PLANNING AND STATISTICAL UNIT/M-HEALTH
NATIONAL DEPARTMENT OF STATISTICS AND INFORMATION
REPUBLIC OF MALI
PLACE NAME__
COMMUNE__
CLUSTER NUMBER___
HOUSEHOLD NUMBER______
RURAL 2
OTHER CITIES 2
OTHER VILLAGES 3
RURAL 4_____
LAST/FIRST NAME AND LINE NUMBER OF MAN__
INTERVIEWER 1 (REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR 2006
INTERVIEWER NAME____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY FILLED OUT 5
INCAPABLE 6
OTHER (SPECIFY)__ 7
NEXT VISIT [FOR INTERVIEWERS 1 AND 2]
DATE__
TIME__
FINAL VISIT
DAY__
MONTH__
YEAR 2006
INTERVIEWER__
RESULT__
LANGUAGE OF QUESTIONNAIRE: FRENCH 1
BAMBARA/MALINKE 02
SONRAI/DJERMA 03
PEUHL/FOULFOULDE 04
SENOUFO 05
MARIKA/SONINKE 06
DOGON 07
MINIANKA 08
TAMACHECK/BELLA 09
BOBO/DAFING 10
BOZO/SONOMO 11
OTHER 96
NO 2
FIELD EDITOR
NAME__
DATE__
OFFICE EDITOR__
KEYED BY___
CONSENT STATEMENT AFTER INFORMATION:
Hello. My name is__ and I work for the Minister of Health and the Minister of Planning. We are conducting a national survey that asks about the health of men, women and children. We would very much appreciate your participation in this survey. I would like to ask you questions about your health (and that of your children). This information will be useful to the government for planning health services. The interview usually takes 20-45 minutes. The information that you give us will be strictly confidential.
Participation in this survey is voluntary and you can refuse to respond to particular questions or to all of the questions. We hope, however, that you will accept to participate in this survey because your opinion is important to us.
Do you have questions about the survey?
Can I begin the interview now?
Signature of interviewer__ Date__
THE RESPONDENT REFUSES TO RESPOND 2 END.
MINUTES__
To begin, I would like to ask you questions about yourself and your household.
102. Until the age of 12 years, did you live the majority of the time in Bamako, in another capital, in a city or in a rural area?
IF A CITY OR CAPITAL ASK THE NAME OF THE CITY.
CAPITAL OTHER COUNTRY 2
OTHER CITIES 3
RURAL AREA 4
103. How long have you been living continuously in (NAME OF CURRENT CITY/VILLAGE OF RESIDENCE)?
IF LESS THAN A YEAR, WRITE 00 YEAR.
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)
104. Just before you moved here, did you live in Bamako, another capital, a city, or village?
IF A CITY, ASK THE NAME OF THE CITY
CAPITAL OTHER COUNTRY 2
OTHER CITIES 3
RURAL AREA 4
105. During the last 12 months, how many times have you travelled outside of your locality and slept elsewhere than at your home?
NO TRIPS 00 (GO TO 107)
106. During the past 12 months, have you been outside of your locality for a whole month?
NO 2
107. In which month and in which 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
NO 2 (GO TO 113)
110. What is the highest level of school you attended: primary (first cycle), primary (second cycle), secondary (high school or technical) or superior?
PRIMARY 2 (SECOND CYCLE) 2
SECONDARY (HIGHSCHOOL/TECHINCAL) 3
SUPERIOR 4
111. What is the last (year/grade) that you achieved at this level?
PRIMARY 2 OR MORE (GO TO 116)
113. Now I would like you to read this sentence out loud: read as much as you can.
SHOW THE CARD TO THE RESPONDENT. (3)
IF THE RESPONDENT CAN NOT READ THE WHOLE PHRASE INSIST: Can you read certain parts of the phrase to me?
CAN READ SOME PARTS 2
CAN READ THE WHOLE PHRASE 3
NO CARD IN THE RIGHT LANGUAGE (SPECIFY LANGUAGE)__4
BLIND 5
114. Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)? (4)
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 from which you make money?
