MAN'S QUESTIONNAIRE
NATIONAL POPULATION COMMISSION
National Health Research Ethics Committee
STATE________
LOCAL GOVT. AREA________
LOCALITY______
ENUMERATION AREA______
RURAL
CLUSTER NUMBER________
BUILDING/STRUCTURE NUMBER ________
NAME AND LINE NUMBER OF MAN______
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE_______
INTERVIEWER'S NAME_______
RESULT________
NEXT VISIT:
DATE______
TIME_____
FINAL VISIT
DAY______
MONTH_____
YEAR____
INT. NUMBER_______
RESULT_____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)_____ 7
YORUBA 2
IGBO 3
ENGLISH 4
OTHER (SPECIFY)____ 6
YORUBA 2
IGBO 3
ENGLISH 4
OTHER (SPECIFY)____ 6
NO 2
SUPERVISOR
NAME ______
DATE_______
FIELD EDITOR
NAME______
DATE______
OFFICE EDITOR ______
KEYED BY______
SECTION 1. RESPONDENT'S BACKGROUND
INFORMED CONSENT
Greetings. My name is ________ and I am working with National Population Commission services. Your household was selected for the survey. The questions usually take about 30 to 60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of the research 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 following persons:
2013 NDHS Contact Person: Project Director; Email: amakaloveth4life@yahoo.com; Phone: 08033318224
NHREC Contact Person: Desk Officer, NHREC; Email: yaminads@yahoo.com; Phone: 08065479926
Do you have any questions? May I begin the interview now?
Signature of interviewer:_________________ Date:____________
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 (class/form/year) you completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.
SECONDARY OR HIGHER (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' CIRCLED (GO TO 111)
110) 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
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
OTHER CHRISTIAN 2
ISLAM 3
TRADITIONALIST 4
OTHER (SPECIFY)____ 6
114) What is your ethnic group?
115) In the last 12 months, how many times have you been away from home for one or more nights?
NONE 00 (GO TO 201)
116) In the last 12 months, have you been away from home for more than one month at a time?
NO 2
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 8 (GO TO 206)
202) Do you have any sons or daughters that 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?
(AGE IN COMPLETED YEARS)
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?
217) When (NAME'S) mother was pregnant with (NAME), did she ever have any antenatal check-ups?
NO 2 (GO TO 219)
DON'T KNOW 3 (GO TO 219)
218) Were you ever present during any of those antenatal check-ups?
NOT PRESENT 2
219) Was (NAME) born in a hospital or health facility?
OTHER 2
220) What was the main reason why (NAME)'s mother did not deliver in a hospital or health facility?
FACILITY CLOSED 2
TOO FAR/NO TRANSPORTATION 3
DON'T TRUST FACILITY/POOR QUALITY SERVICE 4
NO FEMALE PROVIDER 5
NOT THE FIRST CHILD 6
CHILD'S MOTHER DID NOT THINK IT WAS NECESSARY 7
HE DID NOT THINK IT WAS NECESSARY 8
FAMILY DID NOT THINK IT WAS NECESSARY 9
OTHER (SPECIFY) ________ 96
DON'T KNOW 98
221) When a child has diarrhea, 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?)
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
NO 2
_________
NO 2
302) In the last few months have you:
NO 2
NO 2
NO 2
NO2
NO2
NO 2
NO 2
NOT A SINGLE "YES" (HAS NOT HEARD OR READ MESSAGE) (GO TO 303)
302B) Please tell me which family planning messages you have heard or seen in the past few months?
PROBE: Any others? PROBE UNTIL YOU HAVE EXHAUSTED ALL ANSWERS.
UNSPACED CHILDREN MAKES THE GOING TOUGH. FOR THE LOVE OF YOUR FAMILY, GO FOR CHILD SPACING TODAY B
WELL-SPACE CHILDREN ARE EVERY PARENT'S JOY C
IT'S NOT TOO LATE TO PREVENT UNWANTED PREGNANCY D
WHY IS YOUR WIFE LOOKING SO GOOD? E
OTHER (SPECIFY)______ X
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 has sexual relations?
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 you 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 311)
308) Do you know of a place where a person can get condoms?
NO 2 (GO TO 311)
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
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC SECTOR (SPECIFY)_____ F
PHARMACY H
CHEMIST/PMS I
PRIVATE DOCTOR J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)_________ M
CHURCH O
FRIENDS/RELATIVES P
NGO Q
310) If you wanted to, could you yourself get a condom?
NO 2
311) CHECK 301 (08): KNOWS FEMALE CONDOM
NO (GO TO 401)
312) Do you know of a place where a person can get female condoms?
NO 2 (GO TO 401)
313) 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
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC SECTOR (SPECIFY)_____ F
PHARMACY H
CHEMIST/PMS I
PRIVATE DOCTOR J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)_________ M
CHURCH O
FRIENDS/RELATIVES P
NGO Q
314) If you wanted to, could you yourself get a female condom?
