DEMOGRAPHIC AND HEALTH SURVEYS IN GUINEA - 2005 MEN'S QUESTIONNAIRE
PLACE NAME _____
NAME OF HOUSEHOLD HEAD _____
CLUSTER NUMBER _____
HOUSEHOLD NUMBER _____
REGION _____
URBAN/RURAL:
RURAL 2
CONAKRY/CAPITAL NATURAL REGION/OTHER CITY/RURAL:
CAPITAL REGION 2
OTHER CITY 3
RURAL 4
NAME OF MAN _____
LINE NO. OF MAN _____
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER'S NAME _____
RESULT _____
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) _____
NEXT VISIT
DATE _____
TIME _____
FINAL VISIT
DAY _____
MONTH _____
YEAR 2005
NAME _____
RESULT _____
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) _____
TOTAL NUMBER OF VISITS _____
LANGUAGE OF QUESTIONNAIRE: FRENCH
LANGUAGE OF INTERVIEW:
2 SOUSSOU
3 PEUHL
4 MALINKE
5 KISSI
6 LOMA
7 KPELE
8 OTHERS
INTERPRETER:
NO 2
FIELD EDITOR
NAME _____
DATE _____
OFFICE EDITOR _____
KEYED BY _____
SECTION 1. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENT
INTRODUCTION AND CONSENT:
CONSENT AFTER INFORMATION:
Hello. My name is ____ and I work with the National Institute of Statistics. We are conducting a national survey that asks men, women, and children about various health issues. We would very much appreciate your participation in this survey. I would like to ask you some questions about your health (and the health of your children). This information will help the government to plan health services. The survey usually takes about 20 to 45 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shared with anyone other than members of our survey team.
Participation in this survey is voluntary, and if we should come to any questions 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. 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 being the interview now?
SIGNATURE OF INTERVIEWER _____
DATE _____
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END INTERVIEW)
First I would like to ask some questions about you and your household
102. For most of the time until you were 12 years old, did you live in a big city, a city, or a rural location? IF A CITY, PLEASE ASK THE NAME OF THE CITY.
CITY 2
RURAL 3
103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)? IF LESS THAN ONE YEAR, RECORD '00' YEARS.
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)
104. Just before you moved here, did you live in a big city, a city, or a rural location?
IF A CITY, ASK THE NAME OF THE CITY.
CITY 2
RURAL 3
105. In the past twelve months, how many times have you traveled out of your home location and slept somewhere other than your home?
NONE 00 (GO TO 107)
106. Have you been outside of your home location for more than one continuous month in the last 12 months?
NO 2
107. In what month and what year were you born?
DOESN'T KNOW MONTH 98
DOESN'T KNOW YEAR 9998
108. How old were you at your last birthday?
COMPARE AND CORRECT 107 AND/OR 108 IF INCONSISTENT.
109. Have you ever attended school?
NO 2 (GO TO 113)
110. What is the highest level of school you attended: primary, secondary 1, secondary 2, professional A, professional B, or superior?
2 SECONDARY 1
3 SECONDARY 2
4 PROFESSIONAL A
5 PROFESSIONAL B
6 SUPERIOR
111. What is the highest (grade/form/year) you completed at this level?
SECONDARY OR HIGHER (GO TO 116)
113. 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
ABEL TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) _____ 4
BLIND/VISUALLY IMPAIRED 5
114. Have you ever participated in a literacy program or any other program that involved learning to read or write (not including primary school)?
NO 2
CODE '1' OR '5' CIRCLED (GO TO 117)
116. Do you read a newspaper or magazine 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
117. Do you listen to the radio 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
118. Do you watch television 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
119. Do you currently have a job of any kind, for which you earn money?
NO 2
120. Have you had any kind of job in the last 12 months for which you earned money?
NO 2
121. What have you done most of the time in the last 12 months?
LOOKED FOR WORK 2 (GO TO 129)
INACTIVE 3 (GO TO 129)
COULDN'T WORK/HANDICAPPED 4 (GO TO 129)
HOUSEWORK/CHILDCARE 5 (GO TO 129)
OTHER (SPECIFY) _____ 6 (GO TO 129)
122. What is your occupation, that is, what kind of work do you mainly do?
DOES NOT WORK IN AGRICULTURE (GO TO 125)
124. 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?
