categories
Skip
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?
No 2-skip to 206
Don't know 8-skip to 206
202) Do you have any sons or daughters that you have fathered who are now living with you?
No 2-skip to 204
203) How many sons live with you?
And how many daughters live with you?
If none, record '00'
Daughters at home_____
204) Do you have any sons or daughters that you have fathered who are alive but do not live with you?
No 2-skip 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, recode '00'
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, who made any movement, sound or effort to breathe, or who showed any other signs of life even if for a very short time?
No 2-skip to 208
Don't know 8-skip to 208
207) How many boys have died?
And how many girls have died?
If none, record '00'
Girls dead_____
208) Sum answers to 203, 205, and 207 and enter total.
If none, record 00.
Has only had one child-skip to 211
Has not had any children-skip to 301
210) Did all of the children you have fathered have the same biological mother?
No 2
211) Check 208:
Has had more than one child:
Has had only one child:
No living children-skip to 301
213) Check 203 and 205:
More than one living child:
Only one living child:
(Youngest) Child is age 3 years or older --skip to 301
215) Check 203 and 205:
More than one living child:
Only one living child:
216) When (name)'s mother was pregnant with (name), did she have any antenatal check-ups?
No 2-skip to 218
Don't know 8-skip to 218
217) Were you ever present during any of those antenatal check-ups?
Not present 2
218) Was (name) born in a hospital or a health facility?
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?
About the same 2
Less than usual 3
Nothing to drink 4
Don't know 8
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)?
Probe: Women can have an operation to avoid having any more children.
No 2
Probe: Men can have an operation to avoid having any more children.
No 2
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 months. [##translator note: the French original did, in fact, indicate this as months, not years]
No 2
Probe: Women can have an injection by a heath provider that stops them from becoming pregnant for one or more months.
No 2
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.
No 2
Probe: Women can take a pill every day to avoid becoming pregnant.
No 2
Probe: Men can put a rubber sheath on their penis before sexual intercourse.
No 2
Probe: Women can place a sheath in their vagina before sexual intercourse.
No 2
Probe: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
No 2
Probe: A woman uses 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.
No 2
Probe: Up to six months after childbirth, before the menstrual period has returned, women use a method requiring frequent breastfeeding day and night.
No 2
Probe: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
No 2
Probe: Men can be careful and pull out before climax.
No 2
(specify)
(specify)
No 2
302) In the last few months have you:
No 2
No 2
No 2
No 2
No 2
No 2
No 2
No 2
No 2
303) In the last few months, have you discussed family planning with a health worker or health professional?
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?
No 2-skip to 306
Don't know 8-skip 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?
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?
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 business and a man should not have to worry about it.
b) Women who use contraception may become promiscuous.
Disagree 2
Don't know 8
Section 4. Marriage and sexual activity
No.
Questions and filters
Coding categories
Skip
401) Are you currently married or living with a woman as if married?
Yes, living with a woman 2-skip to 404
No, not in union 3
402) Have you ever been married or lived together with a woman as if married?
Yes, lived with a woman 2
No 3-skip to 413
403) What is your marital status now: are you widowed, divorced, or separated?
Divorced 2
Separated 3
All skip to 410
404) Is your (wife/partner) living with you now or is she staying elsewhere?
Staying elsewhere 2
405) Do you have other wives or do you live with other women as if married?
No (only one) 2-skip to 407
406) Altogether, how many wives or live-in partners do you have?
407) Check 405:
One wife/partner:
Line number____
More than one wife/partner:
Line number____
Record the name and the line number from the household questionnaire for each wife and life-in partner.
If a woman is not listed in the household, record 00.
Ask 408 for each person.
408) Ask 408 for each person.
How old was (name) on her last birthday?
More than one wife/partner-skip to 411
410) Have you been married or lived with a woman only once or more than once?
More than once 2
411) Check 405 and 410:
Both are code 2:
Don't know month 98
Year-skip to 413
Don't know year 9998
Other:
Don't know month 98
Year-skip to 413
Don't know year 9998
412) How old were you when you started living with her?
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 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 when you had sexual intercourse for the very first time?
Age in years
First time when started living with (first) wife/partner 95
415) Now I would like to ask you some questions 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 recorded in years.
Weeks ago 2-skip to 417
Months ago 3-skip to 417
Years ago 4-skip to 427
Last sexual partner
Second-to-last sexual partner
Third-to-last sexual partner
416) When was the last time you had sexual intercourse with this person?