NO 2
SECTION 4. MARRIAGE AND SEXUAL ACTIVITY
401) Are you currently married or living together with 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
NO 3 (GO TO 413)
403) What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2 (GO TO 413)
SEPARATED 3 (GO TO 413)
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) 2 (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 LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE AND LIVE-IN PARTNER. IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.
ASK 408 FOR EACH PERSON.
408) How old was (NAME) on her last birthday?
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 (GO TO 411A)
411) In what month and year did you start living with your (wife/partner)?
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 sexual activity in order to gain a better understanding of some important life issues. How old were you when you had sexual intercourse 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 questions 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 had sexual intercourse?
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 had sexual intercourse with this person?
WEEKS AGO 2 _______
MONTHS AGO 3 _______
418) The last time you had sexual intercourse with this person), was a condom used?
NO 2 (GO TO 420)
419) Was a condom used every time you had sexual intercourse with this person in the last 12 months?
NO 2
420) What was your relationship to this person with whom you had sexual intercourse?
IF GIRLFRIEND: Were you living together as if married?
IF YES, CIRCLE '2'.
IF NO, CIRCLE '3'.
LIVE-IN PARTNER 2
GIRLFRIEND NOT LIVING WITH RESPONDENT 3
CASUAL ACQUAINTANCE 4
CLIENT/PROSTITUTE 5
OTHER (SPECIFY)_____ 6
MARRIED MORE THAN ONCE OR BLANK (GO TO 423)
OTHER (GO TO 423)
423) How long ago did you first have sexual intercourse with this person?
WEEKS AGO 2
MONTHS AGO 3
YEARS AGO 4
424) How many times during the last 12 months did you have sexual intercourse with this person?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER IS 95 OR MORE, WRITE '95'.
DON'T KNOW 98
426) Apart from this person, have you had sexual intercourse with any other person in the last 12 months?
NO 2 (GO TO 428)
427) In total, with how many different people have you had sexual intercourse in the last 12 months? 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 having sexual intercourse?
NO 2
431) Have you ever paid anyone in exchange for having sexual intercourse?
NO 2 (GO TO 434)
432) The last time you paid someone in exchange for having sexual intercourse, was a condom used?
NO 2 (GO TO 434)
433) Was a condom used during sexual intercourse every time you paid someone in exchange for having sexual intercourse in the last 12 months?
NO 2
DON'T KNOW 8
434) In total, with how many different people have you had sexual intercourse in your lifetime?
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.
DUREX 2
RUGH RIDER 3
TWIN LOTUS 4
DON'T KNOW 98
437) From where did you obtain the condom last time?
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 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELDWORKER 15
OTHER PUBLIC SECTOR (SPECIFY)_____ 16
PHARMACY 22
CHEMIST/PMS 23
PRIVATE DOCTOR 24
MOBILE CLINIC 25
FIELDWORKER 26
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)_________ 27
CHURCH 32
FRIENDS/RELATIVES 33
NGO 34
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 prevent pregnancy?
RECORD ALL MENTIONED.
MALE STERILIZATION B
IUD C
INJECTABLES D
IMPLANTS E
PILL F
FEMALE CONDOM G
DIAPHRAGM H
FOAM/JELLY I
LAM J
RHYTHM METHOD K
WITHDRAWAL L
OTHER MODERN METHOD X
OTHER TRADITIONAL METHOD Y
SECTION 5. FERTILITY PREFERENCES
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 8 (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 (GO TO 508):
How long would you like to wait from now before the birth of (a/another) child?
WIFE/PARTNER PREGNANT: 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 _______ (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 _________
SOON/NOW 993
HE/ALL HIS WIVES/PARTNERS ARE INFECUND 994
OTHER (SPECIFY)______ 996
DON'T KNOW 998
HAS LIVING CHILDREN:
If you could 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?
NO LIVING CHILDREN:
If you could choose exactly the number of children to have in your whole life, how many would that be?
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?
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 jobs 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 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 (GO TO 612)
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 jointly with someone else?
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4
613) Do you own any land either alone or jointly 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 one uninfected sex partner who has no other sex partners?
NO 2
DON'T KNOW 8
703) Can people get the AIDS virus 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?
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
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.
GOVT. HEALTH CENTER 12 (GO TO 718)
STAND-ALONE VCT CENTER 13 (GO TO 718)
FAMILY PLANNING CLINIC 14 (GO TO 718)
MOBILE CLINIC 15 (GO TO 718)
FIELDWORKER 16 (GO TO 718)
SCHOOL BASED CLINIC 17 (GO TO 718)
OTHER PUBLIC SECTOR (SPECIFY)_____ 18 (GO TO 718)
PHARMACY 23 (GO TO 718)
MOBILE CLINIC 24 (GO TO 718)
FIELDWORKER 25 (GO TO 718)
SCHOOL BASED CLINIC 26 (GO TO 718)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)____ 27 (GO TO 718)
CORRECTIONAL FACILITY 32 (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
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER F
OTHER PUBLIC SECTOR (SPECIFY)____ G
STAND-ALONE VCT CENTER I
PHARMACY J
MOBILE CLINIC K
FIELDWORKER 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
721A) Do you personally know someone who has been denied health services in the last 12 months because he or she has or is suspected to have the AIDS virus?