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
OTHER 6
125. How many months have you worked in the last 12 months?
126. Are you paid or do you earn cash of any kind for this work, or are you not paid at all?
CASH AND KIND 2
IN KIND ONLY 3 (GO TO 129)
NOT PAID 4 (GO TO 129)
127. Who mainly decides how the money you earn will be used?
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
128. On average, how much of your household's expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all?
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL 5
NONE, HER INCOME IS ALL SAVED 6
CHRISTIAN 2
ANIMIST 3
NO RELIGION 4
OTHER (SPECIFY) _____ 5
130. What is your nationality?
SIERRA LEONEAN 02 (GO TO 201)
LIBERIAN 03 (GO TO 201)
BISSAU-GUINEAN 04 (GO TO 201)
MALIAN 05 (GO TO 201)
IVOIRIAN 06 (GO TO 201)
SENEGALESE 07 (GO TO 201)
OTHER (SPECIFY) _____ 96 (GO TO 201)
PEUHL 02
MALINKE 03
KISSI 04
TOMA 05
GUERZE 06
OTHER (SPECIFY) _____ 96
132. What language do you mainly speak at home?
PEUHL 02
MALINKE 03
KISSI 04
TOMA 05
KPELE 06
FRENCH 07
ENGLISH 08
ARABIC 09
OTHER (SPECIFY) _____96
Now I would like to ask about any children you have had during your life. I am only interested in the children that are biologically yours.
201. Have you fathered any children?
NO 2 (GO TO 206)
DOESN'T KNOW 8 (GO TO 206)
202. Do you have any sons or daughters that you have fathered who are now living with you?
NO 2 (GO TO 204)
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 who are alive but do not live with you?
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'.
206. Have you ever had any sons or daughters who were born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life at birth but only survive a few hours or days?
NO 2 (GO TO 208)
DOESN'T KNOW 8 (GO TO 208)
207. How many boys have died?
And how many girls have died?
IF NONE, RECORD '00'.
208. (Other than the children you just listed), did you have any:
a) Other boys or girls who are still alive, of who you are the biological father, but who you didn't recognize and who don't have your name?
b) Other boys or girls who were born alive but later died, of who you are the biological father, but who you didn't recognize and who don't have your name?
YES TO AT LEAST ONE OF THE TWO (CHECK AND CORRECT 201 TO 207 AS NECESSARY)
209. SUM ANSWERS TO 203, 205, AND 207 AND ENTER TOTAL.
IF NONE, RECORD '00'.
HAS HAD ONLY ONE CHILD (GO TO 213)
HAS NOT HAD ANY CHILDREN (GO TO 301)
211. Do all of your children have the same biological mother?
NO 2
212. In all, how many women have you fathered children with?
213. How old were you when your (first) child was born?
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. 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. FOR EACH METHOD WITH CODE '1' OR '2' CIRCLED IN 301, ASK 302.
301.Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2
302. Have you ever used (METHOD)?
NO 2
NO 2
NO 2
DOESN'T KNOW 8
NO 2
Now I would like to ask you about a woman's risk of pregnancy.
303. 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?
NO 2 (GO TO 305)
DOESN'T KNOW 8 (GO TO 305)
304. Is this time just before her period begins, during her period, right after her period had ended, or halfway between two periods?
RIGHT AFTER HER PERIOD HAS ENDED 02
IN THE MIDDLE OF CYCLE 03
JUST BEFORE HER PERIOD BEGINS 04
OTHER (SPECIFY) _____6
DOESN'T KNOW 8
305. Do you think that a woman who is breastfeeding her baby can become pregnant?
NO 2
IT DEPENDS 3
DOESN'T KNOW 8
306. Now I would like to 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) Women are the ones who get pregnant; as such she is the one who should use contraception.