NO 2
120. During the last 12 months did you have a job, any type, from which you made money?
NO 2
121. What did you do most of the time during the last 12 months?
LOOK FOR WORK 2 (GO TO 129)
INACTIVE 3 (GO TO 129)
COULD NOT WORK/HANDICAPPED 4 (GO TO 129)
DOMESTIC WORK/CHILDCARE 5 (GO TO 129)
OTHER (SPECIFY)__6
122. What is (was) your occupation, that is to say, what kind of work do (did) you mainly do?
DOES NOT WORK IN AGRICULTURE (GO TO 125)
124. Do you work on your own land, or your family's land, or land that you rent, or someone else's land?
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
OTHER 6
125. During the last 12 months, how many did you work?
126. Are you paid in cash or in kind for this work or are you not paid at all?
MONEY AND KIND 2
IN KIND ONLY 3 (GO TO 129)
NOT PAID 4 (GO TO 129)
127. Who decides how the money you earn will be used?
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE TOGETHER 5
128. On average, how much of your household 's expenses are paid by what you earn: almost nothing, less than half, about half, more than half or all?
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL 5
NONE, ALL EARNINGS ARE KEPT 6
CHRISTIAN 2
ANIMIST 3
NO RELIGION 4
OTHER (SPECIFY) __6
131. What is your ethnicity (for Malians)/your nationality (for foreigners)?
MALINKE 02
PEUHL 03
SARAKOLE/MARKA 04
SONRAÏ 05
DOGON 06
TAMACHEK 07
SÉNOUGO/MINIANKA 08
BOBO 09
OTHER (SPECIFY)__96
OTHER AFRICAN COUNTRY 11
OTHER NATIONALITIES 12
132. What language do you mostly speak at home?
MALINKE 02
PEUHL 03
SARAKOLE/MARKA 04
SONRAÏ 05
DOGON 06
TAMACHEK 07
SÉNOUGO/MINIANKA 08
BOBO 09
OTHER (SPECIFY)__96
Now I would like to ask you questions about your children. I am only interested in the children of whom you are the biological father.
201. Do you have or have you had any children?
NO 2 (GO TO 206)
DOESN'T KNOW (GO TO 206)
202. Do you have any sons or daughters of whom you are the father and who are now living with you?
NO 2 (GO TO 204)
203. How many sons live with you?
How many daughters live with you?
IF NONE, RECORD '00'
DAUGHTERS AT HOME__
204. Do you have any sons or daughters to whom you have given birth and 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?
How many daughters are alive but do not live with you?
IF NONE, RECORD '00'
DAUGHTERS ELSEWHERE__
206. Did you have a son or daughter who was born alive but later died?\
IF NO, PROBE: Any who cried and showed signs of live at birth but only survived a few hours or days?
NO 2 (GO TO 208)
DOESN'T KNOW (GO TO 208)
207. How many sons have died?
And how many daughters have died?
IF NONE, RECORD '00'
DAUGHTERS DEAD__
208. (Besides the children that you just mentioned), did you have:
A) other sons or daughters who are still alive, of whom you are the biological father, but whom you would not recognize or who do not carry your name?
B) other sons or daughters who were born alive and who died later, of whom you are the biological father, but whom you would not recognize or who do not carry your name?
YES IN AT LEAST ONE OF THE CASES PROBE AND CORRECT 201 TO 207.
209. SUM ANSWERS TO Q.203, 205, AND 207 AND RECORD THE TOTAL
IF NONE, RECORD '00'.
ONLY HAD ONE CHILD (GO TO 213)
DID NOT HAVE ANY CHILDREN (GO TO 301)
211. Do all of the children of whom you are the biological father have the same biological mother?
NO 2
212. In all, with how many women have you had children with?
213. How old were you when your first child was born?
Now I would like to talk to you about family planning- the various ways or methods that a couple can use to delay or avoid a pregnancy.
CIRCLE CODE 1 ON LINE 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN CONTINUE DOWN COLUMN 301 READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF THE METHOD IS RECOGNIZED AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.
301. Which methods have you heard about? FOR THE METHODS SPONTANEOUSLY MENTIONED, ASK: Have ever heard about (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
(SPECIFY)__
302. Have you ever used (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
DOESN'T KNOW 8
NO 2
NO 2
NO 2
Now I would like to ask you questions about the risks 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 intercourse?
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 has ended, or halfway between two periods?
DURING HER PERIOD 2
JUST AFTER THE END OF HER PERIOD 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY)__6
DOESN'T KNOW 8
Now I would like to read you some declarations about contraception.
306. Could you tell me if you agree or disagree with each one of these declarations?
DISAGREES 2
DOESN'T KNOW 8
DISAGREES 2
DOESN'T KNOW 8
DISAGREES 2
DOESN'T KNOW 8
SECTION 4. MARRIAGE AND SEXUAL ACTIVITY
401. Are you currently married or do you currently live with a woman?
YES, LIVES WITH A WOMAN 2 (GO TO 404)
NO, NOT IN UNION 3 (GO TO 406)
402. How many wives do you currently have?
IF ONLY ONE, RECORD '01'.
