LIBERIA INSTITUTE OF STATISTICS AND GEO-INFORMATION SERVICES
2013 LIBERIA DEMOGRAPHIC AND HEALTH SURVEY
MAN'S QUESTIONNAIRE
PLACE NAME_____
NAME OF HOUSEHOLD HEAD_____
LDHS CLUSTER NUMBER_______
HOUSEHOLD NUMBER_______
NAME AND LINE NUMBER OF MAN______________
FIRST VISIT
DATE_____
INTERVIEWER NAME_____
RESULT*_____
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY)_________
NEXT VISIT:
DATE _____
TIME_____
(REPEAT FOR SECOND AND THIRD VISITS)
FINAL VISIT:
DAY____
MONTH_____
YEAR 2013
INT. NUMBER______
RESULT____
FIELD EDITOR
NAME_____
OFFICE EDITOR_____
KEYED BY______
SECTION 1. RESPONDENT'S BACKGROUND
INTRODUCTION AND CONSENT
INFORMED CONSENT
Hello. My name is ______________________________. I am working with the Liberia Institute of Statistics and Geo-Information Services (LISGIS). We are conducting a survey about demographics and health all over Liberia. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 20 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.
In case you need more information about the survey, you may contact the person listed on this card.
Do you have any questions? May I begin the interview now?
SIGNATURE OF INTERVIEWER:____________________________ DATE:______________
RESPONDENT AGREES TO BE INTERVIEWED 1 (CONTINUE)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
MINUTES____
102) In what month and year were you born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
103) How old were you at your last birthday? COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT.
104) Have you ever attended school?
NO 2 (GO TO 108)
105) What is the highest level of school you attended: primary, secondary, or higher?
SECONDARY 2
HIGHER 3
106) What is the highest (grade/form/year) you completed at that level? IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.
SECONDARY (GO TO 110)
108) Now I would like you to read this sentence to me. SHOW CARD TO RESPONDENT.
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?
ABLE TO READ ONLY PARTS 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' CIRCLE (GO TO 111)
110) Do you read a newspaper or magazine at least once a week, less than a week or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
111) 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
112) 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
MUSLIM 2
TRADITIONAL RELIGION 3
NO RELIGION
OTHER (SPECIFY)_____ 6
114) What dialect do you speak (besides English?)
GBANDI 02
BELLE 03
DEY 04
GIO 05
GOLA 06
GREBO 07
KISSI 08
KPELLE 09
KRAHN 10
KRU 11
LORMA 12
MANDINGO 13
MANO 14
MENDE 15
SARPO 16
VAI
NONE/ONLY ENGLISH 18
OTHER 96
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 (GO TO 206)
DON'T KNOW (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'.
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 (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'.
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 or showed signs of life but did not survive?
NO 2 (GO TO 208)
DON'T KNOW 8 (GO 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 HAD ONLY ONE CHILD (GO TO 212)
HAS NOT HAD ANY CHILDREN (GO TO 301)
210) Did all of the children you have fathered have the same biological mother?
NO 2
211) In all, how many women have you fathered children with?
212) How old were you when your (first) child was born?
NO LIVING CHILDREN (GO TO 301)
214) How old is your (youngest) child?
OTHER (GO TO 301)
216) What is the name of your (youngest) child? WRITE NAME OF (YOUNGEST) CHILD
217) When (NAME)'s mother was pregnant with (NAME), did she have any prenatal check-ups?
NO 2 (GO TO 219)
DON'T KNOW 8 (GO TO 219)
218) Were you ever present during any of those prenatal check-ups?
NOT PRESENT 2
219) Was (NAME) born in a hospital or health facility?
OTHER 2
220) When a child has running stomach 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 or birth control - the various ways or methods that a couple can use to delay or avoid a pregnancy.
Have you ever heard of (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 2
NO 2
302) In the last few months have you:
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 does man business?
NO 2 (GO TO 306)
DON'T KNOW 8 (GO 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) I will now read some statements about contraception. Please tell me if you agree or disagree with each one.
DISAGREE 2
DON'T KNOW 8
DISAGREE 2
DON'T KNOW 8
307) CHECK 301 (07): KNOWS MALE CONDOM
NO (GO TO 401)
308) Do you know of a place where a person can get male condoms?
NO 2 (GO TO 401)
309) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER B
GOVT. CLINIC C
COMMUNITY HEALTH VOL/gCHV D
NACP E
OTHER PUBLIC SECTOR (SPECIFY) F
PHARMACY H
PRIVATE DOCTOR I
PLANNED PARENTHOOD ASSN. LIB. J
MOBILE CLINIC K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) L
CHURCH N
FRIENDS/RELATIVES O
OTHER (SPECIFY) X
310) If you wanted to, could you yourself get a condom?