Weeks ago 2
Months ago 3
417) The last time you had sexual intercourse this person, was a condom used?
No 2-skip to 419
418) Was a condom used every time you had sexual intercourse with this person in the last 12 months?
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, circle 2
If no, circle 3
Live-in partner 2
Girlfriend not living with respondent 3
Casual acquaintance 4
Client/Sex worker 5
Other (specify) 6
420) How long ago did you first have sexual intercourse with this person?
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-numeric answer, probe to get an estimate. If number of partner is 95 or more, record 95.
Don't know 98
423) Apart from this person, have you had sexual intercourse with any other person in the last 12 months?
No 2-(Skip to 426)
424) 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 95 or more, write 95
Don't know 98
No partners are sex workers-skip to 427
426) Check 419 and 417 (all columns)
Condom used with every sex worker-skip to 431
427) In the last 12 months, did you pay anyone in exchange for having sexual intercourse?
No 2
428) Have you ever paid anyone in exchange for having sexual intercourse?
No 2-skip to 431
429) The last time you paid someone in exchange for having sexual intercourse, was a condom used?
No 2-skip 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?
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?
No 2
432) Have you ever given any gift or other goods in order to have sex or to become sexually involved with anyone?
No 2
433) In total, with how many different people have you had sexual intercourse in your life?
If non-numeric number, probe to get an estimate
If the number if more than 95, write '95'
Don't know 98
434) Check 417, most recent partner (first column):
Not asked-skip to 438
No condom used-skip 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 you used at that time?
If brand not known, ask to see the package.
Cool 02
No Logo 03
Other (specify) 96
Don't know 98
436) From where did you obtain the condom the last time?
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)
Govt. Health Center 12
Mobile clinic 13
Fieldworker 14
Other public sector (specify) 16
Pharmacy 22
Private doctor 23
Mobile clinic 24
Religious hospital 25
Other private medical (specify) 26
Other source
Shop 41
Church 42
Friend/relative 43
Other (specify) 96
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?
No 2-skip to 440
Don't know 8-skip to 440
438) The last time you had sex did you or your partner use any method to avoid or prevent a pregnancy?
No 2-skip to 440
Don't know 8-skip 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.
Male sterilization B
IUD C
Injectables D
Implants E
Pill F
Female condom G
Emergency contraception I
Standard days method J
Lactational Amen. Method K
Rhythm method L
Withdrawal M
Other modern method X
Other traditional method Y
All skip to 501
440) Do you know of a place where you can obtain a method of family planning?
No 2
Section 5. Fertility preferences
No.
Questions and filters
Coding Categories
Skip
Not currently married and not living with a partner-skip to 514
Man sterilized-skip to 514
More than one wife/partners-skip to 509
504) Is your (wife/partner) currently pregnant?
No 2-skip to 507
Don't Know 8-skip 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 another child, or would you prefer not have any more children?
No more 2-skip to 514
Undecided/don't know 8-skip to 514
506) After the birth of the child you are expecting now, how long would you wait before the birth of another child?
Years 2
Soon/now 993
Other (specify) 996
Don't know 998
All skip to 514
507) Check 208:
Has fathered children:
No more/none 2-skip to 514
Says couple can't get pregnant 3-skip to 514
Wife/partner sterilized 4-skip to 514
Undecided/don't know 8-skip to 514
Has not fathered children:
No more/none 2-skip to 514
Says couple can't get pregnant 3-skip to 514
Wife/partner sterilized 4-skip to 514
Undecided/don't know 8-skip to 514
508) Check 208:
Has fathered children:
Years 2
Soon/now 993
Says couple can't get pregnant 994
Other (specify) 996
Don't know 998
All skip to 514
Has not fathered children:
Years 2
Soon/now 993
Says couple can't get pregnant 994
Other (specify) 996
Don't know 998
All skip to 514
509) Are any of your (wives/partners) currently pregnant?
No 2-skip to 512
Don't know 8-skip 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 have any more children?
No more 2-skip to 514
Undecided/don't know 8-skip 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?