DISAGREE 2
DOESN'T KNOW 8
DISAGREE 2
DOESN'T KNOW 8
DISAGREE 2
DOESN'T KNOW 8
SECTION 4. MARRIAGE AND SEXUAL ACTIVITY
401. Are you currently married or living with a woman as if married?
YES, LIVING WITH A WOMAN 2 (GO TO 404)
NO, NOT IN UNION 3 (GO TO 406)
402. How many spouses/wives live with you total?
IF ONLY ONE SPOUSE, RECORD '01'
403. Are there other women with whom you live with as if you were married?
NO 2 (GO TO 405)
404. Altogether, how many wives do you have/partners do you live with as if married?
IF ONLY ONE SPOUSE/PARTNER, RECORD '01'.
405. Other than the wives/partners that you just mentioned, are there currently any other women with whom you have regular or occasional sexual intercourse?
OCCASIONAL PARTNER(S) ONLY 2 (GO TO 409)
REGULAR AND OCCASIONAL PARTNER(S) 3 (GO TO 409)
NO OTHER SEXUAL PARTNER 4 (GO TO 409)
406. Do you currently have a regular or occasional sexual partner, or no sexual partner at all?
OCCASIONAL PARTNER(S) ONLY 2
REGULAR AND OCCASIONAL PARTNER(S) 3
NO OTHER SEXUAL PARTNER 4
407. Have you ever been married or lived with a woman?
YES, LIVED WITH WOMAN 2 (GO TO 411)
YES, BOTH 3
NO 4 (GO TO 416)
408. What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2 (GO TO 411)
SEPARATED 3 (GO TO 411)
409. BASED ON THE HOUSEHOLD QUESTIONNAIRE, RECORD THE NAME AND LINE NUMBER OF EACH WIFE/PARTNER PROVIDED IN QUESTIONS 402 AND 404 ONLY. IF A WIFE/PARTNER DOESN'T LIVE IN THE HOUSEHOLD, RECORD '00' IN THE SPACE CORRESPONDING TO THAT WIFE/PARTNER. THE NUMBER OF SPACES FILLED OUT SHOULD BE EQUAL TO THE NUMBER OF WIVES AND PARTNERS.
IF THE SUM OF 402 AND 404 EQUALS 1: Please tell me the name of your wife/partner.
IF THE SUM OF 402 AND 404 EQUALS 2 OR MORE: Please tell me the name of each of your current wives (and/or of each woman you are living with as if married). Start with the one who is the first you lived with. FILL OUT THE RESPONSES FOR EACH WIFE/PARTNER.
PARTNER 2
410A. How old was your wife/partner at her last birthday?
FILL OUT THE RESPONSES FOR EACH WIFE/PARTNER.
TWO WIVES/PARTNERS OR MORE (GO TO 414)
411. Have you been married or lived with a woman only once, or more than once?
MORE THAN ONCE 2
WAS MARRIED/LIVED WITH 1 WOMAN ONLY ONCE (411 CODE IS '1'): In what month and year did you start living with your wife/partner?
Q. 411 CODE IS '2' OR OTHER: 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?
DOESN'T KNOW MONTH 98
DOESN'T KNOW YEAR 9998
415. How old were you when you started living with her?
Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues.
416. How old were you when you first had sexual intercourse (if ever)?
AGE IN YEARS _____ (GO TO 416B)
FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE/PARTNER 95 (GO TO 416B)
416A. Do you intend to wait until you get married to have sexual intercourse for the first time?
NO 2 (GO TO 439)
DOESN'T KNOW 8 (GO TO 439)
AGE 25-59 YEARS (GO TO 417)
416C. Was a condom used the first time you had sexual intercourse?
NO 2
416D. How old was the person you first had sexual intercourse with?
DOESN'T KNOW 98
416E. Was this person older than you, younger than you, or about the same age as you?
YOUNGER 2 (GO TO 417)
ABOUT THE SAME AGE 3 (GO TO 417)
DOESN'T KNOW/DOESN'T REMEMBER 8 (GO TO 417)
416F. Would you say this person was ten or more years older than you, or less than ten years older than you?
