MEN'S QUESTIONNAIRE
PLACE NAME______________
REGION ____________
EA NUMBER ____________
STRUCTURE NUMBER _____________
HOUSEHOLD NUMBER _______________
WOMEN'S QUESTIONNAIRE 2
NAME AND LINE NUMBER OF RESPONDENT______________
MEDIUM CITY 2
SMALL CITY 3
TOWN 4
VILLAGE 5
INTERVIEW 1
DATE ____
INTERVIEWER'S NAME ____
RESULT*____
NEXT VISIT:
DATE ____
TIME ____
INTERVIEW 2
DATE ____
INTERVIEWER'S NAME ____
RESULT* _____
NEXT VISIT:
DATE ____
TIME ____
INTERVIEW 3
DATE ___
INTERVIEWER'S NAME ____
RESULT* ___
FINAL VISIT
DAY ____
MONTH ____
YEAR 19___
NAME _____
RESULT ____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED (SPECIFY) 5
INCAPACITATED 6
OTHER (SPECIFY) ______ 7
LANGUAGE OF QUESTIONNAIRE** ___
NATIVE LANGUAGE OF RESPONDENT** ___
AKAN 2
GA 3
EWE 4
HAUSA 5
DAGBANI 6
OTHER (SPECIFY) _____ 7
NO 2
SUPERVISOR ____
NAME _____
DATE _____
FIELD EDITOR ____
NAME _____
DATE _____
OFFICE EDITOR ___
KEYED BY___
SECTION M1. RESPONDENT'S BACKGROUND
MINUTES ___
M102. First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a city, in a town, or in a village?
TOWN 2
VILLAGE 3
M103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN ONE YEAR ENTER '00'.
ALWAYS (SINCE BIRTH) 95 (SKIP TO M105)
VISITOR 96 (SKIP TO M105)
M104. Just before you moved here, did you live in a city, in a town, or in a village?
TOWN 2
VILLAGE 3
M105. In what month and year were you born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 98
M106. How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.
M107. Have you ever attended school?
NO 2 (SKIP TO M111)
M108. What is the highest level of school you attended: primary, middle/jss, secondary/sss, or higher?
MIDDLE/JSS 2
SECONDARY/SSS 3
HIGHER 4
M109. What is the highest grade you completed at that level?
SECONDARY/SSS AND HIGHER ___ (SKIP TO M112)
M111. Can you read and understand a letter or newspaper easily, with difficulty, or not at all?
WITH DIFFICULTY 2
NOT AT ALL 3 (SKIP TO 113)
M112. Do you usually read a newspaper or magazine at least once a week?
NO 2
M113. Do you usually listen to a radio every day?
NO 2
M114. Do you usually watch television at least once a week?
NO 2
ANGLICAN 02
METHODIST 03
PRESBYTERIAN 04
SPIRITUALIST 05
OTHER CHRISTIAN 06
MOSLEM 07
TRADITIONAL 08
NO RELIGION 09
OTHER (SPECIFY) ___ 96
M116. To which ethnic group do you belong?
AKWAPIM 02
FANTE 03
OTHER AKAN 04
GA/ADANGBE 05
EWE 06
GUAN 07
MOLE-DAGBANI 08
GRUSSI 09
GRUMA 10
HAUSA 11
OTHER (SPECIFY) ____ 96
M117. What is your occupation, that is, what kind of work do you mainly do?
_______
_______
DOES (DID) NOT OWRK IN AGRICULTURE ___ (SKIP TO M120)
M119. Do you work mainly on your own land or on family land, or do you rent land,
or do you work on someone else's land?
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
M120. Do you do this work for a member of your family, for someone else, or are you self-employed?
SOMEONE ELSE 2
SELF-EMPLOYED 3
M121. 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
M122. During the last 12 months, how many months did you work?
M123. How much do you usually earn for this work?
PROBE: Is this by the day, by the week, or by the month?
