KENYA NATIONAL BUREAU OF STATISTICS
KENYA DEMOGRAPHIC AND HEALTH SURVEY 2008
HOUSEHOLD QUESTIONNAIRE
Serial number ______________
CONFIDENTIAL
CENTRAL 2
COAST 3
EASTERN 4
NYANZA 5
R.VALLEY 6
WESTERN 7
NORTHEASTERN 8
DISTRICT _____________________
LOCATION/TOWN ____________________
SUBLOCATION/WARD _________________
NASSEP CLUSTER NUMBER _______________
KDHS CLUSTER NUMBER __________________
HOUSEHOLD NUMBER ____________
NAME OF HOUSEHOLD HEAD ________
NAKURU/ELDORET/THIKA/NYERI 2
SMALL TOWN 3
RURAL 4
IS HOUSEHOLD SELECTED FOR MAN'S SURVEY
NO 2
INTERVIEWER VISIT 1
DATE ______________
INTERVIEWER'S NAME _______________
RESULT** ______________
NEXT VISIT:
DATE ______
TIME _____
INTERVIEWER VISIT 2
DATE ______________
INTERVIEWER'S NAME _______________
RESULT** ______________
NEXT VISIT:
DATE ______
TIME _____
INTERVIEWER VISIT 3
DATE ______________
INTERVIEWER'S NAME _______________
RESULT** ______________
FINAL VISIT
DAY ____
MONTH ____
YEAR 200__
INT. CODE ___
RESULT ____
LINE NO. OF RESP TO HOUSEHOLD QUESTION __
2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT
3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY) _________
SUPERVISOR
NAME _________ ___
DATE ___________
FIELD EDITOR
NAME __________ ___
DATE __________
OFFICE EDITOR __
KEYED BY __
Hello. My name is ________ and I am working with the Kenya National Bureau of Statistics. We are conducting a national survey that asks about various health issues. We would very much appreciate your participation in this survey.
This information will help the government to plan health services. The survey usually takes between 30 to 60 minutes to complete.
Whatever information you provide will be kept 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 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. However, we hope that you will participate in this survey since your views are important.
At this time, do you want to ask me anything about the survey?
May I begin the interview now?
Signature of interviewer: ___________
Date: ___________
RESPONDENT AGREES TO BE INTERVIEWED 1
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 ( END)
Now we would like some information about the people who usually live in your household or who are staying with you now.
1. LINE NO. (THE NUMBER OF PERSONS LISTED BY THE RESPONDENT)
2. USUAL RESIDENTS AND VISITORS: Please give me the names of the persons who usually live in your household and guests of the household who stayed here last night, starting with the head of the household.
AFTER LISTING THE NAMES AND RECORDING THE RELATIONSHIP AND SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE.
THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-33 FOR EACH PERSON.
3. RELATIONSHIP TO HEAD OF HOUSEHOLD: What is the relationship of (NAME) to the head of the household?
CODES FOR Q.3
RELATIONSHIP TO HEAD OF HOUSEHOLD:
02 = WIFE OR HUSBAND
03 = SON OR DAUGHTER
04 = SON-IN-LAW OR DAUGHTER-IN-LAW
05 = GRANDCHILD
06 = PARENT
07 = PARENT-IN-LAW
08 = BROTHER OR SISTER
09 = NIECE/NEPHEW BY BLOOD
10 = NIECE/NEPHEW BY MARRIAGE
11 = OTHER RELATIVE
12 = ADOPTED/FOSTER/ STEPCHILD
13 = NOT RELATED
98 = DON'T KNOW
4. SEX: Is (NAME) male or female?
F 2
5. Does (NAME) usually live here?
N 2
6. Did (NAME) stay here last night?
N 2
8. What is (NAME'S) current marital status?
2 = DIVORCED/SEPARATED
3 = WIDOWED
4 = NEVER MARRIED AND NEVER LIVED TOGETHER
9. CIRCLE LINE NUMBER OF ALL WOMEN AGE 15-49.
*LINE NO. OF WOMAN SELECTED FOR Qs ON DOMESTIC VIOLENCE.