LESS THAN TEN YEARS OLDER 2
OLDER, DOESN'T KNOW HOW MUCH 3
417. When was the last time you had sexual intercourse?
IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS
WEEKS AGO 2 _____
MONTHS AGO 3 _____
YEARS AGO 4 _____ (GO TO 436A)
[ASK QUESTIONS 418-434 FOR THE LAST (THREE) SEXUAL PARTNER(S)]
418. The last time you had sexual intercourse (with this second/third) person, was a condom used?
NO 2 (GO TO 421)
419. What is the main reason you used the condom this time?
RESPONDENT WANTED TO AVOID PREGNANCY 2
RESPONDENT WANTED TO AVOID BOTH STD'S/AIDS AND PREGNANCY 3
DIDN'T TRUST PARTNER/SUSPECTS PARTNER HAS OTHER PARTNERS 4
PARTNER INSISTED 5
OTHER (SPECIFY) _____ 6
DOESN'T KNOW 8
420. Did you use a condom every time you had sexual intercourse with this person in the last 12 months?
NO 2
RESPONDENT STERILIZED (GO TO 426)
CONDOM WAS USED TO AVOID PREGNANCY ('2' OR '3' CIRCLED): The last time you had sexual intercourse with this woman, did you or your partner do something or use a method other than the condom to avoid pregnancy?
OTHER ('1', '4', '5', '6' OR '8') CIRCLED, OR QUESTION NOT ASKED: The last time you had sexual intercourse with this woman, did you or your partner do something or use a method to avoid pregnancy?
NO 2 (GO TO 424)
DOESN'T KNOW 8 (GO TO 426)
423. What method was used?
IF MORE THAN ONE METHOD USED, CIRCLE THE HIGHEST LISTED METHOD.
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMEN. METHOD 11
PERIODIC ABSTINENCE 12
WITHDRAWAL 13
OTHER METHOD (SPECIFY) _____ 96
DOESN'T KNOW 98
OTHER (GO TO 425)
425. What is the main reason you did not use a contraceptive method to avoid pregnancy?
CONTRAPTION IS A WOMAN'S BUSINESS 12
NO NEED, A CONDOM WAS USED TO AVOID STDS/AIDS 13
COUPLE SUB-FECUND/IN FECUND 24
WIFE/PARTNER PREGNANT 25
WIFE/PARTNER POSTPARTUM LACTATIONAL AMENORRHEA 26
WIFE/PARTNER BREASTFEEDING 27
WANTS (OTHER) CHILDREN 28
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
COSTS TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
DOESN'T KNOW 98
426. The last time you had sexual intercourse with this (second, third) person, did either you or your partner drink alcohol?
NO 2 (GO TO 428)
427. Were you or your partner drunk at that time?
IF YES: Who was drunk?
PARTNER ONLY 2
RESPONDENT AND PARTNER BOTH 3
NEITHER 4
428. 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 '02'. IF NO, CIRCLE '03'.
LIVE-IN PARTNER 02 (GO TO 434, EXCEPT THIRD LAST PARTNER: GO TO 435)
GIRLFRIEND NOT LIVING WITH RESPONDENT 03
CASUAL ACQUAINTANCE 04
PROSTITUTE 05
OTHER (SPECIFY) _____ 96
429. For how long (have you had/did you have) a sexual relationship with this person?
IF YOU ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAY.
MONTHS 2 _____
YEARS 3 _____
434. Apart from (this person/these two people), have you had sexual intercourse with any other person in the last 12 months? [DO NOT ASK FOR THIRD-TO-LAST PARTNER]
NO 2 (GO TO 436)
435. In total, with how many different people have you had sexual intercourse with in the last 12 months?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'.
DOESN'T KNOW 98
AT LEAST ONE PARTNER IS PROSTITUTE (AT LEAST ONE '05' IS CIRCLED) (GO TO 438)
436A. In the last 12 months, did you pay anyone in exchange for having sexual intercourse?
NO 2 (GO TO 438)
436B. The last time you paid someone in exchange for having sexual intercourse, was a condom used?
NO 2 (GO TO 438)
436C. Was a condom used during sexual intercourse every time you paid someone in exchange for sexual intercourse in the last 12 months?
