2019-20 LIBERIA DEMOGRAPHIC AND HEALTH SURVEY MAN'S QUESTIONNAIRE
GOVERNMENT OF LIBERIA
LIBERIA INSTITUTE OF STATISTICS AND GEO-INFORMATION SERVICES
PLACE NAME __________________
NAME OF HOUSEHOLD HEAD _________________
CLUSTER NUMBER ________________
HOUSEHOLD NUMBER __________________
NAME AND LINE NUMBER OF MAN __________________
DATE ________________
INTERVIEWER'S NAME _________________
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER ___________________(SPECIFY) 7
FINAL VISIT
DAY __________
MONTH __________
YEAR 20___
INTERVIWER NUMBER _____________
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER ___________________(SPECIFY) 7
TOTAL NUMBER OF VISITS ____________________
NUMBER _________________
Hello. My name is _______________________________________. I am working with the Liberia Institute of Statistics and Geo-Information Services. We are conducting a survey about health and other topics 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 the card that has already been given to your household.
Do you have any questions?
May I begin the interview now?
SIGNATURE OF INTERVIEWER ____________________
DATE ________________
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
SECTION 1. RESPONDENT'S BACKGROUND
101. RECORD THE TIME.
MINUTES ____________
102. How long have you been living continuously in (NAME OF CURRENT COUNTY)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.
ALWAYS 95 (SKIP TO 105)
VISITOR 96 (SKIP TO 105)
103. Just before you moved here, did you live in a city, in a town, or in a rural area?
TOWN 2
RURAL AREA 3
104. Before you moved here, which county did you live in?
BONG 02
GBARPOLU 03
GRAND BASSA 04
GRAND CAPE MOUNT 05
GRAND GEDEH 06
GRAND KRU 07
LOFA 08
MARGIBI 09
MARYLAND 10
MONTSERRADO 11
NIMBA 12
RIVER CESS 13
RIVER GEE 14
SINOE 15
OUTSIDE OF LIBERIA 96
105. In what month and year were you born?
DON'T KNOW MONTH 98
YEAR _________________
DON'T KNOW YEAR 9998
106. How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT
107. Have you ever attended school?
NO 2 (SKIP TO 111)
108. What is the highest level of school you attended: elementary, junior high, senior high, or higher?
JUNIOR HIGH (GRADES 7-9) 2
SENIOR HIGH (GRADES 10-12) 3
HIGH 4
109. What is the highest grade you completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'
HIGHER (SKIP TO 113)
111. Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT.
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?
ABLE TO READ ONLY PART OF THE SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE _________________(SPECIFY LANGUAGE) 4
BLIND/VISUALLY IMPAIRED 5
CODE '1' OR '5' CIRCLED (SKIP TO 114)
113. Do you read a newspaper or magazine at least once a week, less than once a week or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
114. Do you listen to the radio at least once a week, less than once a week or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
115. Do you watch television at least once a week, less than once a week or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
116. Do you own a mobile telephone?
NO 2 (SKIP TO 118)
117. Do you use your mobile phone for any financial transactions?
NO 2
118. Do you have an account in a bank or other financial institution that you yourself use?
NO 2
119. Have you ever used the internet?
NO 2 (SKIP TO 122)
120. In the last 12 months, have you used the internet?
IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.
NO 2 (SKIP TO 122)
121. During the last one month, how often did you use the internet: almost every day, at least once a week, less than once a week, or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
MUSLIM 2
TRADITIONAL RELIGION 3
NO RELIGION 4
OTHER __________________(SPECIFY) 6
123. 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
SAPRO 16
VAI 17
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 (SKIP TO 206)
DON'T KNOW 8 (SKIP TO 206)
202. Do you have any sons or daughters that you have fathered who are now living with you?
NO 2 (SKIP TO 204)
203a. How many sons live with you?
IF NONE, RECORD '00'.
b. And how many daughters live with you?
IF NONE, RECORD '00'.
204. Do you have any sons or daughters that you have fathered who are alive but do not live with you?
NO 2 (SKIP TO 206)
205a. How many sons are alive but do not live with you?
IF NONE, RECORD '00'.
b. And how many daughters are alive but do not live with you?
IF NONE, RECORD '00'.
206. Have you ever fathered a son or a daughter who was born alive but later died?
IF NO, PROBE: Any baby who cried, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?