403. Are there other women with whom you live as if you are married?
NO 2
404. With how many women do you live as if married?
IF ONLY ONE WIFE/PARTNER, RECORD '01'
405. Besides your wife/wives/partner(s) that you declared, do you currently have other women (another woman) with whom you have sexual intercourse regularly or occasionally?
OCCASIONAL PARTNER(S) ONLY 2 (GO TO 409)
REGULAR AND OCCASIONAL PARTNERS 3 (GO TO 409)
NO OTHER SEXUAL PARTNERS 4 (GO TO 409)
406. Do you currently have a regular sexual partner, and occasional sexual partner, or no sexual partner at all?
OCCASIONAL PARTNER(S) ONLY 2
REGULAR AND OCCASIONAL PARTNERS 3
NO OTHER SEXUAL PARTNERS 4
407. Have you ever been married or lived with a woman?
YES, HAS ONLY LIVED WITH A WOMAN 2 (GO TO 411)
YES, BOTH 3
NO 4 (GO TO 416)
408. What is your current marital situation: are you widowed, divorced or separated?
DIVORCED 2 (GO TO 411)
SEPARATED 3 (GO TO 411)
409. LOOKING AT THE HOUSEHOLD QUESTIONNAIRE, WRITE THE NAME AND LINE NUMBER OF EACH WIFE/PARTNER DECLARED IN QUESTIONS 402 AND 404 ONLY. IF A WIFE/PARTNER DOES NOT LIVE IN THE HOUSEHOLD, RECORD '00' IN THE BOXES CORRESPONDING TO THIS WIFE/PARTNER. THE NUMBER OF FILLED IN BOXES MUST BE EQUAL TO THE NUMBER OF WIVES AND PARTNERS.
[REPEAT QUESTIONS 410 AND 410A FOR EACH ELIGIBLE WIFE/PARTNER]
THE SUM OF 402 AND 404 EQUALS 1
Please, tell me the name of you wife/partner.
THE SUM OF 402 AND 404 EQUALS 2 OR MORE.
Please, tell me the name of your wives and partners with whom you live. Begin with the first one with whom you lived.
PARTNER 2
PARTNER 2
410A. How old was your wife/partner at her last birthday?
TWO OR MORE WIVES/PARTNERS (GO TO 414)
411. Have you been married or lived with a woman only once or more than once?
MORE THAN ONCE 2
MARRIED/LIVED WITH ONE WOMAN ONLY ONCE AND 411=1
In which month in which year did you begin living with your wife/partner?
OTHER
I would like to talk about when, for the first time, you were married/began to live with a woman as if married. In which month and in which year were you married/did you begin to live with a woman for the first time?
DOESN'T KNOW THE MONTH 98
DOESN'T KNOW THE YEAR 9998
415. How old were you when you began to live with her?
Now I would like to ask you some questions about your sexual activity in order to better understand certain problems in family life.
416. How old were you when you had sexual intercourse for the first time (if you have already had sexual intercourse)?
416A. Do you intend to wait to be married to begin having sexual intercourse?
NO 2 (GO TO 439)
DOESN'T KNOW/NOT SURE 8 (GO TO 439)
AGE 25-59 (GO TO 417)
416C. The last time you had sexual intercourse, was a condom used?
NO 2
DOESN'T KNOW 98
416D. How old was the person with whom you had sexual intercourse for the first time?
DOESN'T KNOW 98
416E. Was this person older, younger or about the same age as you?
YOUNGER 2 (GO TO 417)
SAME AGE 3 (GO TO 417)
DOESN'T KNOW/CANNOT REMEMBER 8 (GO TO 417)
416F. Would you say that this person was older than you by ten or more years or by less than ten years?