Years 2
Soon/now 993
Other (specify) 996
Don't know 998
All skip to 514
512) Check 208:
Has fathered children:
No more/none 2-skip to 514
Says couple can't get pregnant 3-skip to 514
Wife (wives)/partner(s) sterilized 4-skip to 514
Undecided/don't know 8-skip to 514
Has not fathered children:
No more/none 2-skip to 514
Says couple can't get pregnant 3-skip to 514
Wife (wives)/partner(s) sterilized 4-skip to 514
Undecided/don't know 8-skip to 514
513) Check 208:
Has fathered children:
Years 2
Soon/now 993
Says couple can't get pregnant 994
Other (specify) 996
Don't know 998
Has not fathered children:
Years 2
Soon/now 993
Says couple can't get pregnant 994
Other (specify) 996
Don't know 998
514) Check 203 and 205:
Has living children:
Number
Other (specify) 96-skip to 601
No living children:
Probe for a numeric response.
Number
Other (specify) 96-skip 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 if it's a boy or a girl?
Number Girls ____
Number Either____
Other (specify) 96
Section 6. Employment and gender roles
No.
Questions and filters
Coding categories
Skip
601) Have you done any work in the last seven days?
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 vacation, illness, maternity, or any other such reason?
No 2
603) Have you done any work in the last 12 months?
No 2-skip 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?
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 and kind 2
In kind only 3
Not paid 4
Not currently married and not living with a partner-skip to 612
Other --skip 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?
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?
Wife/partner 2
Respondent and wife/partner jointly 3
Someone else 4
Other (specify) 6
611) Who usually makes decisions about making major household purchases?
Wife/partner 2
Respondent and wife/partner jointly 3
Someone else 4
Other (specify) 6
612) Do you own this or any other house either alone or jointly with someone else?
Jointly only 2
Both alone and jointly 3
Does not own 4-skip to 615
613) Do you have a title deed for any house you own?
No 2-skip to 615
Don't know 8-skip to 615
614) Is your name on the title deed?
No 2
Don't know 8
615) Do you own any agricultural or non-agricultural land either alone or jointly with someone else?
Jointly only 2
Both alone and jointly 3
Does not own 4-skip to 618
616) Do you have a title deed for any land you own?
No 2-skip to 618
Don't know 8-skip to 618
617) Is your name on the title deed?
No 2
Don't know 8
618) In your opinion, is a husband justified in hitting or beating his wife in the following situations:
No 2
DK 8
No 2
DK 8
No 2
DK 8
No 2
DK 8
No 2
DK 8
Section 7. HIV/AIDS
No.
Questions and filters
Coding categories
Skip
701) Now I would like to talk about something else.
Have you ever heard of an HIV or AIDS?
No 2-skip to 727
702) HIV is the virus that can lead to AIDS. Can people reduce their chance of getting the AIDS virus by having just one uninfected sex partner who has no other sex partners?
No 2
Don't know 8
703) Can people get the AIDS virus from mosquito bites?
No 2
Don't know 8
704) Can people reduce their chance of getting HIV by using a condom every time they have sex?
No 2
Don't know 8
705) Can people get HIV by sharing food with a person who has AIDS?
No 2
Don't know 8
706) Can people get HIV because of witchcraft or other supernatural means?
No 2
Don't know 8
707) Is it possible for a healthy-looking person to have HIV?
No 2
Don't know 8
708) Can the virus that causes HIV be transmitted from a mother to a child?
No 2
Don't Know 8
No 2
Don't Know 8
No 2
Don't Know 8
Other-skip 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?
No 2
DK 8
711) Check for the 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 for HIV?
No 2-skip to 716
713) How many months ago was your most recent HIV text?
Two or more years 95
714) I don't want to know the results, but did you get the results of the test?
No 2
Probe to identify the type of source and circle the appropriate code.
Govt. Health Center 12
Stand-Alone HTC Center 13
Family planning clinic 14
Mobile HTC Services 15
Other public sector (specify) 16
Stand-Alone HTC Center 22
Pharmacy 23
Mobile HTC Services 24
Other private medical (specify) 26
Workplace 32
Correctional facility 33
Other (specify) 96
All skip to 718
716) Do you know of a place where people can go to get an HIV test?
No 2-skip to 718
717) Where is that?
Any other place?
Probe to identify the type of source and circle the appropriate code.
If unable to determine if public or private sector, write the name of the place
(Name of place)
Govt. Health Center B
Stand-Alone HTC Center C
Family planning clinic D
Mobile HTC Services E
Other public sector (specify) F
Stand-Alone HTC Center H
Pharmacy I
Mobile HTC Services J
Other private medical (specify) K
Other (specify) X
718) Have you ever heard of test kits people can use to test themselves for HIV?
