PLACE NAME _____
NAME OF HEAD OF HOUSEHOLD _____
HOUSEHOLD NUMBER _____
COMPOUND NUMBER _____
CLUSTER NUMBER _____
REGION _____
RURAL 2
DAKAR/REGIONAL CAPITAL/OTHER CITY/RURAL:
REGIONAL CAPITAL 2
OTHER CITY 3
RURAL 4
CHECK THE HOUSEHOLD SURVEY: QUESTIONS ABOUT SEXUAL ACTIVITY (542, 543) SHOULD BE ASKED OF MEN (1) OF WOMEN (2) IN THE INDIVIDUAL SURVEY.
ADDITIONAL QUESTIONS 2
FIRST INTERVIEW (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE_____
INTERVIEWER NAME_____
RESULT___
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTIALLY FILLED OUT
6 INCAPACITATED
7 OTHER (SPECIFY) _____
NEXT VISIT
DATE______
TIME______
FINAL VISIT
DAY_____
MONTH_____
YEAR 2005
INTERVIEWER CODE______
RESULT______
2 WOLOF
3 POULAR
4 SERER
5 MANDINGUE
6 DIOLA
8 OTHERS
NO 2
SUPERVISOR
NAME_____
DATE_____
FIELD EDITOR
NAME_____
DATE_____
OFFICE EDITOR_____
KEYED BY_____
SECTION 1. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENT
INTRODUCTION AND CONSENT:
CONSENT STATEMENT AFTER INFORMATION:
Hello. My name is_____ and I work for the Minister of Health. We are conducting a national survey that asks about the health of 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 20-30 minutes. The information that you give us will be strictly confidential and will be shared with no one.
Do you have questions about the survey?
Can I begin the interview now?
SIGNATURE OF INTERVIEWER_____
DATE_____
THE RESPONDENT REFUSES TO RESPOND 2 (END INTERVIEW)
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 a big city, in a city or in a rural area?
REGIONAL CAPITAL 2
OTHER CITIES 3
RURAL AREA 4
FOREIGN COUNTRY 6
103. How long have you been living continuously in (NAME OF CURRENT CITY/VILLAGE OF RESIDENCE)? IF LESS THAN A YEAR, WRITE '00' YEARS.
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)
104. Just before you moved here, did you live in a big city, a city, or in a village?
REGIONAL CAPITAL 2
OTHER CITIES 3
RURAL AREA 4
FOREIGN COUNTRY 6
105. In which month and in which year were you born?
DOESN'T KNOW MONTH 98
DOESN'T KNOW YEAR 9998
106. How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.
NO 2 (GO TO 111)
108. What is the highest level of school you attended: primary, secondary (first cycle), secondary (second cycle), superior or other?
SECONDARY (1ST CYCLE) 2
SECONDARY (2ND CYCLE) 3
SUPERIOR 4
OTHER 7
109. What is the last (year/grade) that you achieved at this level?
SECONDARY OR MORE (GO TO 114)
111. 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 CANNOT 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
112. Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)?
NO 2 (GO TO 113)
112A. In which languages were the literacy programs in which you participated?
PROBE: Any other?
RECORD ALL THAT IS MENTIONED.
WOLOF B
POULAR C
SERER D
DIOLA E
MANDINGUE F
SONINKE G
OTHER (SPECIFY) _____X
CODE '1' OR '5' CIRCLED (GO TO 115)
114. 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
115. 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
116. 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
117. Do you currently have a job from which you make money?
NO 2
118. During the last 12 months, did you have a job, any type, from which you made money?
NO 2
119. What did you do most of the time during the last 12 months?
LOOKED FOR WORK 2 (GO TO 127)
INACTIVE 3 (GO TO 127)
COULD NOT WORK/HANDICAPPED 4 (GO TO 127)
DOMESTIC WORK/CHILDCARE 5 (GO TO 127)
OTHER (SPECIFY) _____6 (GO TO 127)
120. 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 123)
122. 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
123. During the last 12 months, how many months did you work?
124. 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 127)
NOT PAID 4 (GO TO 127)
125. Who decides how the money you earn will be used?
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER TOGETHER 3
FATHER/MOTHER 4
UNCLE 5
SOMEONE ELSE 6
RESPONDENT AND SOMEONE ELSE TOGETHER 7
126. 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) _____5
NO 2 (GO TO 201)
POULAR 02
SERER 03
MANDINGUE 04
DIOLA 05
SONINKE 06
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 8 (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'.