LESS THAN 10 YEARS 2
OLDER, DOESN'T KNOW HOW MUCH 3
417. When did you last have sex?
IF IT WAS 12 MONTHS AGO OR MORE, THE RESPONSE MUST BE CONVERTED AND RECORDED IN YEARS,
2__WEEKS AGO
3__MONTHS AGO
4__YEARS AGO (GO TO 436A)
[REPEAT QUESTIONS 418-434 FOR UP TO THREE PEOPLE]
418. The last time you had sexual intercourse with this (second, third) person, was a condom used?
NO 2 (GO TO 421)
419. What was the main reason why you used a condom at this time?
RESPONDENT WANTS TO AVOID PREGNANCY 2
RESPONDENT WANTS TO AVOID BOTH MST/AIDS AND PREGANCY 3
DID NOT TRUST PARTNER/SUSPECTED PARTNER TO HAVE OTHER PARTNERS 4
PARTNER INSISTED 5
OTHER(SPECIFY)__6
DOESN'T KNOW 8
420. Have you used a condom each time you had sex with this person during the past 12 months?
NO 2
RESPONDENT STERILIZED (GO TO 426)
CONDOM USED TO AVOID PREGNANCY ('2' OR '3' CIRCLED)
The last time you had sexual intercourse with this woman, did you or your partner use another method besides a condom to avoid pregnancy?
OTHER ('1,' '4,' '5,' '6,' OR '8' CIRCLED OR 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)
IF MORE THAN ONE METHOD WAS USED, CIRCLE THE CODE THE METHOD THAT COMES FIRST IN THIS LIST.
PILL 03
IUD 04
INJECTIONS 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATION AMEN. METHOD 11
RHYTHM METHOD 12
WITHDRAWAL 13
OTHER METHOD 96
DOESN'T KNOW 98
OTHER (GO TO 425)
425. What is the main reason why you did not use a method of contraception to avoid pregnancy?
CONTRACEPTION IS A WOMAN'S ISSUE 12
NO NEED, A CONDOM WAS USED TO AVOID MST/AIDS 13
COUPLE UNDER FERTILE/STERILE 24
WIFE/PARTNER WAS/IS PREGNANT 25
WIFE/PARTNER POSTPARTUM AMENORRHEA 26
WIFE/PARTNER BREASTFED 27
WANTED (OTHER) CHILDREN 28
WIFE/PARTNER OPPOSED 32
OTHER PEOPLE OPPOSED 33
RELIGIOUS INTERDICTION 34
KNOWS NO SOURCE 42
FEAR OF SECONDARY EFFECTS 52
NOT ACCESSIBLE/TOO FAR 53
TOO EXPENSIVE 54
NOT PRACTICAL TO USE 55
INTERFERES WITH BODY'S NATURAL PROCESSES 56
DOESN'T KNOW 98
426. The last time you had sexual intercourse with this (second, third) person, did you or this person drink alcohol?
NO 2 (GO TO 428)
427. Were you or this person drunk at that time?
IF YES: who was drunk?
ONLY PARTNER 2
RESPONDENT AND PARTNER 3
NEITHER 4
427A. Did you pay in kind or in money?
NO 2
428. What was your relationship with the person with whom you had sexual intercourse?
PARTNER LIVING WITH RESPONDENT 02 (GO TO 434)
GIRLFRIEND NOT LIVING WITH RESPONDENT 03
OCCASIONAL ENCOUNTER 04
SEX PROFESSIONAL 05
OTHER (SPECIFY)__96
IF GIRLFRIEND: Do you live together as if you were married?
IF NO, CIRCLE '03
429. For how long have you been having sex with this person?
IF THE RESPONDENT ONLY HAD SEX ONCE, RECORD '01' DAY.
MONTHS 2__
YEARS 3__
434. Besides (this/these two people) have you had sexual intercourse with someone else during the past 12 months?
NO 2 (GO TO 436)
435. In all, with how many people have you had sexual intercourse during the last 12 months?
IN THE CASE OF A NON NUMERIC RESPONSE, PROBE TO GET AN ESTIMATE.
IF THE NUMBER IS MORE THAN '95', RECORD '95'
DOESN'T KNOW 98
436. CHECK 428 ALL THE COLUMNS:
AT LEAST ONE PARTNER IS A SEX PROFESSIONAL (AT LEAST ONE '05' IS CIRCLED) (GO TO 438)
436A. During the last 12 months, did you pay someone in exchange for sex?
NO 2 (GO TO 438)
436B. The last time you paid someone in exchange for sex, was a condom used?
NO 2 (GO TO 438)
436C. During the last 12 months, did you use a condom during sexual intercourse, each time you paid someone in exchange for sex?
NO 2
DOESN'T KNOW/NOT SURE 8
438. In all, with how many different people have you had sexual intercourse in your whole life?
IN THE CASE OF A NON NUMERICAL RESPONSE, PROBE FOR AN ESTIMATE.
IF THE NUMBER IS MORE THAN '95', RECORD '95'
DOESN'T KNOW 98
438B. CHECK THE PRESENCE OF OTHER PEOPLE.