NO 2 (SKIP TO 208)
DON'T KNOW 8 (SKIP TO 208)
207a. How many boys have died?
IF NONE, RECORD '00'
b. And how many girls have died?
IF NONE, RECORD '00'
208. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'.
HAS NOT HAD ANY CHILDREN (SKIP TO 301)
HAS HAD MORE THAN ONE CHILD (CONTINUE)
210. Did all of the children you have fathered have the same biological mother?
NO 2
a. HAS HAD MORE THAN ONE CHILD: How old were you when your first child was born?
b. HAS HAD ONLY ONE CHILD: How old were you when your child was born?
NO LIVING CHILDREN (SKIP TO 301)
a. MORE THAN ONE LIVING CHILD: How old is your youngest child?
b. ONLY ONE LIVING CHILD: How old is your child?
(YOUNGEST) CHILD IS AGE 3 YEARS OR OLDER (SKIP TO 301)
a. MORE THAN ONE LIVING CHILD: What is the name of your youngest child?
b. ONLY ONE LIVING CHILD: What is the name of your child?
216. When (NAME)'s mother was pregnant with (NAME), did she have any prenatal check-ups?
NO 2 (SKIP TO 218)
DON'T KNOW 8 (SKIP TO 218)
217. Were you ever present during any of those prenatal check-ups?
NOT PRESENT 2
218. Was (NAME) born in a hospital or health facility?
OTHER 2
219. 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 - the various ways or methods that a couple can use to delay or avoid a pregnancy. Have you ever heard of (METHOD)?
PROBE: Women can have an operation to avoid having any more children.
NO 2
02. Male Sterilization.
PROBE: Men can have an operation to avoid having any more children.
NO 2
03. IUD.
PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse which can prevent pregnancy for one or more years.
NO 2
04. Injectables, Depo.
PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
NO 2
05. Implants, Jadelle.
PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
NO 2
06. Pill.
PROBE: Women can take a pill every day to avoid becoming pregnant.
NO 2
07. Condom, Raincoat.
PROBE: Men can put a rubber sheath on their penis before woman business.
NO 2
08. Female Condom.
PROBE: Women can place a sheath in their vagina before man business.
NO 2
09. Emergency Contraception.
PROBE: As an emergency measure, within five days after they have unprotected man business, women can take special pills to prevent pregnancy.
NO 2
10. CycleBeads/Standard Days Method.
PROBE: A woman uses a string of colored beads to know the days she can get pregnant. On the days she can get pregnant, she uses a condom or does not do man business.
NO 2
11. Lactational Amenorrhea Method (LAM).
PROBE: Up to six months after childbirth, before the menstrual period has returned, women use a method requiring frequent breastfeeding day and night.
NO 2
12. Rhythm Method.
PROBE: To avoid pregnancy, women do not do man business on the days of the month they think they can get pregnant.
NO 2
13. Withdrawl.
PROBE: Man can be careful and pull out before climax.
NO 2
14. Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES, TRADITIONAL METHOD _________________(SPECIFY) B
NO Y
302. In the last few months have you:
NO 2
b. Seen anything about family planning on the television?
NO 2
c. Read about family planning in a newspaper or magazine?
NO 2
d. Recieved a voice or text message about family planning on a mobile phone?
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 (SKIP TO 306)
DON'T KNOW 8 (SKIP TO 306)
305. Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER ___________________(SPECIFY) 6
DON'T KNOW 8
306. After the birth of a child, can a woman become pregnant before her menstrual period has returned?
NO 2
DON'T KNOW 8
307. I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.
DISAGREE 2
DON'T KNOW 8
b. Women who use contraception may become promiscuous
DISAGREE 2
DON'T KNOW 8
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 (SKIP TO 404)
NO, NOT IN UNION
402. Have you ever been married or lived together with a woman as if married?
YES, LIVED WITH A WOMAN 2
NO 3 (SKIP TO 413)
403. What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2 (SKIP TO 410)
SEPARATED 3 (SKIP TO 410)
404. Is your (wife/partner) living with you now or is she staying elsewhere?
STAYING ELSEWHERE 2
405. Do you have other wives or do you live with other women as if married?
NO (ONLY ONE WIFE) 2 (SKIP TO 407)
406. Altogether, how many wives or live-in partners do you have?
a. ONE WIFE/PARTNER: Please tell me the name of (your wife/the 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 WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.