NO 2
DOESN'T KNOW/UNSURE 8
438. In total, with how many different men have you had sex in your life?
IF NON-NUMERIC NUMBER, PROBE TO GET AN ESTIMATE.
IF THE NUMBER IF MORE THAN 95, WRITE '95'.
DOESN'T KNOW 98
438B. CHECK FOR PRESENCE OF OTHER PEOPLE. DO NOT CONTINUE UNTIL YOU ARE COMPLETELY ALONE WITH RESPONDENT.
PRIVACY IMPOSSIBLE 2 (GO TO 439)
438C. The first time you had sexual intercourse, did you want to have sexual intercourse, or were you forced against your will?
WAS FORCED 2
REFUSED TO RESPOND/NO RESPONSE 3
438D. Did anyone make you have sexual intercourse against your will in the last 12 months?
NO 2
439. Do you know of a place where a person can get condoms?
NO 2 (GO TO 501)
440. Where is this source?
Any other place?
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.
HEALTH CENTER B
MEDICAL POST C
FAMILY PLANNING CLINIC D
COMMUNITY WORKER E
OTHER PUBLIC (SPECIFY) _____ F
PHARMACY H
HEALTH FIELDWORKER J
OTHER PRIVATE MEDICAL (SPECIFY) _____ K
BAR/NIGHTCLUB M
KIOSK N
APRON O [note: Original word is "tablier," and after extensive search, the only term that corresponds is apron or work coat, neither of which make sense]
FRIENDS/ACQUAINTANCES/RELATIVES P
OTHER (SPECIFY) _____ X
441. If you wanted to, could you yourself get a condom?
NO 2
DOESN'T KNOW/UNSURE 8
OTHER (GO TO 501)
443. Where did you get the condom last time?
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.
HEALTH CENTER 12
MEDICAL POST 13
FAMILY PLANNING CLINIC 14
COMMUNITY WORKER 15
OTHER PUBLIC (SPECIFY) _____ 16
PHARMACY 22
HEALTH FIELDWORKER 23
OTHER PRIVATE MEDICAL (SPECIFY) _____ 26
BAR/NIGHTCLUB 32
KIOSK 33
APRON 34 [note: Original word is "tablier," and after extensive search, the only term that corresponds is apron or work coat, neither of which make sense]
FRIENDS/ACQUAINTANCES/RELATIVES 35
HOTEL/MOTEL 36
OTHER (SPECIFY) _____ 96
DOESN'T KNOW 98
444. Do you know the brand name of the condoms that you used last time?
RECORD NAME OF BRAND.
SULTAN 2
INOTEX 3
MAXIMUM 4
OTHER (SPECIFY) _____ 6
DOESN'T KNOW 8
445. The last time you bought condoms, how many did you buy?
DOESN'T KNOW 98
NEVER BOUGHT CONDOMS 99 (GO TO 501)
DOESN'T KNOW 9998
SECTION 5. FERTILITY PREFERENCES
501. CHECK 410:
HAS 2 OR MORE WIVES/PARTNERS (GO TO 502)
NOT ASKED (GO TO 505)
502. Is your wife/partner (are any of your wives/partners) currently pregnant?
NO 2
DOESN'T KNOW 8
NO, WIFE/PARTNER PREGNANT OR DOESN'T KNOW: 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?
YES, WIFE/PARTNER PREGNANT: Now I have some questions about the future. After the child your wife/partner is expecting now, would you like to have another child, or would you prefer not to have any more children?
NO MORE/NONE 2 (GO TO 505)
WIFE/PARTNER CAN'T GET PREGNANCY/STERILIZED 3 (GO TO 505)
UNDECIDED/DOESN'T KNOW 8 (GO TO 505)
504. How long would you like to wait from now before the birth of (a/another) child?
YEARS 2 _____
SOON/NOW 993
AFTER MARRIAGE 995
OTHER (SPECIFY) _____ 996
DOESN'T KNOW 998
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 throughout your whole life, how many would that be?