DO NOT CONTINUE UNTIL YOU ARE COMPLETELY IN PRIVATE WITH THE RESPONDENT
PRIVACY IMPOSSIBLE 2 (GO TO 439)
438C. The first time you had sexual intercourse, would you say that you wanted to have sexual intercourse or would you say that you were forced against your will?
WAS FORCED 2
REFUSED TO RESPOND/NO RESPONSE 3
438D. During the last 12 months, has someone made you have sexual intercourse against your will?
NO 2
439. Do you know a place where one could get condoms?
NO 2 (GO TO 501)
440. Where is this?
Is there another place?
IF THE PLACE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE.
REGIONAL HOSPITAL B
CSREF (heath referral center) C
PMI (protection maternelle et infantile - a program created in France to give free care to expecting/recent mothers) /MATERNITY D
CSCOM (Centre de Santé Communitaire) Community Health Center E
OTHER PUBLIC (SPECIFY)__F
PHARMACY H
HEALTHCARE WORKER J
OTHER PRIVATE MEDICAL (SPECIFY)__K
BAR/NIGHTCLUB M
KIOSK N
AMBULENT SALESPERSON O
FRIEND/ACQUAINTANCE/RELATIVE P
OTHER (SPECIFY)__X
441. If you wanted to, could you procure a condom?
NO 2
DOESN'T KNOW/NOT SURE 8
OTHER (GO TO 501)
443. Where did you get condoms the last time?
IF THE PLACE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE.
REGIONAL HOSPITAL 12
CSREF (heath referral center) 13
PMI (protection maternelle et infantile - a program created in France to give free care to expecting/recent mothers) /MATERNITY 14
CSCOM (Centre de Santé Communitaire) Community Health Center 15
OTHER PUBLIC (SPECIFY)__16
PHARMACY 22
HEALTHCARE WORKER 23
OTHER PRIVATE MEDICAL (SPECIFY)__26
BAR/NIGHTCLUB 32
KIOSK 33
AMBULANT SALESPERSON 34
FRIENDS/ACQUAINTANCES/RELATIVES 35
HOTEL/MOTEL 36 (GO TO 501)
OTHER (SPECIFY) ___ 96
DOESN'T KNOW 98
444. Do you know the brand name of the condoms that you used last time?
MANNIX 2
INNOTEX 3
PRESA 4
OTHER (SPECIFY)__6
DOESN'T KNOW 8
445. The last time you bought condoms, how many did you buy?
NEVER BOUGHT CONDOMS 99 (GO TO 501)
DOESN'T KNOW 9998
SECTION 5. FERTILITY PREFERENCES
HAS 2 WIVES/PARTNERS OR MORE (GO TO 502)
NOT ASKED (GO TO 505)
502. Is your wife/partner (one of your wives/partners) currently pregnant?
NO 2
NOT SURE 3
Now I have some questions about the future.
503. CHECK 502:
NO, NO PREGNANT WIFE/PARTNER/NOT SURE
Would you like to have a (another) child, or do you prefer to have no (more) children at all?
YES, WIFE/PARTNER PREGNANT
After the child that your wife/partner is expecting, would you like to have a (another) child, or do you prefer to have no (more) children at all?
NO MORE/NO 2 (GO TO 505)
WIFE/PART. CAN NOT GET PREGNANT/IS 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__
AFTER MARRIAGE 995
OTHER (SPECIFY)__996
DOESN'T KNOW 998
HAS LIVING CHILDREN
If you could return to the time when you did not have children and choose the number of children that you will have in your life, how many would you have? PROBE TO GET A NUMERIC RESPONSE.
NO LIVING CHILDREN
If you could choose the number of children that you will have in your life, how many would you have? PROBE TO GET A NUMERIC RESPONSE.
NUMBER __
OTHER (SPECIFY)__96 (GO TO 507)
506. Among these children, how many boys do you want, how many girls, and for how many is the gender not important?
NUMBER OF GIRLS__
NOT IMPORTANT__
OTHER (SPECIFY) __96
507. Do you approve or disapprove of couples who use a method to avoid pregnancies?
DISAPPROVE 2
DOESN'T KNOW/NOT SURE 8
508. During the last few months, have you heard about family planning:
On the radio?
On the television?
In newspapers or magazines?
NO 2
NO 2
NO 2
510. During the past few months, have you discussed the practice of family planning with your friends, neighbors, or relatives?