LINE NUMBER ________________
b. 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 WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.
LINE NUMBER ________________
408. How old was (NAME) on her last birthday?
MORE THAN ONE WIFE/PARTNER (SKIP TO 411)
410. Have you been married or lived with a woman only once or more than once?
ONLY ONCE 2
a. BOTH ARE CODE '2': In what month and year did you start living with your (wife/partner)?
DON'T KNOW MONTH 98
YEAR _______________ (SKIP TO 413)
DON'T KNOW YEAR 9998
b. OTHER: 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
YEAR _______________ (SKIP TO 413)
DON'T KNOW YEAR 9998
412. How old were you when you first started living with her?
413. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
414. I would like to ask some questions about sexual activity in order to gain a better understanding of some important life issues. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question. How old were you when you did woman business for the very first time?
AGE IN YEARS ______________________
415. I would like to ask you about your recent sexual activity. When was the last time you did woman business?
IF LESS THAN 12 MONTHS, ANSWERS MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.
WEEKS AGO 2 __________________________ (SKIP TO 417)
MONTHS AGO 3 __________________________ (SKIP TO 417)
YEARS AGO 4 _________________________ (SKIP TO 427)
416. When was the last time you did woman business with this person?
WEEKS AGO 2 ____________
MONTHS AGO 3 ____________
417. The last time you did woman business with this person, was a condom used?
NO 2 (SKIP TO 419)
418. Was a condom used every time you did woman business with this person in the last 12 months?
NO 2
419. What was your relationship to this person with whom you did woman business?
IF GIRLFRIEND: Were you living together as if married?
IF YES, RECORD '2'.
IF NO, RECORD '3'.
LIVE-IN PARTNER 2
GIRLFRIEND NOT LIVING WITH RESPONDENT 3
CASUAL ACQUAINTANCE 4
CLIENT/SEX WORKER 5
OTHER _____________(SPECIFY) 6
420. How long ago did you first do woman business with this person?
WEEKS AGO 2 ________________
MONTHS AGO 3 ________________
YEARS AGO 4 _______________
421. How many times during the last 12 months did you do woman business with this person?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF TIMES IS 95 OR MORE, RECORD '95'.
DON'T KNOW 98
423. Apart from this person, have you done woman business with any other person in the last 12 months?
NO 2 (SKIP TO 425)
424. In total, with how many different people have you done woman business in the last 12 months?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, RECORD '95'.
DON'T KNOW 98
NO PARTNERS ARE SEX WORKERS (SKIP TO 427)
426. CHECK 419 AND 417 (ALL COLUMNS):
OTHER (SKIP TO 431)
427. In the last 12 months, did you pay anyone in exchange for doing woman business?
NO 2
428. Have you ever paid anyone in exchange for doing woman business?
NO 2 (SKIP TO 431)
429. The last time you paid someone for doing woman business, was a condom used?
NO 2 (SKIP TO 431)
430. Was a condom used during woman business every time you paid someone in exchange for doing woman business in the last 12 months?
NO 2
DON'T KNOW 8
431. In the past 12 months have you given any gifts or other goods in order to do woman business or to become sexually involved with anyone?
NO 2
432. Have you ever given any gifts or other goods in order to do woman business or to become sexually involved with anyone?
NO 2
433. In total, with how many different people have you done woman business in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, RECORD '95'.
DON'T KNOW 98
434. CHECK 417: MOST RECENT PARTNER (FIRST COLUMN)
CONDOM USED (CONTINUE)
NO CONDOM USED (SKIP TO 438)
437. The last time you did woman business did you or your partner use any method other than a condom to avoid or prevent a pregnancy?
NO 2 (SKIP TO 440)
DON'T KNOW 8 (SKIP TO 440)
438. The last time you did woman business did you or your partner use any method to avoid or prevent a pregnancy?
NO 2 (SKIP TO 440)
DON'T KNOW 8 (SKIP TO 440)
439. What method did you or your partner use?
PROBBE: Did you or your partner use any other method to prevent prgnancy?
RECORD ALL MENTIONED.