NO 2
SECTION 4. MARRIAGE AND SEXUAL ACTIVITY
401) Are you currently married or living together with a woman as if married?
YES, LIVING WITH A WOMAN 2 (GO 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 (GO TO 413)
403) What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2 (GO TO 410)
SEPARATED 3 (GO 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) (GO TO 407)
406) Altogether, how many wives or live-in partners do you have?
ONE WIFE/PARTNER:
Please tell me the name of (your wife/the woman you are living with as if married).
MORE THAN ONE WIFE/PARTNER:
Please tell me the name of each of your wives or each woman you are living with as if married.
RECORD THE NAME AND THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE AND LIVE-IN PARTNER.
IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.
LINE NUMBER___
(Repeat as needed if more than one wife/partner)
How old was (NAME) on her last birthday?
(Record age for all wives/live-in partners)
MORE THAN ONE WIFE/PARTNER (GO TO 411A)
410) Have you been married or lived with a woman only once or more than once?
MORE THAN ONCE 2 (GO TO 411A)
411) In what month and year did you start living with your (wife/partner)?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
411A) Now I would like to ask about your first (wife/partner). In what month and year did you start living with her?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
412) How old were you when you first started living with her?
413) CHECK FOR THE PRESENCE OF OTHERS.
BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
414) Now I would like to ask some questions about woman business in order to gain a better understanding of some important life issues.
How old were you when you did woman business 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. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.
416) When was the last time you did woman business?
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___
MONTHS AGO 3___
YEARS AGO 4___ (GO TO 430)
417) When was the last time you did woman business with this person?
WEEKS AGO 2___
MONTHS AGO 3___
418) The last time you did woman business (with this second/third woman) did you use a condom?
NO 2 (GO TO 420)
419) Did you use a condom every time you did woman business with this person in the last 12 months?
NO 2
420) What was your relationship to this person with whom you did woman business?
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 (GO TO 423)
CASUAL ACQUAINTANCE 4 (GO TO 423)
CLIENT/PROSTITUTE 5 (GO TO 423)
OTHER (SPECIFY) 6 (GO TO 423)
MARRIED MORE THAN ONCE OR BLANK (GO TO 423)
OTHER (GO TO 423)
423) How long ago did you first do woman business with this (second/third) woman?
WEEKS AGO 2___
MONTHS AGO 3___
YEARS AGO 4___
424) How many times during the last 12 months have you done woman business with this woman?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF TIMES IS 95 OR MORE, WRITE '95'.
DON'T KNOW 98
426) Apart from (this person/these two people), have you had woman business with any other person in the last 12 months?
NO 2 (GO TO 428)
427) In the last 12 months, how many women have you done woman business with?
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 PROSTITUTES (GO TO 430)
429) CHECK 420 AND 418 (ALL COLUMNS)
OTHER (GO TO 434)
430) In the last 12 months, did you pay anyone in exchange for doing woman business?
NO 2
431) Have you ever paid anyone in exchange for doing woman business?
NO 2 (GO TO 434)
432) The last time you paid someone in exchange for doing woman business, did you use a condom?
NO 2 (GO TO 434)
433) Was a condom used for woman business every time you paid someone in exchange for doing woman business in the last 12 months?
NO 2
DON'T KNOW 8
434) In your whole life, how many women have you done woman business with?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, WRITE '95'.
DON'T KNOW 98
435) CHECK 418, MOST RECENT PARTNER (FIRST COLUMN):
NOT ASKED (GO TO 438)
NO CONDOM USED (GO TO 438)
436) You told me that a condom was used the last time you had sex. What is the brand name of the condom used at that time?
IF BRAND NOT KNOWN, ASK TO SEE THE PACKAGE.
MOH/NACP FREE 02
OTHER 96
DON'T KNOW 98
437) From where did you obtain the condom the last time?
PROBE TO IDENTIFY TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER 12
GOVT. CLINIC 13
NACP 14
PHARMACY 22
PRIVATE DOCTOR 23
PLANNED PARENTHOOD ASSN. LIB. 24
MOBILE CLINIC 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 26
CHURCH 32
FRIENDS/RELATIVES 33
438) The last time you had sex did you or your partner use any method (other than a condom) to avoid or prevent a pregnancy?
NO 2 (GO TO 501)
DON'T KNOW 8 (GO TO 501)
439) What method did you or your partner use?