PER DAY 2 _____
PER WEEK 3 _____
PER MONTH ____
PER YEAR 5 ____
OTHER (SPECIFY) _____ 9999996
M202. Do you have any sons or daughters whom you have fathered who are living with you?
NO 2 (SKIP TO M204)
M203. How many sons live with you?
And how many daughters live with you?
IF NONE, RECORD '00'.
DAUGHTERS AT HOME ___
M204. Do you have any sons or daughters whom you have fathered who are alive but do not live with you?
NO 2 (SKIP TO M206)
M205. 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'.
DAUGHTERS ELSEWHERE ___
M206. Have you ever fathered a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few hours or days?
NO 2 (SKIP TO M208)
M207. How many boys have died? And how many girls have died?
IF NONE, RECORD '00'.
GIRLS DEAD ___
M208. SUM ANSWERS TO M203, M205, M207, AND ENTER TOTAL.
IF NONE, RECORD '00'.
M209. Just to make sure that I have this right: you have had in TOTAL______ children during your life. Is that correct?
NO __ (PROBE AND CORRECT M202-M207 AS NECESSARY.)
HAS NEVER HAD CHILDREN __ (SKIP TO M301)
M211. In what month and year was your last child born?
YEAR 19___
LAST CHILD BORN BEFORE JANUARY 1993 ___ (SKIP TO M301)
M213. When you were expecting your lastborn child, did you want to have the child then, did you want to wait until later, or did you not want to have any (more) children at all?
LATER 2
NOT AT ALL 3
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 M301 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN COLUMN M301, 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 M301, ASK M302 AND M303.
M301. Which ways or methods have you heard about?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
M302. Have you and your husband/partner ever used (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 1
M303. Do you know where a person could go to get (method)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
AT LEAST ONE "YES" (EVER USED) ___ (SKIP TO M307)
M305. Have you or your wife/partner ever used anything or tried in any way to delay or avoid having a child?
NO 2 (SKIP TO M310)
M306. What have you used or done?
CORRECT M302 AND M303 (AND M301 IF NECESSARY).
M307. Now I would like to ask you about the first time that you did something or used a method to avoid having a child. How many living children did you have at that time, if any?
IF NONE, RECORD '00'
.
MAN STERILIZED__ (SKIP TO M311A)
M309. Are you or your wife/partner currently doing something or using any method to delay or avoid having a child?
NO 2
M310. What is the main reason you are not using a method of contraception to avoid pregnancy?
INFREQUENT SEX 22 (SKIP TO M312)
MENOPAUSAL/HYSTERECTOMY 23 (SKIP TO M312)
SUBFECUND/INFECUND 24 (SKIP TO M312)
POSTPARTUM/BREASTFEEDING 25 (SKIP TO M312)
WANTS (MORE) CHILDREN 26 (SKIP TO M312)
WIFE PREGNANT 27 (SKIP TO M312)
HUSBAND OPPOSED 32 (SKIP TO M312)
OTHERS OPPOSED 33 (SKIP TO M312)
RELIGIOUS PROHIBITION 34 (SKIP TO M312)
KNOWS NO SOURCE 42 (SKIP TO M312)
FEAR OF SIDE EFFECTS 52 (SKIP TO M312)
LACK OF ACCESS/TOO FAR 53 (SKIP TO M312)
COST TOO MUCH 54 (SKIP TO M312)
INCONVENIENT TO USE 55 (SKIP TO M312)
INTERFERES WITH BODY'S NATURAL PROCESS 56 (SKIP TO M312)
DON'T KNOW 98 (SKIP TO M312)
M311. Which method are you using?
M311A. CIRCLE '08' FOR MALE STERILIZATION.
IUD 02
INJECTIONS 03
NORPLANT 04
DIAPHRAGM/FOAM/JELLY 05
CONDOM 06
FEMALE STERILIZATION 07
MALE STERILIZATION 08
PERIODIC ABSTINENCE 09
WITHDRAWAL 10
LACTATIONAL AMENORRHEA METHOD 11
OTHER (SPECIFY) _____ 96
M312. Have you used a condom in the last four weeks?