MALE STERILIZATION B (SKIP TO 501)
IUD C (SKIP TO 501)
INJECTABLES D (SKIP TO 501)
IMPLANTS E (SKIP TO 501)
PILL F (SKIP TO 501)
CONDOM G (SKIP TO 501)
FEMALE CONDOM H (SKIP TO 501)
EMERGENCY CONTRACEPTION I (SKIP TO 501)
CYCLEBEADS/STANDARD DAYS METHOD J (SKIP TO 501)
LACTATIONAL AMENORRHEA METHOD K (SKIP TO 501)
RHYTHM METHOD L (SKIP TO 501)
WITHDRAWL M (SKIP TO 501)
OTHER MODERN METHOD X (SKIP TO 501)
OTHER TRADITIONAL METHOD Y (SKIP TO 501)
440. Do you know of a place where you can obtain a method of family planning?
NO 2
SECTION 5. FERTILITY PREFERENCES
501. CHECK 401:
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (SKIP TO 514)
MAN STERILIZED (SKIP TO 514)
MORE THAN ONE WIFE/PARTNER (SKIP TO 509)
504. Is your (wife/partner) currently pregnant?
NO 2 (SKIP TO 507)
DON'T KNOW 8 (SKIP TO 507)
505. Now I have some questions about the future. After the child you and your (wife/partner) are expecting now, would like to have another child, or would you prefer not to have any more children?
NO MORE 2 (SKIP TO 514)
UNDECIDED/DON'T KNOW 8 (SKIP TO 514)
506. After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?
YEARS 2 _________ (SKIP TO 514)
SOON/NOW 993 (SKIP TO 514)
OTHER _________________(SPECIFY) 996 (SKIP TO 514)
DON'T KNOW 998 (SKIP TO 514)
a. HAS FATHERED CHILDREN: Now I have some questions about the future. Would you like to have another child, or would you prefer not to have any more children?
NO MORE/NONE 2 (SKIP TO 514)
SAYS COUPLE CAN'T GET PREGNANT 3 (SKIP TO 514)
WIFE/PARTNER STERILIZED 4 (SKIP TO 514)
UNDECIDED/DON'T KNOW 8 (SKIP TO 514)
b. HAS NOT FATHERED CHILDREN: Now I have some questions about the future. Would you like to have a child, or would you prefer not to have any children?
NO MORE/NONE 2 (SKIP TO 514)
SAYS COUPLE CAN'T GET PREGNANT 3 (SKIP TO 514)
WIFE/PARTNER STERILIZED 4 (SKIP TO 514)
UNDECIDED/DON'T KNOW 8 (SKIP TO 514)
a. HAS FATHERED CHILDREN: How long would you like to wait from now before the birth of another child?
YEARS ___________ 2 (SKIP TO 514)
SOON/NOW 993 (SKIP TO 514)
SAYS COUPLE CAN'T GET PREGNANT 994 (SKIP TO 514)
OTHER _______________(SPECIFY) 996 (SKIP TO 514)
DON'T KNOW 998 (SKIP TO 514)
b. HAS NOT FATHERED CHILDREN: How long would you like to wait from now before the birth of a child?
YEARS ___________ 2 (SKIP TO 514)
SOON/NOW 993 (SKIP TO 514)
SAYS COUPLE CAN'T GET PREGNANT 994 (SKIP TO 514)
OTHER _______________(SPECIFY) 996 (SKIP TO 514)
DON'T KNOW 998 (SKIP TO 514)
509. Are any of your (wives/partners) currently pregnant?
NO 2 (SKIP TO 512)
DON'T KNOW 8 (SKIP TO 512)
510. Now I have some questions about the future. After the (child/children) you and your (wives/partners) are expecting now, would you like to have another child, or would you prefer not to have any more children?
NO MORE 2 (SKIP TO 514)
UNDECIDED/DON'T KNOW 8 (SKIP TO 514)
511. After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?
YEARS 2 ______________(SKIP TO 514)
SOON/NOW 993 (SKIP TO 514)
OTHER __________________(SPECIFY) 996 (SKIP TO 514)
DON'T KNOW 998 (SKIP TO 514)
a. HAS FATHERED CHILDREN: Now I have some questions about the future. Would you like to have another child, or would you prefer not to have any more children?
NO MORE/NONE 2 (SKIP TO 514)
SAYS COUPLE CAN'T GET PREGNANT 3 (SKIP TO 514)
(WIFE/WIVES/PARTNER(S)) STERILIZED 4 (SKIP TO 514)
UNDECIDED/DON'T KNOW 8 (SKIP TO 514)
b. HAS NOT FATHERED CHILDREN: Now I have some questions about the future. Would you like to have a child, or would you prefer not to have any children?