No 2-skip to 720
719) Have you ever tested yourself for HIV using a self-testing kit?
No 2
720) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?
No 2
Don't know/not sure/it depends 8
721) Do you think children living with HIV should be allowed to attend school with children who do not have HIV?
No 2
DK/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 if the test results is positive for HIV?
No 2
DK/Not sure/Depends 8
723) Do people talk badly about people living with HIV, or who are thought to be living with HIV?
No 2
DK/Not sure/Depends 8
724) Do people living with HIV, or thought to be living with HIV, lose the respect of other people?
No 2
DK/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.
Disagree 2
DK/Not sure/Depends 8
726) Do you fear that you could get HIV if you come into contact with the saliva of a person living with HIV?
No 2
Says he has HIV 3
DK/Not sure/Depends 8
727) Check 701:
Heard about HIV or AIDS- Apart from HIV, have you heard about other infections that can be transmitted through sexual contact?
Not heard about HIV or AIDS- Have you heard about infections that can be transmitted through sexual contact?
No 2
Has not had sexual intercourse-skip to 736
729) Check 727: Heard about other sexually transmitted infections?
No-skip 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?
No 2
Don't know 8
731) Sometimes men experience an abnormal discharge from their penis. During the last 12 months, have you had an abnormal discharge from your penis?
No 2
Don't know 8
732) Sometimes men have a sore or ulcer near their penis. During the last 12 months, have you had a sore or ulcer near your penis?
No 2
Don't know 8
Has not had an infection or does not know --skip to 736
734) The last time you had (infection from 730/731/732), did you seek any kind of advice or treatment?
No 2-skip to 736
735) Where did you go?
Any other place?
Probe to identify the type of source and circle the appropriate code.
If unable to determine if public or private sector, write the name of the place
(Name of place(s))
Govt. Health Center B
Stand-Alone HTC Center C
Family planning clinic D
Mobile HTC Services E
Other public sector (specify) F
Stand-Alone HTC Center H
Pharmacy I
Mobile HTC Services J
Other private medical (specify) K
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?
No 2
Don't know 8
737) Is a wife justified in refusing to have sex with her husband when she knows her husband has sex with a woman other than his wives?
No 2
Don't know 8
Section 8. Other health issues
No.
Questions and filters
Coding categories
Skip
801) Some men are circumcised, that is, the foreskin is completely removed from the penis. Are you circumcised?
No 2-skip to 805
Don't know 8-skip to 805
802) How old were you when you got circumcised?
During childhood (Under 5 years) 95
Don't know 98
803) Who did the circumcision?
Health worker/professional 2
Other 3
Don't know 8
Home of a health worker/professional 2
Circumcision done at home 3
Ritual site 4
Other home/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-numeric answer, probe to get an estimate.
None 00-skip to 808
806) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or another healthcare worker?
If the number of injections is over 90 or daily for 3 months or more, record 90.
If the response is not numeric, probe to obtain an estimate.
None-00-skip to 808
807) The last time you got an injection from a health worker, did he/she take the syringe and needle form a new, unopened package?
No 2
Don't know 8
808) Do you currently smoke tobacco every day, some days, or not at all?
Some says 2
Not at all 3-skip to 810
809) In the past, have you smoked tobacco every day?
No 2-skip to 812
810) In the past, have you ever smoked tobacco every day, some days, or not at all?
Some says 2-skip to 813
Not at all 3-skip 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.
If respondent report using the product but not every day, record "888." If the product is not used at all, record "000."
All skip 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 report using the product but not every week, record "888." If the product is not used at all, record "000."
813) Do you currently use smokeless tobacco every day, some days, or not at all?
Some days 2-skip to 815
Not at all 3-skip to 816
814) On average, how many of the following products do you currently use each day? Also, let me know if you use the product, but not every day.
If respondent report using the product but not every day, record "888." If the product is not used at all, record "000."
All skip to 816
815) On average, how many of the following products do you currently use each week? Also, let me know if you use the product, but not every week.
If respondent report using the product but not every week, record "888." If the product is not used at all, record "000."
816) Are you covered by any health insurance?
No 2-skip to 817a
817) What type of health insurance are you covered by?
Record all mentioned
Health insurance through employer B
Social security C
Other privately purchased commercial health insurance D
Other (specify) X
817a) Is there are charge for the caring of children under 5 with malaria in Benin?