NO 2 (GO TO 512)
511. With whom did you discuss this? Anyone else?
RECORD EVERYTHING MENTIONED.
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER(S) F
SON(S) G
STEP MOTHER(S)/MOTHER(S) IN LAW H
FRIEND(S)/NEIGHBOR(S) I
OTHER (SPECIFY)__X
512. During these past months, did you discuss the practice of family planning with a health worker or health professional?
NO 2
SECTION 6. AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS
Now I would like to talk to you about something else.
601. Have you ever heard of a disease called AIDS?
NO 2 (GO TO 645)
602. Can people reduce their chance of getting AIDS by having just one uninfected sex partner who has no other sex partners?
NO 2
DOESN'T KNOW 8
603. Can people get AIDS from mosquito bites?
NO 2
DOESN'T KNOW 8
604. Can people reduce their risk of getting aids by using a condom every time they have sex?
NO 2
DOESN'T KNOW 8
605. Can people get AIDS by sharing food with someone who has AIDS?
NO 2
DOESN'T KNOW 8
606. Can people reduce their chance of getting AIDS by not having sexual intercourse at all?
NO 2
DOESN'T KNOW 8
607. Can people get AIDS by witchcraft of other supernatural means?
NO 2
DOESN'T KNOW 8
608. Is there something (else) that a person can do to avoid or reduce their risks of contracting 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 EVERYTHING CITED.
USE CONDOMS B
LIMIT TO ONE PARTNER/STAY LOYAL TO ONE PARTNER C
LIMIT THE NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WITH MULTIPLE PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH THOSE WHO INJECT THEMSELVES WITH DRUGS H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING THE SAME BLADES/RAZORS K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM A TRADITIONAL HEALER N
OTHER (SPECIFY)__W
OTHER (SPECIFY)__X
DOESN'T KNOW Z
610. Is it possible that a person who appears to be healthy, in fact, has AIDS virus?
NO 2
DOESN'T KNOW 8
611. Can the virus that causes AIDS be transmitted from mother to her baby?
During the pregnancy?
During birth?
During breastfeeding?
NO 2
DOESN'T KNOW 8
NO 2
DOESN'T KNOW 8
NO 2
DOESN'T KNOW 8
OTHER (GO TO 614)
613. Are there any special drugs that a doctor or 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 a doctor or nurse can give people infected with the AIDS virus?
NO 2
DOESN'T KNOW 8
615. I don't want to know the results, but have you ever been tested for the AIDS virus?
NO 2 (GO TO 620)
616. When did you last get tested for the AIDS virus?
BETWEEN 12 AND 23 MONTHS 2
TWO OR MORE YEARS AGO 3
617. The last time you had the test, did you yourself ask for the test, was it offered and you accepted, or was it required?
TEST 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 THE PLACE IS A HOSPITAL OR CLINIC, RECORD THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
NATIONAL HOSPITAL 12 (GO TO 622)
REGIONAL HOSPITAL 13 (GO TO 622)
CSREF (heath referral center)14 (GO TO 622)
OTHER PUBLIC (SPECIFY)__15 (GO TO 622)
CDV (Center for vaccine development) 20 (GO TO 622)
PRIVATE HOSPITAL/CLINIC 21
PRIVATE LAB 22
OTHER PRIVATE MEDICAL (SPECIFY)__26 (GO TO 622)
620. Do you know of a place where people can get tested for the AIDS virus?
NO 2 GO TO 622
621. Where is this? Is there another place?
RECORD ALL PLACES MENTIONED.
IF THE PLACE IS A HOSPITAL OR CLINIC, RECORD THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
NATIONAL HOSPITAL B
REGIONAL HOSPITAL C
CSREF (heath referral center) D
OTHER PUBLIC(SPECIFY)__F
CDV (Center for vaccine development) H
PRIVATE HOSPITAL/ CLINIC I
PRIVATE LAB J
OTHER PRIVATE MEDICAL (SPECIFY)__K
622. Would you buy fresh vegetables from a shopkeeper or vendor if you knew the person had the AIDS virus?
NO 2
DOESN'T KNOW 8
623. If a member of your family had the AIDS virus would you like it to remain a secret or not?
NO 2
DOESN'T KNOW/NOT SURE/IT DEPENDS 8
624. If a member of your family become sick with the AIDS virus would you be willing to take care of him/her in your own household?
NO 2
DOESN'T KNOW/NOT SURE/IT DEPENDS 8
625A. If a female teacher has the AIDS virus but is not sick, should she be able to continue teaching in the school?