PROBE: Did you or your partner use any other method to avoid pregnancy?
RECORD ALL MENTIONED.
MALE STERILIZATION B
IUD C
INJECTABLES D
IMPLANTS E
PILL F
CONDOM G
FEMALE CONDOM H
FOAM/JELLY I
CYCLEBEADS/STANDARD DAYS J
LACTATIONAL AMEN. METHOD K
RHYTHM METHOD L
WITHDRAWAL M
OTHER MODERN METHOD X
OTHER TRADITIONAL METHOD Y
SECTION 5. FERTILITY PREFERENCES
501) CHECK 401:
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (GO TO 509)
MAN STERILIZED (GO TO 509)
503) (Is your (wife/partner)/Are any of your (wives/partners)) currently pregnant?
NO 2 (GO TO 505)
DON'T KNOW 8 (GO TO 505)
504) Now I have some questions about the future. After the (child/children) you and your (wife(wives)/partner(s)) are expecting now, would you like to have another child, or would you prefer not to have any more children?
NO MORE 2 (GO TO 509)
UNDECIDED/DON'T KNOW (GO TO 509)
505) Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?
NO MORE/NONE 2 (GO TO 509)
SAYS COUPLE CAN'T GET PREGNANT 3 (GO TO 509)
WIFE (WIVES)/PARTNER(S) STERILIZED 4 (GO TO 509)
UNDECIDED/DON'T KNOW 8 (GO TO 509)
MORE THAN ONE WIFE/PARTNER (GO TO 508)
WIFE/PARTNER NOT PREGNANT OR DON'T KNOW:
YEARS 2___ (GO TO 509)
SOON/NOW 993 (GO TO 509)
COUPLE INFECUND 994 (GO TO 509)
OTHER (SPECIFY) 996 (GO TO 509)
DON'T KNOW 998 (GO TO 509)
WIFE/PARTNER PREGNANT:
YEARS 2___ (GO TO 509)
SOON/NOW 993 (GO TO 509)
COUPLE INFECUND 994 (GO TO 509)
OTHER (SPECIFY) 996 (GO TO 509)
DON'T KNOW 998 (GO TO 509)
508) How long would you like to wait from now before the birth of (a/another) child?
YEARS 2___ (GO TO 509)
SOON/NOW 993 (GO TO 509)
COUPLE INFECUND 994 (GO TO 509)
OTHER (SPECIFY) 996 (GO TO 509)
DON'T KNOW 998 (GO TO 509)
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?
PROBE FOR A NUMERIC RESPONSE.
NUMBER___
OTHER (SPECIFY) 96 (GO TO 601)
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.
NUMBER___
OTHER (SPECIFY) 96 (GO TO 601)
510) How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter if it's a boy or a girl?
GIRLS
EITHER
SECTION 6. EMPLOYMENT AND GENDER ROLES
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 leave, illness, vacation, or any other such reason?
NO 2
603) Have you done any work in the last 12 months?
NO 2 (GO 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 kind of work or are you not paid at all?
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4
CURRENTLY MARRIED OR LIVING WITH A PARTNER (GO TO 608)
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (GO TO 612)
CODE 1 OR 2 CIRCLED (GO TO 609)
OTHER (GO 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 joint with someone else?
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4
614) In your opinion, is a husband justified in hitting or beating his wife in the following situations:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
701) Now I would like to talk about something else. Have you ever heard of an illness called AIDS?
NO 2 (GO TO 723)
702) Can people reduce their chance of getting the AIDS virus by having just on uninfected sex partner who has no other sex partners?
NO 2
DON'T KNOW 8
703) Can people get HIV from mosquito bites?
NO 2
DON'T KNOW 8
704) Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?
NO 2
DON'T KNOW 8
705) Can people get the AIDS virus by sharing food with a person who has AIDS?
NO 2
DON'T KNOW 8
706) Can people get the AIDS virus because of witchcraft or other supernatural means?
NO 2
DON'T KNOW 8
707) Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DON'T KNOW 8
708) Can the virus that causes AIDS be transmitted from a mother to her baby:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
OTHER (GO TO 711)
710) 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
DON'T KNOW 8
711) CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
712) I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?
NO 2 (GO TO 716)
713) How many months ago was your most recent HIV test?