NO 2 (SKIP TO M401)
M313. What is the brand name of the condom you last used?
RECORD NAME OF BRAND.
NO BRAND NAME 95
DON'T KNOW 96
M314. How much did a pack of condoms cost you the last time you got them?
PARTNER OBTAINED IT 9991
FREE 9992
OTHER 9996
DON'T KNOW 9998
M315. How many condoms were in the pack the last time you got them?
DON'T KNOW 98
M316. Do you use more condoms now than a year ago, about the same number, or fewer?
SAME 2 (SKIP TO M401)
FEWER 3 (SKIP TO M41)
M317. What is the main reason you use more condoms now than a year ago?
FEAR OF GETTING OTHER STDS 2
FAMILY PLANNING 3
LESS EXPENSIVE NOW 4
MORE AVAILABLE NOW 5
INCREASED SEXUAL ACTIVITY 7
OTHER (SPECIFY) ____ 6
DON'T KNOW 8
M401. PRESENCE OF OTHERS AT THIS POINT.
NO 2
NO 2
NO 2
NO 2
M402. Are you currently married or living with a woman?
YES, LIVING WITH A WOMAN 2 (SKIP TO M402B)
NO, NOT IN UNION 3 (SKIP TO M403)
M402A. How many wives do you have?
M402B. How many women are you living with as if you are married?
M402C. WRITE THE LINE NUMBERS FROM THE HOUSEHOLD QUESTIONNAIRE FOR HIS WIFE/WIVES.
IF A WIFE DOES NOT LIVE IN THE HOUSEHOLD, WRITE '00'.
THE NUMBER OF BOXES FILLED MUST EQUAL THE NUMBER OF WIVES.
M403. Do you currently have a regular sexual partner, an occasional sexual partner, or no sexual partner at all?
OCCASIONAL SEXUAL PARTNER 2
NO SEXUAL PARTNER 3
M404. Have you ever been married or lived with a woman?
YES, LIVED WITH A WOMAN 2 (SKIP TO M406)
NO 3 (SKIP TO M410)
M405. What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2
SEPARATED 3
M406. Have you been married or lived with a woman only once, or more than once?
MORE THAN ONCE 2
MARRIED/LIVED WITH A WOMAN ONLY ONCE ___ (In what month and year did you start living with your wife/partner?)
MARRIED/LIVED WITH A WOMAN MORE THAN ONCE ___ (Now we will talk aboutyour first wife/partner. In what month and year did you start living with her?)
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
M408. How old were you when you started living with her?
MARRIED/LIVED WITH A WOMAN ONLY ONCE ___ (SKIP TO M410)
MARRIED/LIVED WITH A WOMAN MORE THAN ONCE ___ (Now we will talk about your current wife/partner. In what month and year did you start living with him?)
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
M410. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues. When was the last time you had sexual intercourse (if ever)?
DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___
KNOWS CONDOM __ (The last time you had sex, was a condom used?)
DOES NOT KNOW CONDOM __ (Some men use a condom, which means that they put a rubber sheath on their penis during sexual intercourse. The last time you had sex, was a condom used?)
NO 2
M412. Do you know of a place where you can get condoms?
NO 2 (SKIP TO M414)
M413. Where is that? Anywhere else?
RECORD ALL MENTIONED.
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
GVT. HEALTH CENTRE B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELD WORKER E
OTHER PUBLIC (SPECIFY) ____ F
PHARMACY H
CHEMIST I
DRUG STORE J
MOBILE CLINIC K
FIELD WORKER L
FP/PPAG CLINIC M
MATERNITY HOME N
OTHER PRIVATE (SPECIFY) ____ O
SHOP Q
FRIEND/RELATIVE R
OTHER (SPECIFY) ____ S
CURRENTLY MARRIED OR LIVING WITH A WOMAN ___ (In the last 12 months, how many different women have you had sex with, other than your (wife/wives/partner)?)
NOT IN UNION ___ (In the last 12 months, how many different women have you had sex with?)