10. CIRCLE LINE NUMBER OF ALL CHILDREN AGE 0-5.
11. CIRCLE LINE NUMBER OF ALL MEN AGE 15-54.
TICK HERE IF CONTINUATION SHEET USED ___
2A) Just to make sure that I have a complete listing. Are there any other persons such as small children or infants that we have not listed?
NO __
2B) Are there any other people who may not be members of your family, such as domestic servants, lodgers, or friends who usually live here?
NO __
2C) Are there any guests or temporary visitors staying here, or anyone else who stayed here last night, who have not been listed?
NO __
23. Has (NAME) ever attended school?
NO 2 (GO TO 32)
CODES FOR Qs. 24, 26 AND 28: EDUCATION LEVEL:
1 = PRIMARY
2 = POST-PRIMARY, VOCATIONAL
3 = SECONDARY, A LEVEL
4 = COLLEGE (MIDDLE LEVEL)
5 = UNIVERSITY
8 = DON'T KNOW
98 = DON'T KNOW
24. What is the highest level of school (NAME) has attended?
What is the highest grade (NAME) completed at that level?
CURRENT/RECENT SCHOOL ATTENDANCE
25. Did (NAME) attend school at any time during the 2008 school year?
N 2 (SKIP TO 27)
26. During the 2008 school year, what level and grade is/was (NAME) attending?
27. Did (NAME) attend school at any time during the 2007 school year?
N 2 (GO TO 32)
28. During the 2007 school year, what level and grade did (NAME) attend?
.
32. Has (NAME) ever been registered with the civil authority?
2=YES, REGISTERED WITHOUT BIRTH CERTIFICATE (GO TO NEXT LINE)
3=NOT REGISTERED (GO TO 33)
8 =DON'T KNOW (GO TO NEXT LINE)
33. Why was (NAME) never registered?
2=LITTLE MONEY
3=NOT AWARE
4=NOT NECESSARY
5=NOMADIC LIFE DIFFICULT TERRAIN INSECURITY
8=OTHER
GRID TO SELECT ONE WOMAN PER HOUSEHOLD
LOOK AT THE LAST DIGIT OF THE QUESTIONNAIRE SERIAL NUMBER ON THE COVER PAGE. THIS IS THE NUMBER OF THE ROW YOU SHOULD GO TO.
CHECK THE TOTAL NUMBER OF WOMEN 15-49 IN COLUMN (9) OF THE HOUSEHOLD QUESTIONNAIRE. THIS IS THE NUMBER OF THE COLUMN YOU SHOULD GO TO.
FIND THE BOX WHERE THE ROW AND THE COLUMN MEET AND CIRCLE THE NUMBER THAT APPEARS IN THE BOX. THIS NUMBER IS USED TO IDENTIFY WHETHER THE FIRST ('1'), SECOND ('2'), THIRD ('3'), ETC. ELIGIBLE WOMAN
LISTED IN THE HOUSEHOLD SCHEDULE WILL BE ASKED THE DOMESTIC VIOLENCE QUESTIONS.
PUT AN ASTERISK (*) NEXT TO THE LINE NUMBER OF THE SELECTED WOMAN IN COL. 9.
EXAMPLE: IF THE QUESTIONNAIRE SERIAL NUMBER IS '3716', GO TO ROW '6'.
IF THERE ARE THREE ELIGIBLE WOMEN IN THE HOUSEHOLD, GO TO COLUMN '3'.
FIND THE BOX WHERE ROW '6' AND COLUMN '3' MEET.
THE NUMBER IN THAT BOX ('2') INDICATES THAT THE SECOND ELIGIBLE WOMAN IN THE HOUSEHOLD LISTING SHOULD BE ASKED THE DOMESTIC VIOLENCE QUESTIONS.
SUPPOSE THE LINE NUMBERS OF THE THREE WOMEN ARE '02', '03', AND '07'. THE WOMAN TO BE ASKED THE DOMESTIC VIOLENCE QUESTIONS IS THE SECOND ONE, I.E., THE WOMAN ON LINE '03'.