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.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
GOVT. HEALTH CENTER 12 (GO TO 718)
GOVT. HEALTH CLINIC 13 (GO TO 718)
STAND-ALONE VCT CENTER 14 (GO TO 718)
NACP 15 (GO TO 718)
OTHER PUBLIC SECTOR (SPECIFY) 16 (GO TO 718)
PRIVATE DOCTOR 22 (GO TO 718)
STAND-ALONE VCT CENTER 23 (GO TO 718)
PHARMACY 24 (GO TO 718)
PLANNED PARENTHOOD ASSN. LIB 25 (GO TO 718)
MOBILE CLINIC 26 (GO TO 718)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 27 (GO TO 718)
716) Do you know of a place where people can go to get tested for the AIDS virus?
NO 2 (GO TO 718)
717) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
GOVT. HEALTH CENTER B
GOVT. HEALTH CLINIC C
STAND-ALONE VCT CENTER D
NACP E
OTHER PUBLIC SECTOR (SPECIFY) F
PRIVATE DOCTOR H
STAND-ALONE VCT CENTER I
PHARMACY J
PLANNED PARENTHOOD ASSN. LIB K
MOBILE CLINIC L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) M
718) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?
NO 2
DON'T KNOW 8
719) If a member of your family got infected with the AIDS virus, would you want it to remain a secret or not?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
720) If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
721) 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
DON'T KNOW/NOT SURE/DEPENDS 8
722) Should children age 12-24 be taught about using a condom to avoid getting AIDS?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
HEARD ABOUT AIDS:
Apart from AIDS, have you heard about other infections that can be transmitted through woman business?
NO 2
NOT HEARD ABOUT AIDS:
Have you heard about infections that can be transmitted through woman business?
NO 2
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 732)
725) CHECK 723: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?
NO (GO TO 727)
726) Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through woman business?
NO 2
DON'T KNOW 8
727) Sometimes men experience an abnormal discharge from their penis/private parts. During the last 12 months, have you had an abnormal discharge from your penis/private parts?
NO 2
DON'T KNOW 8
728) Sometimes men have a sore or ulcer near their penis/private parts. During the last 12 months, have you had a sore or ulcer near your penis/private parts?
NO 2
DON'T KNOW 8
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 732)
730) The last time you had (PROBLEM FROM 726/727/728), did you seek any kind of advice or treatment?
NO 2 (GO TO 732)
731) Where did you go? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
GOVT. HEALTH CENTER B
GOVT. HEALTH CLINIC C
STAND-ALONE VCT CENTER D
OTHER PUBLIC SECTOR (SPECIFY) E
PRIVATE DOCTOR G
STAND-ALONE VCT CENTER H
PHARMACY I
PLANNED PARENTHOOD ASSN. LIB J
MOBILE CLINIC K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) L
TRADITIONAL PRACTITIONER N
BLACK BAGGER/DRUG PEDDLER O
732) If a wife knows her husband has a disease that she can get doing man business, is she justified in asking that they a use condom when they do man business?
NO 2
DON'T KNOW 8
733) Is a wife justified in refusing to man business with her husband when she knows he has sex with women other than his wives?
NO 2
DON'T KNOW 8
SECTION 8. OTHER HEALTH ISSUES
801) Some men are circumcised, that is, the foreskin is completely removed from the penis. Are you circumcised?
NO 2
DON'T KNOW 8 (GO TO 805)
802) 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 (GO TO 805)
803) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?
IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (GO TO 805)
804) The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?
NO 2
DON'T KNOW 8
805) Do you currently smoke cigarettes?
NO 2 (GO TO 807)
806) In the last 24 hours, how many cigarettes did you smoke?
807) Do you currently smoke or use any (other) type of tobacco?
NO 2 (GO TO 809)
808) What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.
CHEWING TOBACCO B
SNUFF C
CIGAR D
OTHER (SPECIFY) X
809) Now I would like to ask you a few questions about drinking alcohol. In the past month, have you drunk alcohol such as beer, palm wine, or liquor?
NO 2 (GO TO 812)
810) In the past month, how often have you drunk alcohol?
PROBE: How many times in a month?
ALMOST EVERY DAY 2
1-2 TIMES A WEEK 3
2-3 TIMES A MONTH
ONCE A MONTH 5
811) When you did drink alcohol, how many drinks did you usually have?
We count one drink as one can or bottle of beer, one glass of wine, or one shot of liquor.
812) Are you covered by any health insurance?
NO 2 (GO TO 814)
813) 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
MINUTES___
INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT RESPONDENT: ___________
COMMENTS ON SPECIFIC QUESTIONS: __________
ANY OTHER COMMENTS: _______
SUPERVISOR'S OBSERVATIONS:__________
NAME OF SUPERVISOR: ___
DATE: _______
EDITOR'S OBSERVATIONS:_________
NAME OF EDITOR: __________
DATE: _________