NO LIVING CHILDREN: If you could choose exactly the number of children to have throughout your whole life, how many would that be?
PROBE FOR A NUMERIC RESPONSE.
NUMBER _____
OTHER (SPECIFY) _____ 96 (GO TO 507)
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?
OTHER (SPECIFY) _____96
OTHER (SPECIFY) _____96
OTHER (SPECIFY) _____96
507. Would you say that you approve or disapprove of couples using a contraceptive method to avoid getting pregnant?
DISAPPROVE 2
DOESN'T KNOW/UNSURE 8
508. In the last few months have you heard about family planning:
On the radio?
On the television?
In a newspaper or a magazine?
NO 2
NO 2
NO 2
510. In the last few months, have you discussed the practice of family planning with your friends, neighbors, or relatives?
NO 2 (GO TO 512)
RECORD ALL PERSONS MENTIONED.
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTERS(S) F
SON(S) G
MOTHER(S)-IN-LAW H
FRIENDS/NEIGHBORS I
OTHER (SPECIFY) _____ X
512. In the last few months, have you discussed the practice of family planning with a health worker or health care professional?
NO 2
SECTION 6. AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS
Now I would like to talk about something else.
601. Have you ever heard of an illness called AIDS?
NO 2 (GO TO 635)
602. 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
DOESN'T KNOW 8
603. Can people get the AIDS virus from mosquito bites?
NO 2
DOESN'T KNOW 8
604. Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?
NO 2
DOESN'T KNOW 8
605. Can people get the AIDS virus by sharing food with a person who has AIDS?
NO 2
DOESN'T KNOW 8
606. Can people reduce their chance of getting the AIDS virus by not having sexual intercourse at all?
NO 2
DOESN'T KNOW 8
607. Can people get the AIDS virus because of witchcraft or other supernatural means?
NO 2
DOESN'T KNOW 8
608. Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?
NO 2 (GO TO 610)
DOESN'T KNOW 8 (GO TO 610)
609. What can a person do?
Anything else?
RECORD ALL WAYS MENTIONED.
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 INTRAVENOUSLY H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING RAZORS/BLADES K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM TRADITIONAL PRACTITIONER N
OTHER (SPECIFY) _____W
OTHER (SPECIFY) _____X
DOESN'T KNOW Z
610. Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DOESN'T KNOW 8
611. Can the virus that causes AIDS be transmitted from a mother to a child:
During pregnancy?
During delivery?
During breastfeeding?
NO 2
DOESN'T KNOW 8
NO 2
DOESN'T KNOW 8
NO 2
DOESN'T KNOW 8
NOT ONE 'YES' (GO TO 614)
613. Are there any special drugs that a doctor or a nurse can give to a woman infected with the AIDS virus to reduce the risk of transmission to the baby?
NO 2
DOESN'T KNOW 8
614. Are there any special drugs that people infected with the AIDS virus can get from a doctor or a nurse?
NO 2
DOESN'T KNOW 8
615. I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?
NO 2 (GO TO 620)
616. When was the last time you were tested?
12-23 MONTHS AGO 2
2 OR MORE YEARS AGO 3
617. The last time you had the test, did you yourself ask for the test, was if offered to you and you accepted, or was it required?
OFFERED AND ACCEPTED 2
REQUIRED 3
618. I don't want to know the results, but did you get the results of the test?
NO 2
IF SOURCE IS HOSPITAL OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
CHU [note: Internet research did not turn anything up on this location, but it is clearly some type of public health facility] 12 (GO TO 622)
REGIONAL HOSPITAL 13 (GO TO 622)
HOSPITAL [note: original shows "hospital pref.", the "pref." portion may mean preferential or preferred; again, this is some type of public hospital] 14 (GO TO 622)
CMC [note: Internet research did not turn anything up on this location, but it is clearly some type of public health facility] 15 (GO TO 622)
OTHER PUBLIC (SPECIFY) _____16 (GO TO 622)
PRIVATE LABORATORY 22 (GO TO 622)
OTHER PRIVATE MEDICAL (SPECIFY) _____ 26 (GO TO 622)
620. Do you know of a place where people can go to get tested for the AIDS virus?
NO 2 (GO TO 622)
621. Where is that?
Any other place?