204. Do you have any sons or daughters to whom you are the father 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'.
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 life at birth but only survived a few hours or days?
NO 2 (GO TO 208)
DOESN'T KNOW 8 (GO TO 208)
207. How many sons have died?
And how many daughters have died?
IF NONE, RECORD '00'.
208. (Besides the children that you just mentioned) did you have:
a) Any 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 201-207)
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?
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 NOT SPONTANEOUSLY MENTIONED, ASK: Have ever heard about (METHOD)?
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO NEXT METHOD)
NO 2 (GO TO 303)
NO 2
NO 2
NO 2
DOESN'T KNOW 8
NO 2
NO 2
DOESN'T KNOW 8
Now I would like to ask you some questions about pregnancy risks.
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 2 PERIODS 4
OTHER (SPECIFY) _____6
DOESN'T KNOW 8
305. In your opinion, can a woman who is breastfeeding become pregnant?
NO 2
IT DEPENDS 3
DOESN'T KNOW 8
306. Now I would like to read you some declarations about contraception. Could you tell me if you agree or disagree with each one of these declarations?
A. Contraception is a woman's issue in which a man should not be interested.
B. A woman who uses contraception can be considered a woman of loose morals.
C. The woman is the one who can become pregnant, so it is she who is the one who should use contraception.
DISAGREES 2
DOESN'T KNOW 8
DISAGREES 2
DOESN'T KNOW 8
DISAGREES 2
DOESN'T KNOW 8
SECTION 4A. MARRIAGE AND SEXUAL ACTIVITY
401. Are you currently married or do you currently live with a woman?
YES, LIVES WITH A WOMAN 2
NO, NOT IN UNION 3 (GO TO 406)
LIVES WITH A WOMAN (GO TO 404)
402. Do you currently have only one wife or several?
IF ONLY ONE WIFE, RECORD '01'.
IF MORE THAN ONE WIFE, ASK: How many wives do you currently live with?
403. Are there other women with whom you live with as if you are married?
NO 2 (GO TO 405)
404. Do you have one (other) partner or more that you live with as if married?
IF ONLY ONE OTHER PARTNER, RECORD '01'.
IF MORE THAN ONE OTHER PARTNER, ASK: With how many women do you live with as if married?
405. Besides your wife/wives/partner(s) that you mentioned, 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, an 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 MENTIONED 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.
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
410A. How old was your wife/partner at her last birthday?
2 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 1 WOMAN ONLY ONCE AND 411 EQUALS '1': In which month and 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 in and 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)?
AGE IN YEARS ____ (GO TO 416B)
FIRST TIME WHEN BEGAN TO LIVE WITH (FIRST) WIFE/PARTNER 95 (GO TO 416B)
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 YEARS (GO TO 417)
416C. The first time you had sexual intercourse, was a condom used?
NO 2
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)
THE SAME AGE 3 (GO TO 417)
DOESN'T KNOW/DOES NOT REMEMBER 8 (GO TO 417)
416F. Would you say that this person was 10 years or more older than you or less than 10 years older than you?
LESS THAN TEN 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 438)
[ASK QUESTIONS 418-434 FOR THE LAST (THREE) PARTNER(S)]
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 STD'S/AIDS AND PREGNANCY 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)
423. Which method was used?
IF MORE THAN ONE METHOD WAS USED, CIRCLE THE CODE FOR THE METHOD THAT COMES FIRST IN THIS LIST.
PILL 03
IUD 04
INJECTIONS 05
IMPLANTS 06
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATION AMEN. METHOD 11
RHYTHM METHOD 12
WITHDRAWAL 13
OTHER METHOD (SPECIFY) _____ 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 STD'S/AIDS 13
COUPLE UNDER FERTILE/STERILE 24
WIFE/PARTNER 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
428. What was your relationship with the person with whom you had sexual intercourse?
IF GIRL FRIEND: Do you live together as if you were married?
IF YES, CIRCLE '02'. IF NO, CIRCLE '03'.
PARTNER LIVING WITH RESPONDENT 02 (GO TO 434)
GIRLFRIEND NOT LIVING WITH RESPONDENT 03
OCCASIONAL ENCOUNTER 04
SEX PROFESSIONAL 05
OTHER (SPECIFY) _____96
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?
[DO NOT ASK FOR THIRD-TO-LAST SEXUAL PARTNER]
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 FOR AN ESTIMATE.