No, does not need to be paid 2
Don't know 8
817b) Do women have to pay for a cesarean in Benin?
No, does not need to be paid 2
Don't know 8
30-64 years 2
817c) Can I measure your blood pressure now?
Date
No, respondent did not accept 2-skip to 943
817d) Take blood pressure
Record systolic and diastolic pressure
If you cannot measure the respondent's blood pressure, record the reason
Diastolic
Refused 994
Technical problems 995
Other 996
All skip to 901
Section 9. Non-communicable diseases for women's questionnaire
No.
Questions and filters
Coding categories
Skip to
901) Has a doctor or other health care professional taken your blood pressure?
No 2
Don't know 8
902) Has a doctor or other health care professional told you that you have elevated or high blood pressures?
No 2-skip to 906
903) In the last 12 months, has a doctor or other health care professional that you have elevated or high blood pressure?
No 2
904) Has a doctor or other health care professional prescribed drugs to control your blood pressure?
No 2
905) Are you currently taking drugs to control your blood pressure?
No 2
906) Has a doctor or other health care professional measured the level of sugar in your blood?
No 2
Don't know 8
907) Has a doctor or other health care professional told you that you have high levels of sugar in your blood, or that you have diabetes?
No 2-skip to 911
908) In the last 12 months, has a doctor or other health care professional told you that you have high levels of sugar in your blood, or that you have diabetes?
No 2
909) Has a doctor or other health care professional prescribed drugs to control the levels of sugar in your blood or to control diabetes?
No 2
910) Are you currently taking drugs to control the level of sugar in your blood or to control diabetes?
No 2
911) Has a doctor or other health care professional told you that you have heart disease or a chronic heart problem?
No 2 --skip to 913
912) Are you currently in treatment for heart disease or a chronic heart problem?
No 2
913) Has a doctor or other health care professional told you that you have a pulmonary illness or a chronic pulmonary problem like asthma?
No 2 --skip to 915
914) Are you currently undergoing treatment for a pulmonary illness or a chronic pulmonary problem?
No 2
915) Has a doctor or other health care professional told you that you have cancer or a tumor?
No 2 --skip to 917
916) Are you currently undergoing treatment for cancer or a tumor?
No 2
917) Has a doctor or other health care professional told you have depression?
No 2 --skip to 919
918) Are you currently undergoing treatment for depression?
No 2
919) Has a doctor or other health care professional told you that have arthritis?
No 2 --skip to 921
920) Are you currently undergoing treatment for arthritis?
No 2
921) Has a doctor or other health care professional told you that you have another chronic illness, meaning an illness that lasts a long time?
(Specify chronic illness)
No 2 --skip to 931
922) Are you currently undergoing treatment for (chronic illness from 921)?
No 2
Systolic and diastolic blood pressure not recorded in Q123D and 817D-skip to 937
932) Record and calculate the average systolic and diastolic blood pressure from Q123D and 817D.
933) Blood pressure measurement from Q123D
Diastolic
934) Blood pressure measurement form 817D
Diastolic
Diastolic total
Average diastolic
Skip to 941
Systolic and diastolic blood pressure recorded in Q 123d --skip to 940
Systolic and diastolic blood pressure recorded in Q 817D-skip to 940
Systolic and diastolic blood pressure not recorded in Q 106f --skip to 943
940) Record the systolic and diastolic blood pressure
Diastolic
941) Use the table below to determine the correct code to record the report on blood pressure and the reference form.
Circle the line where you find the value of the systolic pressure from Q936 or Q940.
Next, circle the column with the value of the diastolic pressure from Q936 or Q940.
The value found at the intersection of the line and the column circled in the table should be used to compete Q942.
130-139
140-159
160-179
180-209
?210
85-89
90-99
100-109
110-119
?120
942) In the table below, record the number that you circled in Q941. Next use the instructions to the right of this number to complete the report on blood pressure and the reference form for the respondent. Give the respondent the formula and answer any questions.
Category of blood pressure for respondent/Consult a health care professional to check blood pressure in:
2/slightly higher than normal/12 months
3/higher than normal/2 months
4/moderately high/1 month
5/very high/7 days
6/extremely high/today
Minutes
Interviewer's observations
To be filled in after completing interview
Comments about respondent:
Comments on specific questions:
Any other comments:
Supervisor's observations
Editor's observations