LAST DIGIT OF THE QUESTIONNAIRE SERIAL NUMBER (ROW)
TOTAL NUMBER OF ELIGIBLE WOMEN IN HOUSEHOLD (COLUMN)
1 2 3 4 5 6 7 8
0 1 2 2 4 3 6 5 4
1 1 1 3 1 4 1 6 5
2 1 2 1 2 5 2 7 6
3 1 1 2 3 1 3 1 7
4 1 2 3 4 2 4 2 8
5 1 1 1 1 3 5 3 1
6 1 2 2 2 4 6 4 2
7 1 1 3 3 5 1 5 3
8 1 2 1 4 1 2 6 4
9 1 1 2 1 2 3 7 5
101. What is the main source of drinking water for members of your household?
PIPED TO COMPOUND/PLOT 12 (SKIP TO 106)
PUBLIC TAP/STANDPIPE 13 (SKIP TO 103)
DUG WELL
UNPROTECTED WELL 32 (SKIP TO 103)
UNPROTECTED SPRING 42 (SKIP TO 103)
TANKER TRUCK 61 (SKIP TO 103)
CART WITH SMALL TANK 71 (SKIP TO 103)
SURFACE WATER (RIVER/DAM/LAKE/POND/STREAM/CANAL/IRRIGATION CHANNEL) 81 (SKIP TO 103)
BOTTLED WATER 91
OTHER (SPECIFY) ___________ 96 (SKIP TO 103)
102. What is the main source of water used by your household for other purposes such as cooking and handwashing?
PIPED TO COMPOUND/PLOT 12 (SKIP TO 106)
PUBLIC TAP/STANDPIPE 13
DUG WELL
UNPROTECTED WELL 32
UNPROTECTED SPRING 42
TANKER TRUCK 61
CART WITH SMALL TANK 71
SURFACE WATER (RIVER/DAM/LAKE/POND/STREAM/CANAL/IRRIGATION CHANNEL) 81
OTHER (SPECIFY) ___________ 96
103. Where is that water source located?
IN OWN YARD/PLOT 2 (SKIP TO 106)
ELSEWHERE 3
104. How long does it take to go there, get water, and come back?
MORE THAN 12 HOURS 995
DON'T KNOW 998
105. Who usually goes to this source to fetch the water for your household?
ADULT MAN 2
FEMALE CHILD UNDER 15 YEARS OLD 3
MALE CHILD UNDER 15 YEARS OLD 4
OTHER (SPECIFY) ___________ 6
106. Do you do anything to the water to make it safer to drink?
NO 2 (SKIP TO 108)
DON'T KNOW 8 (SKIP TO 108)
107. What do you usually do to make the water safer to drink? Anything else?
RECORD ALL MENTIONED.
ADD BLEACH/CHLORINE B
STRAIN THROUGH A CLOTH C
USE WATER FILTER (CERAMIC/SAND/COMPOSITE/ETC.) D
SOLAR DISINFECTION E
LET IT STAND AND SETTLE F
OTHER (SPECIFY) ___________ X
DON'T KNOW Z
108. What kind of toilet facility do members of your household usually use?
FLUSH TO SEPTIC TANK 12
FLUSH TO PIT LATRINE 13
FLUSH TO SOMEWHERE ELSE 14
FLUSH, DON'T KNOW WHERE 15
PIT LATRINE WITH SLAB 22
PIT LATRINE WITHOUT SLAB/OPEN PIT 23
BUCKET TOILET 41
HANGING TOILET/HANGING LATRINE 51
NO FACILITY/BUSH/FIELD 61 (SKIP TO 111)
OTHER (SPECIFY) ___________ 96
109. Do you share this toilet facility with other households?
NO 2 (SKIP TO 111)
110. How many households use this toilet facility?
10 OR MORE HOUSEHOLDS 95
DON'T KNOW 98
111. Does your household have:
A clock or watch?
Electricity?
A radio?
A television?
A mobile telephone?