SHOULD NOT BE ALLOWED 2
DOESN'T KNOW/NOT SURE/IT DEPENDS 8
625B. If a male teacher has the AIDS virus but is not sick, should he be able to continue teaching in the school?
SHOULD NOT BE ALLOWED 2
DOESN'T KNOW/NOT SURE/IT DEPENDS 8
626. Do you personally know someone who has been denied health service in the last 12 months because he or she 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 is suspected to have the AIDS virus?
NO 2
628. Do you personally know someone who has been insulted or teased in the last 12 months because he or she is suspected to have the AIDS virus?
NO 2
AT LEAST ONE 'YES' (GO TO 631)
630. Do you know someone who is suspected to have or has 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 the AIDS virus?
NO 2
DOESN'T KNOW/ IT DEPENDS 8
634. Should children age 12-14 be taught to wait until they get married to have sex to avoid getting AIDS?
NO 2
DOESN'T KNOW/ IT DEPENDS 8
635. Do you think that young men should wait until marriage to have sexual intercourse?
NO 2
DOESN'T KNOW/ IT DEPENDS 8
636. Do you think that young women should wait until marriage to have sexual intercourse?
NO 2
DOESN'T KNOW/ IT DEPENDS 8
637. Do you think that married men should only have sexual intercourse with their wives?
NO 2
DOESN'T KNOW/ IT DEPENDS 8
638. Do you think that most of the men you know only have sexual intercourse with their wives?
NO 2
DOESN'T KNOW/ IT DEPENDS 8
639. Do you think that married women should only have sexual intercourse with their husband?
NO 2
DOESN'T KNOW/ IT DEPENDS 8
640. Do you think that most of the women that you know only have sexual intercourse with their husband?
NO 2
DOESN'T KNOW/ IT DEPENDS 8
HEARD ABOUT AIDS
Apart from AIDS have you heard about other diseases 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. When a man has a sexually transmitted infection, which symptom could he have?
Are there other symptoms?
RECORD ALL MENTIONED.
GENITAL DISCHARGE B
FOUL-SMELLING DISCHARGE C
BURNING URINATION D
GENITAL REDNESS/INFLAMMATION E
GENITAL SWELLING F
GENITAL SORE/ULCER G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
WEIGHT LOSS K
IMPOTENCE L
OTHER(SPECIFY)__W
OTHER(SPECIFY)__X
NO SYMPTOMS Y
DOESN'T KNOW Z
643. When a woman has a sexually transmitted infection, which symptom could she have?
Are there other symptoms?
RECORD ALL MENTIONED.
GENITAL DISCHARGE B
FOUL-SMELLING DISCHARGE C
BURNING URINATION D
GENITAL REDNESS/INFLAMMATION E
GENITAL SWELLING F
GENITAL SORE/ULCER G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
WEIGHT LOSS K
DIFFICULTY GETTING PREGNANT 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 ABOUT SEXUALLY TRANSMITTED DISEASES (GO TO 647)
Now I would like to ask you about your health in the last 12 months
646. During the last 12 months have you had a disease which you got from sexual contact?
NO 2
DOESN'T KNOW 8
647. Sometimes a man has a bad smelling penile discharge. During the last 12 months have you had a bad smelling penile discharge?
NO 2
DOESN'T KNOW 8
648. Sometimes men have a genital sore or ulcer. During the past 12 months have you had a sore or ulcer in area of the penis?
NO 2
DOESN'T KNOW 8
HAS NOT HAD AN INFECTION OR DOESN'T KNOW (GO TO 654)
650. The last time you had (PROBLEM MENTIONED IN 646/647/648) did you seek any kind of advice or treatment?
NO 2
651. Where did you go?
Was there another place?
RECORD ALL MENTIONED.
REGIONAL HOSPITAL B
CSREF (heath referral center) C
CSCOM (Centre de Santé Communitaire) Community Health Center D
FREE CLINIC E
MATERNITY F
OTHER PUBLIC (SPECIFY)__G
STI CENTER I
PHARMACY J
HEALTH CARE ROOM K
OTHER PRIVATE MEDICAL (SPECIFY)__L
SHOP N
OTHER (SPECIFY)__X
652. The last time you had (PROBLEM MENTIONED IN 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 she you go?
Was there another place?
RECORD ALL MENTIONED.