NO 2
DON'T KNOW ANYONE WITH AIDS 3 (GO TO 721F)
721B) Do you personally know someone who has been denied involvement in social events, religious services, or community events in the last 12 months because he or she has or is suspected to have the AIDS virus?
NO 2
721C) Do you personally know someone who has been verbally abused or teased in the last 12 months because he or she has or is suspected to have the AIDS virus?
NO 2
AT LEAST ONE "YES" (GO TO 721F)
721E) Do you personally know someone who has or is suspected to have the AIDS virus?
NO 2
721F) Do you agree or disagree with the following statement;
People with the AIDS virus should be ashamed of themselves.
DISAGREE 2
DON'T KNOW/NO OPINION 8
721G) 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
DON'T KNOW/NO OPINION 8
722) Should children age 12-14 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 sexual contact?
NOT HEARD ABOUT AIDS:
Have you heard about infections that can be transmitted through sexual contact?
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 sexual contact?
NO 2
DON'T KNOW 8
727) 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
728) Sometimes men have a sore or ulcer near their penis. During the last 12 months, have you had a sore or ulcer near your penis?
NO 2
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
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER F
OTHER PUBLIC SECTOR (SPECIFY)_____ G
STAND-ALONE VCT CENTER I
PHARMACY J
CHEMIST/PMS STORE K
MOBILE CLINIC L
FIELDWORKER M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)______ N
OTHER (SPECIFY)_____ X
732) If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?
NO 2
DON'T KNOW 8
733) Is a wife justified in refusing to have sex with her husband when she knows her husband 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 (GO TO 805)
DON'T KNOW 8 (GO TO 805)
802) How old were you when you got circumcised?
DURING CHILDHOOD ( LESS THAN 5 YEARS) 95
DON'T KNOW 98
803) Who did the circumcision?
HEALTH WORKER/PROFESSIONAL 2
OTHER 3
DON'T KNOW 8
HOME OF A HEALTH WORKER/PROFESSIONAL 2
CIRCUMCISION DONE AT HOME 3
RITUAL SITE 4
OTHER HOME/PLACE 5
DON'T KNOW 8
805) 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 808)
806) 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 80)
807) 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
808) Do you currently smoke cigarettes?
NO 2 (GO TO 810)
809) In the last 24 hours, how many cigarettes did you smoke?
810) Do you currently smoke or use any (other) type of tobacco?
NO 2 (GO TO 812)
811) What (other) type of tobacco do you currently smoke or use? RECORD ALL MENTIONED.
CHEWING TOBACCO B
SNUFF C
OTHER (SPECIFY)______X
812) Are you covered by any health insurance?
NO 2 (GO TO 901)
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
SECTION 9. FEMALE GENITAL CUTTING
901) Have you ever heard of female circumcision, that is, a practice in which a girl may have part of her genitals cut, for example, excision of the clitoris and the labia minora, scraping of tissue surrounding the vaginal orifice (angurya cuts) or cutting of the vagina (gishiri cuts) and even use of corrosive substances or herbs into the to tighten or narrow it or to cause bleeding.
Have you ever heard about this practice?
NO 2 (GO TO 1001)
902) Do you believe that this practice is required by your religion?
NO 2
NO RELIGION 3
DON'T KNOW 8
903) Do you think that female circumcision should be continued, or should it be stopped?
STOPPED 2
DEPENDS 3
DON'T KNOW 4
SECTION 10. MATERNAL AND ADULT MORTALITY
1001) Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother, including those who are living with you, those living elsewhere and those who have died. How many children did your mother give birth to, including you?
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 1014)
1003) How many of these births did your mother have before you were born?
1004) What was the name given to your oldest brother or sister?
1005) Is (NAME) male or female?
FEMALE 2
NO 2 (GO TO 1008)
DON'T KNOW (GO TO NEXT SIBLING)
1008) How many years ago did (NAME) die?
1009) How old was (NAME) when he/she died?
IF MALE OR DIED BEFORE 12 YEARS OF AGE, GO TO NEXT SIBLING
1010) Was (NAME) pregnant when she died?
NO 2
DON'T KNOW 8
1011) Did (NAME) die during childbirth?
NO 2
1012) Did (NAME) die within two months after the end of a pregnancy or childbirth?
NO 2
1013) How many live born children did (NAME) give birth to during her lifetime?
WHEN NO MORE BROTHERS OR SISTERS, GO TO 1014
MINUTES _________
TO BE FILLED OUT 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________