A non-mobile telephone?
A refrigerator?
A solar panel?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
112. What type of fuel does your household mainly use for cooking?
LPG/NATURAL GAS 02
BIOGAS 03
KEROSENE 04
COAL, LIGNITE 05
CHARCOAL 06
WOOD 07
STRAW/SHRUBS/GRASS 08
AGRICULTURAL CROP 09
ANIMAL DUNG 10
NO FOOD COOKED IN HOUSEHOLD 95 (SKIP TO 117)
OTHER (SPECIFY) ___________ 96
115. Is the cooking usually done in the house, in a separate building, or outdoors?
IN A SEPARATE BUILDING 2 (SKIP TO 117)
OUTDOORS 3 (SKIP TO 117)
OTHER (SPECIFY) ___________ 6 (SKIP TO 117)
116. Do you have a separate room which is used as a kitchen?
NO 2
117. MAIN MATERIAL OF THE FLOOR.
RECORD OBSERVATION.
DUNG 12
PALM/BAMBOO 22
VINYL OR ASPHALT STRIPS 32
CERAMIC TILES 33
CEMENT 34
CARPET 35
118. MAIN MATERIAL OF THE ROOF.
RECORD OBSERVATION.
DUNG/MUD 12
TIN CANS 22
CONCRETE 32
TILES 33
119. MAIN MATERIAL OF THE WALLS.
RECORD OBSERVATION.
CANE/PALM/TRUNKS 12
DIRT 13
STONE WITH MUD 22
UNCOVERED ADOBE 23
PLYWOOD 24
CARDBOARD 25
REUSED WOOD 26
STONE WITH LIME/CEMENT 32
BRICKS 33
CEMENT BLOCKS 34
COVERED ADOBE 35
WOOD PLANKS/SHINGLES 36
120. How many rooms in this household are used for sleeping?
121. Does any member of this household own:
A bicycle?
A motorcycle or motor scooter?
An animal-drawn cart?
A car or truck?
A boat with a motor?
NO 2
NO 2
NO 2
NO 2
NO 2
121A. Does your household own this structure (house, flat, shack), do you rent it, or do you live here without pay?
PAYS RENT/LEASE 2
NO RENT, W. CONSENT OF OWNER 3
NO RENT, SQUATTING 4
121B. Does your household own the land on which the structure (house, flat, shack) sits?
PAYS RENT/LEASE 2
NO RENT, W. CONSENT OF OWNER 3
NO RENT, SQUATTING 4
122. Does any member of this household own any agricultural land?
NO 2 (SKIP TO 124)
123. How many hectares of land (altogether) are owned by the members of this family.
IF MORE THAN 95, WRITE '95.0'.
IF UNKNOWN, WRITE '99.8'.
124. Does this household own any livestock, herds, other farm animals, or poultry?
NO 2 (SKIP TO 125A)
125. How many of the following animals does this household own?
IF NONE, WRITE '00'.
IF MORE THAN 95, WRITE '95'.
IF UNKNOWN, WRITE '98'.
Local cattle (indigeneous)?
Milk cows or bulls?
Horses, donkeys, or mules?
Goats?
Sheep?
Chicken?
COWS/BULLS ___
HORSES/DONKEYS/MULES ___
GOATS ___
SHEEP ___
CHICKEN ___
125A. At any time in the past 12 months, has anyone come into your house to spray the inside walls against mosquitoes?
NO 2 (SKIP TO 127)
DON'T KNOW 8 (SKIP TO 127)
125B. How many months ago was the house sprayed?
IF LESS THAN ONE MONTH, WRITE '00'
PRIVATE COMPANY 2
OTHER (SPECIFY) ___________ 6
DON'T KNOW 8
127. Does your household have any mosquito nets that can be used while sleeping?
NO 2 (SKIP TO 138)
128. How many mosquito nets does your household have?
IF 7 OR MORE NETS, RECORD '7'.
129. ASK THE RESPONDENT TO SHOW YOU THE NETS IN THE HOUSEHOLD.
IF MORE THAN 3 NETS, USE ADDITIONAL QUESTIONNAIRE(S).