M415. How old were you when you first had sexual intercourse?
FIRST TIME WHEN MARRIED 96
SECTION M5. FERTILITY PREFERENCES
CURRENTLY MARRIED OR LIVING WITH A WOMAN ___ (SKIP TO M503)
OCCASIONAL SEXUAL PARTNER ___ (SKIP TO M503)
NO SEXUAL PARTNER ___ (SKIP TO M505A)
M503. Is your wife (or one of your wives/partner) pregnant now?
NO 2 (SKIP TO M505A)
UNSURE 8 (SKIP TO M505A)
M504. When she became pregnant, did you want her to become pregnant then, did you want her to wait until later, or did you not want this pregnancy at all?
LATER 2 (SKIP TO M505B)
NOT AT ALL 3 (SKIP TO M505B)
M505.
(A) WIFE/PARTNER NOT PREGNANT OR UNSURE OR NO WIFE/PARTNER? ___(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?)
(B) WIFE/PARTNER PREGNANT ___ (Now I have some questions about the future.
After the child your wife is expecting now, would you like to have another child, or would you prefer not to have any more children?)
NO MORE/NONE 2 (SKIP TO M507)
SAYS HE CAN'T HAVE ANYMORE 3 (SKIP TO M507)
SAYS WIFE CAN'T GET PREGNANT 4 (SKIP TO M507)
UNDECIDED/DON'T KNOW 8 (SKIP TO M507)
WIFE/PARTNER NOT PREGNANT OR UNSURE OR NO WIFE/PARTNER? ___ (How long would you like to wait from now before the birth of (a/another) child?)
WIFE/PARTNER PREGNANT ___ (After the child your wife is expecting now, how long would you like to wait before the birth of another child?)
YEARS 2 ___
SOON/NOW 993
SAYS WIFE CAN'T GET PREGNANT 994
AFTER MARRIAGE 995
OTHER (SPECIFY) ____ 996
DON'T KNOW 998
M507. CHECK M309: USING A METHOD?
NOT CURRENTLY USING __ (SKIP TO M508)
CURRENTLY USING __ (SKIP TO M512)
M508. Do you think you will use a method to delay or avoid pregnancy within the next 12 months?
NO 2
DON'T KNOW 8
M509. Do you think you will use a method to delay or avoid pregnancy at any time in the future?
NO 2 (SKIP TO M511)
DON'T KNOW 8 (SKIP TO M511)
M510. Which method would you prefer to use?
IUD 02
INJECTIONS 03
IMPLANTS 04
DIAPHRAGM/FOAM/JELLY 05
CONDOM 06
FEMALE STERILIZATION 07
MALE STERILIZATION 08
PERIODIC ABSTINENCE 09
WITHDRAWAL 10
LACATATIONAL AMENORRHEA METHOD 11
OTHER (SPECIFY) ____ 96
UNSURE 98
M510A. Where can you get/obtain advice on (METHOD MENTIONED IN M510)?
GVT. HEALTH CENTRE 12 (SKIP TO M512)
FAMILY PLANNING CLINIC 13 (SKIP TO M512)
MOBILE CLINIC 14 (SKIP TO M512)
FIELD WORKER 15 (SKIP TO M512)
OTHER PUBLIC (SPECIFY) ____ 16 (SKIP TO M512)
PHARMACY 22 (SKIP TO M512)
CHEMIST 23 (SKIP TO M512)
DRUG STORE 24 (SKIP TO M512)
MOBILE CLINIC 25 (SKIP TO M512)
FIELD WORKER 26 (SKIP TO M512)
FP/PPAG CLINIC 27 (SKIP TO M512)
MATERNITY HOME 28 (SKIP TO M512)
OTHER PRIVATE (SPECIFY) _____ 29 (SKIP TO M512)
SHOP 32 (SKIP TO M512)
FRIEND/RELATIVE 33 (SKIP TO 512)
OTHER (SPECIFY) ____ 36 (SKIP TO 512)
M511. What is the main reason that you think you will never use a method?