REGIONAL HOSPITAL B
CSREF (heath referral center) C
CSCOM (Centre de Santé Communitaire) Community Health Center D
FREE CLINIC E
MATERNITY F
OTHER PUBLIC (SPECIFY)__G
STI CENTER I
PHARMACY J
HEALTH CARE ROOM K
OTHER PRIVATE MEDICAL (SPECIFY)__L
SHOP N
OTHER (SPECIFY)__X
654. As you know, some men are circumcised. Did you also undergo this ordeal?
NO 2
SECTION 7A. FEMALE CIRCUMCISION
701. Have you ever heard of female circumcision?
NO 2
702. In certain countries there is a practice that involves cutting a part of the external genitals of girls. Have you heard of this practice?
NO 2 (GO TO 725)
703. What are the advantages to circumcising a girl?
PROBE: other advantages?
RECORD ALL MENTIONED.
SOCIAL RECOGNITION B
BETTER CHANGE FOR MARRIAGE C
PRESERVATION OF VIRGINITY/PREVENT SEXUAL INTERCOURSE BEFORE MARRIAGE D
MORE SEXUAL PLEASURE FOR THE MAN E
RELIGIOUS NECESSITY F
OTHER (SPECIFY)__X
NO ADVANTAGE Y
704. What the advantages of girls not being circumcised?
PROBE: anything else?
RECORD ALL MENTIONED
AVOIDING THE SUFFERING B
MORE SEXUAL PLEASURE FOR HER C
MORE PLEASURE FOR THE MAN D
IN ACCORDANCE WITH RELIGION F
OTHER (SPECIFY)__X
NO ADVANTAGE Y
CODE 'D' CIRCLED IN 703 (GO TO 707)
706. Do you think this practice is a way for preventing girls from having sexual intercourse before marriage or do you think, on the contrary, that this has no effect?
NO EFFECT 2
DOESN'T KNOW 8
CODE 'F' CIRCLED IN 703 AND 704 (GO TO 709)
708. Do you think that this practice is required by your religion?
NO 2
DOESN'T KNOW 8
709. Do you think that this practice should be maintained or that it should disappear?
DISAPPEAR 2
IT DEPENDS 3
DOESN'T KNOW 8
710. Do you think that women want this practice to be preserved or do you think they are favorable to abandoning it?
ABANDONED 2
IT DEPENDS 3
DOESN'T KNOW 8
725. Do you know about an illness called "fistula," that is to say the "urine illness"
NO 2 (GO TO 735)
726A. What, in your opinion, are the causes of this illness?
EVIL SPELLS, FATE B
TOO YOUNG TO GIVE BIRTH C
TOO OLD TO GIVE BIRTH D
TOO THIN TO SUPPORT A PREGNANCY E
TOO MANY SUCCESSIVE BIRTHS F
FREQUENT ILLNESS DURING THE PREGNANCY G
BIRTH OF A LARGE BABY H
BIRTH AT HOME WITHOUT MEDICAL ASSISTANCE I
WILL OF GOD J
OTHERS (SPECIFY) __ X
DOESN'T KNOW Y
726B. What are the main manifestations of this illness?
INVOLUNTARY URINATION B
INVOLUNTARY BOWL MOVEMENTS C
BOTH INVOLUNTARY URINATION AND BOWL MOVEMENTS D
CONSTANTLY WET E
NAUSEATING ODORS F
DIFFICULTY MOVING G
727. Is it possible to treat this illness and to heal it?
NO 2
728. What would you do if you wife had this illness?
CONSULT A TRADITIONAL HEALER OR MARABOUT 2 (GO TO 730)
CARE AT A HOSPITAL WITH PERMANENT ASSISTANCE 3
CARE AT A HOSPITAL WITHOUT VISITS 4
NO ACTION 5 (GO TO 730)
NOT SURE 6 (GO TO 730)
729. What would you do if your wife were cured?
REPUDIATION AFTER CURED 2
NO ACTION 3
730. Do you know women who suffer or who have suffered from fistula?
NO 2 (GO TO 735)
732. How many among them have been cured?
NONE 00 (GO TO 735)
DOESN'T KNOW 98 (GO TO 735)
733. How many among those cured returned to their conjugal dwelling?
734. Can you indicate their current place of residence (locality, commune and region)?
MINUTES__
FILL OUT AFTER HAVING ENDED THE INTERVIEW.
COMMENTS ABOUT THE RESPONDENT _____
COMMENTS ON PARTICULAR QUESTIONS _____
OTHER COMMENTS _____
SUPERVISOR'S OBSERVATIONS _____
NAME__
DATE__
FIELD EDITOR'S OBSERVATIONS _____
NAME__
DATE__