NET NOT OBSERVED 2
130. How many months ago did your household obtain the mosquito net?
IF LESS THAN ONE MONTH, RECORD '00'.
37 OR MORE MONTHS AGO 95
NOT SURE 98
131. OBSERVE OR ASK THE BRAND/TYPE OF MOSQUITO NET.
OLYSET 12 (SKIP TO 135)
SUPANET EXTRA 13 (SKIP TO 135)
OTHER/DK BRAND 16 (SKIP TO 135)
SUPANET 22 (SKIP TO 133)
UNBRANDED RURAL NET 23 (SKIP TO 133)
OTHER/DK BRAND 26 (SKIP TO 133)
DK BRAND 98
132. When you got the net, was it treated with an insecticide to kill or repel mosquitos?
NO 2
NOT SURE 8
133. Since you got the mosquito net, was it ever soaked or dipped in a liquid to kill or repel mosquitos?
NO 2 (SKIP TO 135)
NOT SURE 8 (SKIP TO 135)
134. How many months ago was the net last soaked or dipped?
IF LESS THAN ONE MONTH, RECORD '00'.
25 OR MORE MONTHS AGO 95
NOT SURE 98
134A. The last time the net was treated, was a liquid from a packet like this added to the treatment solution?
SHOW SACHET FOR K-O TAB 1-2-3 BINDING AGENT.
NO 2
NOT SURE 8
134B. The last time the net was treated, was it treated as part of a net retreatment campaign?
NO 2
NOT SURE 8
135. Did anyone sleep under this mosquito net last night?
NO 2 (SKIP TO 137)
NOT SURE 8 (SKIP TO 137)
136. Who slept under this mosquito net last night?
RECORD THE PERSON'S LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.
LINE NO. _____
137. GO BACK TO 129 FOR NEXT NET; OR, IF NO MORE NETS, GO TO 138.
138. ASK RESPONDENT FOR A TEASPOONFUL OF COOKING SALT.
TEST SALT FOR IODINE.
RECORD PPM (PARTS PER MILLION).
BELOW 15 PPM 2
15 PPM AND ABOVE 3
NO SALT IN HH 4
SALT NOT TESTED (SPECIFY REASON) _____________ 6
WEIGHT AND HEIGHT MEASUREMENT FOR CHILDREN AGE 0-5
501. CHECK COLUMN 10. RECORD THE LINE NUMBER AND AGE FOR ALL ELIGIBLE CHILDREN 0-5 YEARS IN QUESTION 502.
IF MORE THAN SIX CHILDREN, USE ADDITIONAL QUESTIONNAIRE. A FINAL OUTCOME MUST BE RECORDED FOR THE WEIGHT AND HEIGHT MEASUREMENT IN 508.
502. LINE NUMBER FROM COLUMN 10. NAME FROM COLUMN 2.
CHILD'S NAME ___________
503. IF MOTHER INTERVIEWED, COPY MONTH AND YEAR FROM BIRTH HISTORY AND ASK DAY; IF MOTHER NOT INTERVIEWED, ASK: What is (NAME'S) birth date?
MONTH _____
YEAR _____
504. CHECK 503:
CHILD BORN IN JANUARY 2003 OR LATER?
NO 2 (GO TO 503 FOR NEXT CHILD OR, IF NO MORE, GO TO 515)
507. MEASURED LYING DOWN OR STANDING UP?
STANDING UP 2
508. RESULT OF WEIGHT AND HEIGHT MEASUREMENT
NOT PRESENT 2
REFUSED 3
OTHER 6
514. GO BACK TO 503 IN NEXT COLUMN IN THIS QUESTIONNAIRE OR IN THE FIRST COLUMN OF THE ADDITIONAL QUESTIONNAIRE(S); IF NO MORE CHILDREN, GO TO 515.