NO MORE/NONE 2 (SKIP TO 514)
SAYS COUPLE CAN'T GET PREGNANT 3 (SKIP TO 514)
(WIFE/WIVES/PARTNER(S)) STERILIZED 4 (SKIP TO 514)
UNDECIDED/DON'T KNOW 8 (SKIP TO 514)
a. HAS FATHERED CHILDREN: How long would you like to wait from now before the birth of another child?
YEARS 2 _______________
SOON/NOW 993
SAYS COUPLE CAN'T GET PREGNANT 994
OTHER ______________________(SPECIFY) 996
DON'T KNOW 998
b. HAS NOT FATHERED CHILDREN: How long would you like to wait from now before the birth of a child?
YEARS 2 _______________
SOON/NOW 993
SAYS COUPLE CAN'T GET PREGNANT 994
OTHER ______________________(SPECIFY) 996
DON'T KNOW 998
a. 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.
NUMBBER ______________
OTHER _____________(SPECIFY) 96 (SKIP TO 601)
b. 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.
NUMBBER ______________
OTHER _____________(SPECIFY) 96 (SKIP TO 601)
515. How many of these children would you like to be boys, how many would you like to be girls and how many would it not matter if it's a boy or a girl?
NUMBER OF GIRLS ________________
NUMBER OF EITHER _________________
OTHER ________________(SPECIFY) 96
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 (SKIP TO 607)
604. What is your occupation? That is, what kind of work do you mainly do?
605. Do you usually work throughout the year, or do you work seasonally, or only once in a while?
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3
606. Are you paid in cash or kind for this work or are you not paid at all?
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (SKIP TO 612)
OTHER (SKIP TO 608)
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) jiontly, or someone else?
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6
611. Who usually makes decisions about making major household purchases?
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6
612. Do you own this or any other house either alone or jointly with someone else?
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4 (SKIP TO 615)
613. Do you have a title deed for any house you own?
NO 2 (SKIP TO 615)
DON'T KNOW 8 (SKIP TO 615)
614. Is your name on the title deed?
NO 2
DON'T KNOW 8
615. Do you own any agricultural or non-agricultural land either alone or jointly with someone else?
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4 (SKIP TO 618)
616. Do you have a title deed for any land you own?
NO 2 (SKIP TO 618)
DON'T KNOW 8 (SKIP TO 618)
617. Is your name on the title deed?
NO 2
DON'T KNOW 8
618. In your opinion, is a husband justified in hitting or beating his wife in the following situations:
NO 2
DON'T KNOW 8
b. If she neglects the children?
NO 2
DON'T KNOW 8
c. If she argues with him?
NO 2
DON'T KNOW 8
d. If she refuses to have sex with him?
NO 2
DON'T KNOW 8
e. If she burns the food?
NO 2
DON'T KNOW 8
701. Now I would like to talk about something else. Have you ever heard of HIV or AIDS?
NO 2 (SKIP TO 727)
702. HIV is the virus that can lead to AIDS. Can people reduce their chance of getting HIV by having just one 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 HIV by using a condom every time they have sex?
NO 2
DON'T KNOW 8
705. Can people get HIV by sharing food with a person who has HIV?
NO 2
DON'T KNOW 8
706. Can people get HIV because of witchcraft or other supernatural means?
NO 2
DON'T KNOW 8
707. Is it possible for healthy-looking person to have HIV?
NO 2
DON'T KNOW 8
708. Can HIV be transmitted from a mother to her baby:
NO 2
DON'T KNOW 8
b. During delivery?
NO 2
DON'T KNOW 8
c. By breastfeeding?
NO 2
DON'T KNOW 8
OTHER (SKIP TO 711)
710. Are there any special drugs that a doctor or a nurse can give to a woman infected with HIV to reduce the risk of transmission to the baby?
NO 2
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 for HIV?