RECORD ALL PLACES MENTIONED.
IF SOURCE IS HOSPITAL OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
CHU [note: Internet research did not turn anything up on this location, but it is clearly some type of public health facility] B
REGIONAL HOSPITAL C
HOSPITAL [note: the original shows "hospital pref.", the "pref." portion may mean preferential or preferred; again, this is some type of public hospital] D
CMC [note: Internet research did not turn anything up on this location, but it is clearly some type of public health facility] F
OTHER PUBLIC (SPECIFY) _____ G
PRIVATE LABORATORY I
OTHER PRIVATE MEDICAL (SPECIFY) _____ J
622. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?
NO 2
DOESN'T KNOW 8
623. If a member of your family contracted the AIDS virus, would you like this to remain a secret or no?
NO 2
DOESN'T KNOW/NOT SURE 8
624. If a relative of yours became sick with the virus that causes AIDS, would you be willing to care for her or him in your own household?
NO 2
DOESN'T KNOW/DEPENDS 8
625. In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in the school?
SHOULD NOT BE ALLOWED 2
DOESN'T KNOW/DEPENDS 8
626. Do you personally know someone who has been denied health services in the last 12 months because he or she has (or is suspected to have) the AIDS virus?
NO 2
DOESN'T KNOW ANYONE WITH AIDS 8 (GO TO 631)
627. 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 has (or is suspected to have) the AIDS virus?
NO 2
628. Do you personally know someone who has been verbally abused or teased in the last 12 months because he or she has or is suspected to have the AIDS virus?
NO 2
AT LEAST ONE 'YES' (GO TO 631)
630. Do you personally know someone who has or is suspected to have the AIDS virus?
NO 2
631. Do you agree or disagree with the following statement: People with the AIDS virus should be ashamed of themselves.
DISAGREE 2
DOESN'T KNOW/NO OPINION 8
632. Do you agree or disagree with the following statement: People with the AIDS virus should be blamed for bringing the disease into the community.
DISAGREE 2
DOESN'T KNOW/NO OPINION 8
633. Should children age 12-14 be taught about using a condom to avoid getting AIDS?
NO 2
DOESN'T KNOW/DEPENDS 8
634. Should children age 12-14 be taught to wait until they get married to have sexual intercourse in order to avoid getting AIDS?
NO 2
DOESN'T KNOW/DEPENDS 8
635. Do you think that young men should wait until marriage to have sexual intercourse?
NO 2
DOESN'T KNOW/DEPENDS 8
636. Do you think that young women should wait until marriage to have sexual intercourse?
NO 2
DOESN'T KNOW/DEPENDS 8
637. Do you think that married men should avoid having sexual intercourse with people other than their spouses?
NO 2
DOESN'T KNOW/DEPENDS 8
638. Do most of the men you know only have sexual intercourse with their spouses?
NO 2
DOESN'T KNOW/DEPENDS 8
639. Do you think that married women should avoid having sexual intercourse with people other than their spouses?
NO 2
DOESN'T KNOW/DEPENDS 8
640. Do most of the women you know only have sexual intercourse with their spouses?
NO 2
DOESN'T KNOW/DEPENDS 8
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?
NO 2 (GO TO 644)
642. If a man has a sexually transmitted disease, what symptoms might he have?
Any other sign or symptom? RECORD ALL SYMPTOMS MENTIONED.
GENITAL DISCHARGE B
FOUL SMELLING DISCHARGE C
BURNING PAIN IN URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
IMPOTENCE L
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
NO SYMPTOMS Y
DOESN'T KNOW Z
643. If a woman has a sexually transmitted disease, what symptoms might she have?
Any other sign or symptom?
RECORD ALL SYMPTOMS MENTIONED.
VAGINAL DISCHARGE B
FOUL SMELLING DISCHARGE C
BURNING PAIN IN URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
HARD TO GET PREGNANT/HAVE A CHILD L
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
NO SYMPTOMS Y
DOESN'T KNOW Z
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 654)
HAS NOT HEARD OF SEXUALLY TRANSMITTED INFECTIONS (GO TO 647)
Now I would like to ask you some questions about your health within the last 12 months.