WEIGHT, HEIGHT AND HIV TESTING FOR WOMEN AGE 15-49
515. CHECK COLUMN 9. RECORD THE LINE NUMBER AND NAME FOR ALL ELIGIBLE WOMEN IN 516. IF THERE ARE MORE THAN THREE WOMEN, USE ADDITIONAL QUESTIONNAIRE(S).
A FINAL OUTCOME MUST BE RECORDED FOR THE WEIGHT AND HEIGHT MEASUREMENT IN 519 AND FOR THE HIV TEST PROCEDURE IN 530.
516. LINE NUMBER (COLUMN 9).
NAME (COLUMN 2).
WOMAN'S NAME ________________
519. RESULT OF WEIGHT AND HEIGHT MEASUREMENT
NOT PRESENT 2
REFUSED 3
OTHER 6
18-49 YEARS 2 (GO TO 525)
521. MARITAL STATUS: CHECK COLUMN 8.
OTHER 2 (GO TO 525)
522. RECORD LINE NUMBER OF PARENT/OTHER ADULT RESPONSIBLE FOR ADOLESCENT. RECORD '00' IF NOT LISTED.
525. READ THE HIV TEST CONSENT STATEMENT. FOR NEVER-IN-UNION WOMEN AGE 15-17, ASK CONSENT FROM PARENT/OTHER ADULT IDENTIFIED IN 522 BEFORE ASKING RESPONDENT'S CONSENT.
PARENT/OTHER RESPONSIBLE ADULT REFUSED 2
RESPONDENT REFUSED 3
CONSENT STATEMENT FOR HIV TEST
READ CONSENT STATEMENT TO EACH RESPONDENT. CIRCLE CODE '1' IN 525 IF RESPONDENT CONSENTS TO THE HIV TEST AND CODE '3' IF SHE REFUSES.
FOR NEVER-IN-UNION WOMEN AGE 15-17, ASK CONSENT FROM THE PARENT OR OTHER ADULT IDENTIFIED AS RESPONSIBLE FOR THE ADOLESCENT (SEE 522) BEFORE ASKING THE ADOLESCENT FOR HER CONSENT. CIRCLE CODE '2' IN 525 IF THE PARENT (OTHER ADULT) REFUSES. CONDUCT THE TEST ONLY IF BOTH THE PARENT (OTHER ADULT) AND THE ADOLESCENT CONSENT.
As part of the survey we also are asking people all over the country to take an HIV test. HIV is the virus that causes AIDS. AIDS is a very serious illness. The HIV test is being done to see how big the AIDS problem is in Kenya.
For the HIV test, we need a few drops of blood from a finger. The equipment used in taking the blood is clean and completely safe. It has never been used before and will be thrown away after each test.
No names will be attached so we will not be able to tell you the test results. No one else will be able to know (your/NAME OF ADOLESCENT's) test results either.
If you want to know whether you have HIV, I can provide you with a list of nearby facilities offering counseling and testing for HIV. I will also give you a voucher for free services for you (and for your partner if you want) that you can use at any of these facilities.
Do you have any questions?
You can say yes to the test, or you can say no. It is up to you to decide.
Will you allow (NAME OF ADOLESCENT to) take the HIV test?
526. CHECK 525 AND PREPARE EQUIPMENT AND SUPPLIES FOR THE HIV TEST IF CONSENT HAS BEEN OBTAINED AND PROCEED WITH THE TEST.
A FINAL OUTCOME FOR THE HIV TEST PROCEDURE MUST BE RECORDED IN 530 FOR EACH ELIGIBLE WOMAN EVEN IF SHE WAS NOT PRESENT, REFUSED, OR COULD NOT BE TESTED FOR SOME OTHER REASON.
PUT THE 2ND BAR CODE LABEL ON THE RESPONDENT'S FILTER PAPER AND THE 3RD ON THE TRANSMITTAL FORM.
530. OUTCOME OF HIV TEST PROCEDURE
NOT PRESENT 2
REFUSED 3
OTHER 6
530A. CHECK 530: OUTCOME OF HIV TEST
BLOOD NOT TAKEN __ (GO TO NEXT WOMAN)
530B. READ THE CONSENT STATEMENT FOR ADDITIONAL TESTS. FOR NEVER-IN-UNION WOMEN AGE 15-17, ASK CONSENT FROM PARENT/OTHER ADULT IDENTIFIED IN 522 BEFORE ASKING RESPONDENT'S CONSENT.