FERTILITY-RELATED REASONS
WIFE PARTNER MENOPAUSAL/HAD WOMB REMOVED 23
SUBFECUND/INFECUND 24
WANTS MORE CHILDREN 25
WIFE/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
KNOWS NO SOURCE 42
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
DON'T KNOW 98
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.
OTHER (SPECIFY) _____ 96 (SKIP TO M514)
M513. 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?
GIRLS NUMBER ___
EITHER NUMBER ___
UP TO GOD 95
OTHER (SPECIFY) ______ 96
M514. Would you say that you approve or disapprove of couples using a method to avoid getting pregnant?
DISAPPROVE 2
NO OPINION 3
M515. Is it acceptable or not acceptable to you for information on family planning to be provided:
On the radio?
On the television?
NOT ACCEPTABLE 2
DK 8
NOT ACCEPTABLE 2
DK 8
M516. In the last few months have you heard about family planning:
On the radio?
On the television?
In a newspaper or magazine?
From a poster?
From leaflets or brochures?
NO 2
NO 2
NO 2
NO 2
NO 2
M517. In the last few months have you discussed the practice of family planning with your friends, neighbors, or relatives?
NO 2 (SKIP TO M519)
M518. With whom? Anyone else?
RECORD ALL MENTIONED.
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
SON F
FATHER-IN-LAW G
FRIENDS/NEIGHBORS H
OTHER (SPECIFY) ____ X
YES, LIVING WITH A WOMAN ___ (SKIP TO M520)
NO, NOT IN UNION ___ (SKIP TO M601)
M520. Spouses/partners do not always agree on everything. Now I want to ask you about your wife's/partner's views on family planning.
Do you think that your wife/partner approves or disapproves of couples using a method to avoid pregnancy?
DISAPPROVES 2
DON'T KNOW 8
M521. How often have you talked to your wife/partner about family planning in the past year?
ONCE OR TWICE 2
MORE OFTEN 3
M522. Do you think your wife/ partner wants the same number of children that you want, or does she want more or fewer than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8
M601. Now I have a few questions about a very important topic. Have you ever heard of an illness called AIDS?
NO 2
M602. From which sources of information have you learned most about AIDS?
Any other sources?
RECORD ALL MENTIONED.
TELEVISION B
NEWSPAPERS/MAGAZINES C
PAMPHLETS/POSTERS D
SLOGANS/MUSIC E
HEALTH WORKERS F
CHURCHES/MOSQUES G
SCHOOLS/TEACHERS H
COMMUNITY MEETINGS I
FRIENDS/RELATIVES J
WORK PLACE K
OTHER (SPECIFY) _____ X
M603. Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?
NO 2 (SKIP TO M607)
DON'T KNOW 8 (SKIP TO M607)
M604. What can a person do? Any other ways?
RECORD ALL MENTIONED.
ABSTAIN FROM SEX B
USE CONDOM C
HAVE ONLY ONE SEX PARTNER D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
AVOID BLOOD TRANSFUSIONS G
AVOID INJECTIONS H
AVOID KISSING I
AVOID MOSQUITO BITES J
AVOID SHARING INFECTED BLADES K
SEEK PROTECTION FROM TRADITIONAL HEALER M
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) ______ X
DON'T KNOW Z
DID NOT MENTION SAFE SEX ___ (SKIP TO M607)
M606. What does "safe sex" mean to you?
USE CONDOMS B
HAVE ONLY ONE SEX PARTNER C
AVOID SEX WITH PROSTITUTES D
AVID SEX WITH HOMOSEXUALS E
OTHER (SPECIFY) _____ X
DON'T KNOW Z
M607. Is it possible for a healthy looking person to have the AIDS virus?
NO 2
DON'T KNOW 8
M608. Is it possible for a woman who has the AIDS virus to give birth to a child with the AIDS virus?
NO 2
DON'T KNOW 8
M609. Is it possible for a woman who has the AIDS virus to pass the virus to her child through breastfeeding?