646. During these last 12 months, have you had a disease which you got through sexual contact?
NO 2
DOESN'T KNOW 8
647. Sometimes men have abnormal discharge from their penis. Have you had any abnormal discharge from your penis in the last 12 months?
NO 2
DOESN'T KNOW 8
648. 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
DOESN'T KNOW 8
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 654)
650. The last time you had (PROBLEM FROM 646/647/648), did you seek any kind of advice or treatment?
NO 2 (GO TO 652)
651. Where did you go?
Any other place?
CIRCLE ALL MENTIONED.
HEALTH CENTER B
MEDICAL POST C
STAND-ALONE VCT CENTER D
FAMILY PLANNING CLINIC E
COMMUNITY WORKER F
OTHER PUBLIC (SPECIFY) _____ G
STAND-ALONE VCT CENTER I
PHARMACY J
HEALTH FIELDWORKER L
OTHER PRIVATE MEDICAL (SPECIFY) _____ M
SHOP O
OTHER (SPECIFY) _____ X
652. The last time you had (PROBLEM FROM 646/647/648), did your partner seek any kind of advice or treatment?
NO 2 (GO TO 654)
DOESN'T KNOW 8 (GO TO 654)
653. Where did she go?
Any other place?
CIRCLE ALL MENTIONED.
GOVERNMENT HEALTH CENTER B
MEDICAL POST C
STAND-ALONE VCT CENTER D
FAMILY PLANNING CLINIC E
COMMUNITY WORKER F
OTHER PUBLIC (SPECIFY) _____ G
STAND-ALONE VCT CENTER I
PHARMACY J
HEALTH FIELDWORKER L
OTHER PRIVATE MEDICAL (SPECIFY) _____ M
SHOP O
OTHER (SPECIFY) _____ X
654. Some men are circumcised. Are you circumcised?
NO 2
SECTION 7. FEMALE CIRCUMCISION
701. Have you ever heard of female circumcision?
NO 2
702. In a number of countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard of this practice?
NO 2 (GO TO 711)
703. What benefits do girls get if they undergo this genital cutting?
PROBE: Are there any other advantages?
RECORD ALL MENTIONED.
SOCIAL ACCEPTANCE B
BETTER MARRIAGE PROSPECTS C
PRESERVE VIRGINITY/PREVENT PREMARITAL SEX D
MORE SEXUAL PLEASURE FOR HUSBAND E
RELIGIOUS REQUIREMENT F
OTHER (SPECIFY) _____ X
NO BENEFITS Y
704. What benefits do girls get if they do not undergo this genital cutting?
PROBE: Anything else?
RECORD ALL MENTIONED.
AVOIDING PAIN B
MORE SEXUAL PLEASURE FOR HER C
MORE SEXUAL PLEASURE FOR THE MAN D
FOLLOWS RELIGION F
OTHER (SPECIFY) _____ X
NO ADVANTAGES Y
CODE 'D' CIRCLED IN 703 (GO TO 707)
706. Would you say that this practice is a way to prevent a girl from having sex before marriage or does it have no effect on premarital sex?
NO EFFECT 2
DOESN'T KNOW 8
CODE 'F' CIRCLED IN QUESTION 703 OR 704 (GO TO 709)
708. Do you believe that this practice is required by your religion?
NO 2
DOESN'T KNOW 8
709. Do you think that this practice should be continued or should it be discontinued?
DISCONTINUED 2
DEPENDS 3
DOESN'T KNOW 8
710. Do you think that women want this practice to be continued or discontinued?
DISCONTINUED 2
DEPENDS 3
DOESN'T KNOW 8
TO BE FILLED IN AFTER COMPLETING INTERVIEW.
COMMENTS ABOUT RESPONDENT _____
COMMENTS ON SPECIFIC QUESTIONS _____
ANY OTHER COMMENTS _____
FIELD EDITOR'S OBSERVATIONS _____
NAME _____
DATE _____