PARENT/OTHER RESPONSIBLE ADULT REFUSED 2
RESPONDENT REFUSED 3
IF CONSENT HAS NOT BEEN GRANTED WRITE 'NO ADDITIONAL TEST' ON THE FILTER PAPER.
530D. GO BACK TO 517 IN NEXT COLUMN IN THIS QUESTIONNAIRE OR IN THE FIRST COLUMNS OF ADDITIONAL QUESTIONNAIRE(S); IF NO MORE WOMEN, GO TO 531.
CONSENT STATEMENT FOR ADDITIONAL TESTS
READ CONSENT STATEMENT TO EACH RESPONDENT. CIRCLE CODE '1' IN 530B IF RESPONDENT CONSENTS TO THE ADDITIONAL TESTS AND CODE '3' IF SHE REFUSES.
FOR NEVER-IN-UNION WOMEN AGE 15-17, ASK CONSENT FROM THE PARENT OR OTHER ADULT IDENTIFIED AS RESPONSIBLE FOR THE ADOLESCENT (SEE 522)
BEFORE ASKING THE ADOLESCENT FOR HER CONSENT. CIRCLE CODE '2' IN 530B IF THE PARENT (OTHER ADULT) REFUSES.
CIRCLE CODE '1' IN 530B IF BOTH THE PARENT (OTHER ADULT) AND THE ADOLESCENT CONSENT.
We ask you to allow Kenya National Bureau of Statistics to store part of the blood sample at the laboratory to be used for testing or research in the future. We are not certain about what tests might be done.
The blood sample will not have any name or other data attached that could identify (you/NAME OF ADOLESCENT). You do not have to agree.
If you do not want the blood sample stored for later use, (you/NAME OF ADOLESCENT) can still participate in the HIV testing in this survey. Will you allow us to keep the blood sample stored for later testing or research?
531. CHECK COLUMN 11. RECORD THE LINE NUMBER AND NAME FOR ALL ELIGIBLE MEN IN 532. IF THERE ARE MORE THAN THREE MEN, USE ADDITIONAL QUESTIONNAIRE(S).
A FINAL OUTCOME MUST BE RECORDED FOR THE HIV TEST PROCEDURE IN 545.
532. LINE NUMBER (COLUMN 11). NAME (COLUMN 2).
MAN'S NAME ________________
18-54 YEARS 2 (GO TO 540)
537. MARITAL STATUS: CHECK COLUMN 8.
OTHER 2 (GO TO 540)
538. RECORD LINE NUMBER OF PARENT/OTHER ADULT RESPONSIBLE FOR ADOLESCENT. RECORD '00' IF NOT LISTED.
540. READ THE HIV TEST CONSENT STATEMENT. FOR NEVER-IN-UNION MEN AGE 15-17, ASK CONSENT FROM PARENT/OTHER ADULT IDENTIFIED IN 538 BEFORE ASKING RESPONDENT'S CONSENT.
PARENT/OTHER RESPONSIBLE ADULT REFUSED 2
RESPONDENT REFUSED 3
541. CHECK 540 AND PREPARE EQUIPMENT AND SUPPLIES FOR THE HIV TEST IF CONSENT HAS BEEN OBTAINED AND PROCEED WITH THE TEST.
A FINAL OUTCOME FOR THE THE HIV TEST PROCEDURE MUST BE RECORDED IN 545 FOR EACH ELIGIBLE MAN EVEN IF HE WAS NOT PRESENT, REFUSED, OR COULD NOT BE TESTED FOR SOME OTHER REASON.
PUT THE 2ND BAR CODE LABEL ON THE RESPONDENT'S FILTER PAPER AND THE 3RD ON THE TRANSMITTAL FORM.