NO 2
DON'T KNOW 8
M610. What do you suggest is the most important thing the government should do for people who have AIDS?
HELP RELATIVES PROVIDE CARE 2
ISOLATE/QUARANTINE 3
SHOULD NOT BE INVOLVED 4
OTHER (SPECIFY) _____ 6
M611. If your relative is suffering from AIDS, who would you prefer to care for him/her?
FRIENDS 2
GOVERNMENT ORGANIZATION 3
RELIGIOUS ORGANIZATION 4
NOBODY/ABANDON 5
OTHER (SPECIFY) _____ 6
M612. Do you think your chances of getting AIDS are small, moderate, great, or that you have no risk at all?
MODERATE 2
GREAT 3
NO RISK AT ALL 4
HAS AIDS 5
DON'T KNOW 8
M613. Has your knowledge of AIDS influenced or changed your decisions about having sex or your sexual behavior? IF YES, PROBE: In what way?
RECORD ALL MENTIONED.
STOPPED ALL SEX B
STARTED USING CONDOMS C
RESTRICTED SEX TO ONE PARTNER D
REDUCED NUMBER OF PARTNERS E
STOPPED SEX WITH PROSTITUTES F
STOPPED HOMOSEXUAL CONTACTS G
OTHER (SPECIFY) ______ X
NO CHANGE IN SEXUAL BEHAVIOR Y
DON'T KNOW Y
M614. Have you heard of other diseases apart from AIDS which could be transmitted through sexual intercourse?
NO 2 (SKIP TO M618)
M615. Name the diseases. Any other? CIRCLE ALL MENTIONED.
SYPHILIS B
HERPES C
HEPATITIS D
OTHER (SPECIFY) _____ X
M616. FOR EACH DISEASE MENTIONED IN Q.M615 ASK THE FOLLOWING QUESTION AND CIRCLE ALL THE PLACES MENTIONED:
Where can a person go to treat (NAME OF DISEASE)? Anywhere else?
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
PHARMACY/CHEMIST/DRUG STORE G
CLINIC H
MOBILE CLINIC I
COMM. HEALTH WORKER J
DRUG PEDDLER L
TRADITIONAL PRACTITIONER M
FAITH HEALER/SPIRITUALIST N
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
PHARMACY/CHEMIST/DRUG STORE G
CLINIC H
MOBILE CLINIC I
COMM. HEALTH WORKER J
DRUG PEDDLER L
TRADITIONAL PRACTITIONER M
FAITH HEALER/SPIRITUALIST N
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
PHARMACY/CHEMIST/DRUG STORE G
CLINIC H
MOBILE CLINIC I
COMM. HEALTH WORKER J
DRUG PEDDLER L
TRADITIONAL PRACTITIONER M
FAITH HEALER/SPIRITUALIST N
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
PHARMACY/CHEMIST/DRUG STORE G
CLINIC H
MOBILE CLINIC I
COMM. HEALTH WORKER J
DRUG PEDDLER L
TRADITIONAL PRACTITIONER M
FAITH HEALER/SPIRITUALIST N
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
PHARMACY/CHEMIST/DRUG STORE G
CLINIC H
MOBILE CLINIC I
COMM. HEALTH WORKER J
DRUG PEDDLER L
TRADITIONAL PRACTITIONER M
FAITH HEALER/SPIRITUALIST N
M617. Do you think your chances of getting sexually transmitted diseases (STDs), other than AIDS, are small, moderate, great, or that you have no risk at all?
MODERATE 2
GREAT 3
NO RISK AT ALL 4
HAS STDs 5
DON'T KNOW 8
MINUTES ___
INTERVIEWER'S OBSERVATIONS
To be filled in after completing interview
Comments about Respondent
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Comments on
Specific Questions
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Any Other
Comments
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SUPERVISOR'S OBSERVATIONS
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Name of Supervisor_______ Date:________
EDITOR'S OBSERVATIONS
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Name of Editor__________ Date: ________