NO 2 (SKIP 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
715. Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
PUBLIC SECTOR
GOVERNMENT HEALTH CENTER 12 (SKIP TO 718)
GOVERNMENT HEALTH CLINIC 13 (SKIP TO 718)
STAND-ALONE VTC CENTER 14 (SKIP TO 718)
NATIONAL AIDS CONTROL PROGRAM 15 (SKIP TO 718)
OTHER PUBLIC SECTOR __________________________(SPECIFY) 16 (SKIP TO 718)
PRIVATE MEDICAL SECTOR
STAND-ALONE VTC CENTER 22 (SKIP TO 718)
PHARMACY 23 (SKIP TO 718)
PLANNED PARENTHOOD ASSN. LIB 24 (SKIP TO 718)
MOBILE CLINIC 25 (SKIP TO 718)
OTHER PRIVATE MEDICAL SECTOR _______________(SPECIFY) 26 (SKIP TO 718)
OTHER SOURCE
SHOP 32 (SKIP TO 718)
OTHER _________________________(SPECIFY) 96 (SKIP TO 718)
716. Do you know of a place where people can go to get an HIV test?
NO 2 (SKIP TO 718)
717. Where is that? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
PUBLIC SECTOR
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH CLINIC C
STAND-ALONE VTC CENTER D
NATIONAL AIDS CONTROL PROGRAM E
OTHER PUBLIC SECTOR __________________________ F
PRIVATE MEDICAL SECTOR
STAND-ALONE VTC CENTER H
PHARMACY I
PLANNED PARENTHOOD ASSN. LIB J
MOBILE CLINIC K
OTHER PRIVATE MEDICAL SECTOR _______________(SPECIFY) L
OTHER _________________________(SPECIFY) X
718. Have you heard of test kits people can use to test themselves for HIV?
NO 2 (SKIP TO 720)
719. Have you ever tested yourself for HIV using a self-test kit?
NO 2
720. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
721. Do you think children living with HIV should be allowed to attend school with children who do not have HIV?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
722. Do you think people hestitate to take an HIV test because they are afraid of how other people will react if the test result is positive for HIV?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
723. Do people talk badly about people living with HIV, or who are thought to be living with HIV?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
724. Do people living with HIV, or thought to be living with HIV, lose the respect of other people?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
725. Do you agree or disagree with the following statement: I would be ashamed if someone in my family had HIV.
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
726. Do you fear that you could get HIV if you come into contact with the saliva of a person living with HIV?
NO 2
SAYS HE HAS HIV 3
DON'T KNOW/NOT SURE/DEPENDS 8
NO 2
b. NOT HEARD ABOUT HIV OR AIDS: Have you heard about infections that can be transmitted through sexual contact?
NO 2
NEVER HAD SEXUAL INTERCOURSE (SKIP TO 736)
729. CHECK 727: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?
NO (SKIP TO 731)
730. Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?
NO 2
DON'T KNOW 8
731. Sometimes men experience an abnormal discharge from their penis. During the last 12 months, have you had an abnormal discharge from your penis?
NO 2
DON'T KNOW 8
732. Sometimes men have a sore or ulcer near this penis. During the last 12 months, have you had a sore or ulcer on or near your penis?
NO 2
DON'T KNOW 8
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (SKIP TO 736)
734. The last time you had (PROBLEM FROM 730/731/732), did you seek any kind of advice or treatment?
NO 2 (SKIP TO 736)
735. Where did you go? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
PUBLIC SECTOR
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH CLINIC C
STAND-ALONE VTC CENTER D
NATIONAL AIDS CONTROL PROGRAM E
OTHER PUBLIC SECTOR __________________________ F
PRIVATE MEDICAL SECTOR
STAND-ALONE VTC CENTER H
PHARMACY I
PLANNED PARENTHOOD ASSN. LIB J
MOBILE CLINIC K
OTHER PRIVATE MEDICAL SECTOR _______________(SPECIFY) L
OTHER SOURCE
OTHER _________________________(SPECIFY) X
736. If a wife knows her husband has disease that she can get from doing man business, is she justified in asking that htey use a condom when they do man business?
NO 2
DON'T KNOW 8
737. Is a wife justified in refusing to do man business with her husband when she knows he has sex with other women?
NO 2
DON'T KNOW 8
SECTION 8. OTHER HEALTH ISSUES
808. Do you currently smoke tobacco every day, some days, or not at all?
SOME DAYS 2
NOT AT ALL 3 (SKIP TO 810)
809. In the past, have you smoked tobacco every day?
NO 2 (SKIP TO 812)
810. In the past, have you ever smoked tobacco every day, some days, or not at all?
SOME DAYS 2 (SKIP TO 813)
NOT AT ALL 3 (SKIP TO 813)
811. On average, how many of the following products do you currently smoke each day? Also, let me know if you use the product, but not every day.
IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY DAY, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.
b. Kreteks?
c. Pipes full of tobacco?
d. Cigars, cheroots, or cigarillos?
e. Number of water pipe/shisha sessions?
f. Any others?
____________________________ (SKIP TO 813)
812. On average, how many of the following products do you currently smoke each week? Also, let me know if you use the product, but not every week.
IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY WEEK, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.
b. Kreteks?
c. Pipes full of tobacco?
d. Cigars, cheroots, or cigarillos?
e. Number of water pipe/shisha sessions?
f. Any others?
____________________________
813. Do you currently use smokeless tobacco every day, some days, or not at all?
SOME DAYS 2 (SKIP TO 815)
NOT AT ALL 3 (SKIP TO 815AA)
814. On average, how many times a day do you use the following products? Also, let me know if you use the product, but not every day.
IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY DAY, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.
b. Snuff, by nose?
c. Chewing tobacco?
d. Any others?
TIMES DAILY ______________________________(SKIP TO 815AA)
815. On average, how many times a week do you use the following products? Also, let me know if you use the product, but not every week.
IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY WEEK, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.
b. Snuff, by nose?
c. Chewing tobacco?
d. Any other?
TIMES WEEKLY _______________________
815AA. Have you ever heard of an illness called tuberculosis or TB?
NO 2 (SKIP TO 816)
815AB. What are the things that can happen to you when you have tuberculosis? Anything else?
RECORD ALL MENTIONED.
COUGHING UP BLOOD B
CHEST PAIN/PAINFUL BREATHING OR COUGHING C
WEIGHT LOSS D
FATIGUE E
FEVER F
NIGHT SWEATS G
OTHER ___________________________________(SPECIFY) X
DON'T KNOW Z
815AC. How does tuberculosis spread from one person to another? Any other way?
RECORD ALL MENTIONED.
THROUGH SHARING UTENSTILS B
THROUGH TOUCHING A PERSON WITH TB C
THROUGH FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER ______________________________(SPECIFY) X
DON'T KNOW Z
815AD. Can tuberculosis be cured?
NO 2
DON'T KNOW 8
815AE. If a member of your family got tuberculosis, would you want it to remain a secret or not?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
816. Are you covered by any health insurance?
NO 2 (SKIP TO 818)
817. What type of health insurance are you covered by?
RECORD ALL MENTIONED.
HEALTH INSURANCE THROUGH EMPLOYER B
SOCIAL SECURITY C
OTHER PRIVATELY PURCHASED COMMERICIAL HEALTH INSURANCE D
OTHER ______________________(SPECIFY) X
818. Do you currently possess a form of identity document for yourself, such as a birth certificate, voter card, or national ID?
NO 2 (SKIP TO 819B)
819A. Do you currently possess a:
NO 2 (CONTINUE TO 819BA)
b. Voter card
NO 2 (CONTINUE TO 819BB)
c. National ID
NO 2 (CONTINUE TO 819BC)
819B. Have you ever tried to obtain a [document from 819A]?
NO 2
b. Voter card
NO 2
c. National ID
NO 2
901. During the Ebola time in Liberia, which counties did you live in? Anywhere else?
RECORD ALL MENTIONED.
BONG B
GBARPOLU C
GRAND BASSA D
GRAND CAPE MOUNT E
GRAND GEDEH F
GRAND KRU G
LOFA H
MARGIBI I
MARYLAND J
MONTSERRADO K
NIMBA L
RIVER CESS M
RIVER GEE N
SINOE O
OUTSIDE OF LIBERIA Z
901A. CHECK 901: ONLY "Z - OUTSIDE OF LIBERIA" CIRCLED?
ONLY Z CIRCLED (SKIP TO 923)
902. Did you get sick with any illness during the Ebola time in Liberia?
NO 2 (SKIP TO 908)
903. In what month and year did you first get sick with the illness during Ebola time in Liberia?
DON'T KNOW MONTH 98
YEAR ___________________
DON'T KNOW YEAR 9998
904. In what county were you when you first got sick with the illness?
BONG 2
GBARPOLU 3
GRAND BASSA 4
GRAND CAPE MOUNT 5
GRAND GEDEH 6
GRAND KRU 7
LOFA 8
MARGIBI 9
MARYLAND 10
MONTSERRADO 11
NIMBA 12
RIVER CESS 13
RIVER GEE 14
SINOE 15
905. When you were sick with the illness, did you have symptoms like fever, vomiting, diarrhea, severe headache, muscle pain, stomach pain, or unexplained bleeding?