CONSENT STATEMENT FOR HIV TEST
READ CONSENT STATEMENT TO EACH RESPONDENT. CIRCLE CODE '1' IN 540 IF RESPONDENT CONSENTS TO THE HIV TEST AND CODE '3' IF HE REFUSES.
FOR NEVER-IN-UNION MEN AGE 15-17, ASK CONSENT FROM THE PARENT OR OTHER ADULT IDENTIFIED AS RESPONSIBLE FOR THE ADOLESCENT (SEE 538) BEFORE ASKING THE ADOLESCENT FOR HIS CONSENT. CIRCLE CODE '2' IN 540 IF THE PARENT (OTHER ADULT) REFUSES. CONDUCT THE TEST ONLY IF BOTH THE PARENT (OTHER ADULT) AND THE ADOLESCENT CONSENT.
As part of the survey we also are asking people all over the country to take an HIV test. HIV is the virus that causes AIDS. AIDS is a very serious illness. The HIV test is being done to see how big the AIDS problem is in Kenya.
For the HIV test, we need a few drops of blood from a finger. The equipment used in taking the blood is clean and completely safe. It has never been used before and will be thrown away after each test.
No names will be attached so we will not be able to tell you the test results. No one else will be able to know (your/NAME OF ADOLESCENT's) test results either.
If you want to know whether you have HIV, I can provide you with a list of nearby facilities offering counseling and testing for HIV. I will also give you a voucher for free services for you (and for your partner if you want) that you can use at any of these facilities.
Do you have any questions?
You can say yes to the test, or you can say no. It is up to you to decide.
Will you allow (NAME OF ADOLESCENT to) take the HIV test?
545. OUTCOME OF HIV TEST PROCEDURE
NOT PRESENT 2
REFUSED 3
OTHER 6
545A. CHECK 545: OUTCOME OF HIV TEST
BLOOD NOT TAKEN __ (GO TO NEXT MAN)
545B. READ THE CONSENT STATEMENT FOR ADDITIONAL TESTS WITH LEFTOVER BLOOD. FOR NEVER-IN-UNION MEN AGE 15-17, ASK CONSENT FROM PARENT/OTHER ADULT IDENTIFIED IN 538 BEFORE ASKING RESPONDENT'S CONSENT.
PARENT/OTHER RESPONSIBLE ADULT REFUSED 2
RESPONDENT REFUSED 3
IF CONSENT HAS NOT BEEN GRANTED WRITE 'NO ADDITIONAL TEST' ON THE FILTER PAPER.
545D. GO BACK TO 536 IN NEXT COLUMN IN THIS QUESTIONNAIRE OR IN THE FIRST COLUMNS OF ADDITIONAL QUESTIONNAIRE(S); IF NO MORE MEN, END INTERVIEW.
CONSENT STATEMENT FOR ADDITIONAL TESTS
READ CONSENT STATEMENT TO EACH RESPONDENT. CIRCLE CODE '1' IN 545B IF RESPONDENT CONSENTS TO THE ADDITIONAL TESTS AND CODE '3' IF HE REFUSES.
FOR NEVER-IN-UNION MEN AGE 15-17, ASK CONSENT FROM THE PARENT OR OTHER ADULT IDENTIFIED AS RESPONSIBLE FOR THE ADOLESCENT (SEE 538) BEFORE ASKING THE ADOLESCENT FOR HIS CONSENT. CIRCLE CODE '2' IN 545B IF THE PARENT (OTHER ADULT) REFUSES.
CIRCLE CODE '1' IN 545B ONLY IF BOTH THE PARENT (OTHER ADULT) AND THE ADOLESCENT CONSENT.
We ask you to allow Kenya National Bureau of Statistics to store part of the blood sample at the laboratory to be used for testing or research in the future. We are not certain about what tests might be done.
The blood sample will not have any name or other data attached that could identify (you/NAME OF ADOLESCENT). You do not have to agree.
If you do not want the blood sample stored for later use, (you/NAME OF ADOLESCENT) can still participate in the HIV testing in this survey. Will you allow us to keep the blood sample stored for later testing or research?