NO 2 (SKIP TO 908)
906. Did you seek advice or treatment or those symptoms from any source?
NO 2 (SKIP TO 908)
907. Where did you seek advice or treatment? Anywhere else?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
PUBLIC SECTOR
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH CLINIC C
MOBILE CLINIC D
RELATIVE/FRIEND/NEIGHBOR WHO IS A HEALTHCARE WORKER E
OTHER PUBLIC SECTOR ______________(SPECIFY) F
PRIVATE MEDICAL SECTOR
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
RELATIVE/FRIEND/NEIGHBOR WHO IS HEALTHCARE WORKER K
OTHER PRIVATE MEDICAL SECTOR _________________(SPECIFY) L
OTHER SOURCE
SHOP N
TRADITIONAL PRACTITIONER O
RELATIVE/FRIEND/NEIGHBOR WHO IS NOT A HEALTHCARE WORKER P
BLACK BAGGER/DRUG PEDDLER Q
OTHER _____________________(SPECIFY) X
908. Were you admitted to an Ebola treatment unit or ETU during the Ebola time in Liberia?
NO 2 (SKIP TO 911)
909. In what month and year were you admitted to an Ebola treatment unit or ETU?
DON'T KNOW MONTH 98
YEAR ____________________
DON'T KNOW YEAR 9998
910. In what county was the Ebola treatment unit or ETU?
BONG 2
GBARPOLU 3
GRAND BASSA 4
GRAND CAPE MOUNT 5
GRAND GEDEH 6
GRAND KRU 7
LOFA 8
MARGIBI 9
MARYLAND 10
MONTSERRADO 11
NIMBA 12
RIVER CESS 13
RIVER GEE 14
SINOE 15
911. Did any members of your household or other persons you were close to like relatives or friends get sick with any illness during the Ebola time in Liberia?
NO 2 (SKIP TO 915)
912. Were you in close contact with any of these people who got sick? By close contact I mean you took care of them when they were sick or shared, for example, the same bed, cooking utensils, or toilet facilities.
NO 2
913. Were any of these people who got sick admitted to an Ebola treatment unit or ETU?
NO 2
DON'T KNOW 8
914. Were you ever on a contact list, that is, did someone ever come to your house to take your temperature two times every day?
NO 2
DON'T KNOW 8
915. Did any members of your household, other relatives, or close friends die during the Ebola time in Liberia?
NO 2 (SKIP TO 918)
DON'T KNOW 8 (SKIP TO 918)
916a. How many members of your household died?
IF NONE, RECORD '00'.
b. How many other relatives died?
IF NONE, RECORD '00'.
c. How many close friends died?
IF NONE, RECORD '00'.
917. Did you attend any of the burials for these deaths?
NO 2
918. Did you ever receive the Ebola vaccine by PREVAIL?
NO 2 (SKIP TO 920)
919. In what month and year were you vaccinated for Ebola by PREVAIL?
DON'T KNOW MONTH 98
YEAR ______________
DON'T KNOW YEAR 9998
920. During the Ebola time in Liberia, did you work in an Ebola treatment unit or ETU?
NO 2
921. During the Ebola time in Liberia, did you work in a health facility that was not an Ebola treatment unit or ETU?
NO 2
921A. Have you ever worked in a health facility?
NO 2
922. During the Ebola time in Liberia, did you care for someone at home who had Ebola?
NO 2
922A. Have you ever gone to the bush to hunt or catch animals?
NO 2 (SKIP TO 923)
922B. What kinds of animals have you hunted or caught in the bush? Any other kind of animal?
RECORD ALL MENTIONED.
BAT B
BIRDS C
DEER D
GROUNDHOG E
MONKEY F
PORCUPINE G
OTHER X
922C. What did you do with the animal(s) once you caught (it/them)? Anything else?
RECORD ALL MENTIONED.
COOK THE ANIMAL B
EAT THE ANIMAL C
SELL THE ANIMAL D
OTHER X
MINUTES _____________
INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT INTERVIEW:
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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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EDITOR'S OBSERVATIONS:
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