IF THE NUMBER IS MORE THAN '95', RECORD '95'
DOESN'T KNOW 98
436. CHECK 428 IN ALL THE COLUMNS (PARTNERS):
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 every 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-NUMERIC RESPONSE, PROBE FOR AN ESTIMATE.
IF THE NUMBER IS MORE THAN '95', RECORD '95'
DOESN'T KNOW 98
439. Do you know of a place where one could get condoms?
NO 2 (GO TO 501)
440. Where is this?
Is there another place?
RECORD ALL MENTIONED.
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.
GOVERNMENT HEALTH CENTER B
GOVERNMENT FAMILY PLANNING CENTER C
HEALTH POST D
HEALTH HUT/RURAL MATERNITY E
COMMUNITY PHARMACY F
STRAT. AVANCÉE/EQU. MOBILE G
HEALTH CARE WORKER H
OTHER PUBLIC (SPECIFY) _____I
PHARMACY K
PRIVATE DOCTOR L
HEALTH CARE WORKER M
OTHER PRIVATE (SPECIFY) _____N
BAR P
SCHOOL Q
RELIGIOUS INSTITUTION R
RELATIVES/FRIENDS S
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.
GOVERNMENT HEALTH CENTER 12
GOVERNMENT FAMILY PLANNING CENTER 13
HEALTH POST 14
HEALTH HUT/RURAL MATERNITY 15
COMMUNITY PHARMACY 16
STRAT. AVANCÉE/EQU. MOBILE 17
HEALTH CARE WORKER 18
OTHER PUBLIC (SPECIFY) _____19
PHARMACY 22
PRIVATE DOCTOR 23
HEALTH CARE WORKER 24
OTHER PRIVATE MEDICAL (SPECIFY) _____26
BAR 32
SCHOOL 33
RELIGIOUS INSTITUTION 34 (GO TO 501)
RELATIVES/FRIENDS 35
OTHER (SPECIFY) _____36
OTHER (SPECIFY) _____96
DOESN'T KNOW 98
444. Do you know the brand name of the condoms that you used last time?
MANIX CONTACT B/6 02
MANIX CRISTAL B/12 03
MANIX XTRA PLEASURE B/12 04
MANIX XTRA PLEASURE B/3 05
MANIX FUTUR 003 B/12 06
VISA PRÉSERVATIF B/3 07
IMOTEX PRÉSERVATIF B/3 08
PROTEC B/3 09
MANIX KINGSIZE 10
OTHER (SPECIFY) _____96
DOESN'T KNOW 98
445. The last time you bought condoms, how many did you buy?
DOESN'T KNOW 98
NEVER BOUGHT CONDOMS 99 (GO TO 501)
DOESN'T KNOW 9998
SECTION 5. FERTILITY PREFERENCES
501. CHECK 410:
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 8
NO, NO PREGNANT WIFE/PARTNER/NOT SURE: Now I have some questions about the future. Would you like to have a (another) child, or do you prefer to have no (more) children at all?
YES, WIFE/PARTNER PREGNANT: Now I have some questions about the future. 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/PARTNER CANNOT 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_____
SOON/NOW 993
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?
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 OF CHILDREN_____
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?
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 635)
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 or other supernatural means?
NO 2
DOESN'T KNOW 8
608. Is there something that (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 WHOM INJECT THEMSELVES WITH DRUGS H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING THE SAME BLADES/RAZORS K
AVOID HUGGING 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
2 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, HEALTH CENTER OR CLINIC, RECORD THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
GOVERNMENT HEALTH CENTER 12 (GO TO 622)
FAMILY PLANNING CENTER 13 (GO TO 622)
TESTING CENTER 14 (GO TO 622)
STRAT. AVANCÉE/EQU. MOBILE 15 (GO TO 622)
HEALTH CARE WORKER 16 (GO TO 622)
OTHER PUBLIC (SPECIFY) _____17
PHARMACY 22 (GO TO 622)
PRIVATE DOCTOR 23 (GO TO 622)
HEALTH CARE WORKER 24 (GO TO 622)
OTHER PRIVATE (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, HEALTH CENTER OR CLINIC, RECORD THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CENTER C
TESTING CENTER D
STRAT. AVANCÉE/EQU. MOBILE E
HEALTH CARE WORKER F
OTHER PUBLIC (SPECIFY) _____G
PHARMACY I
PRIVATE DOCTOR J
HEALTH CARE WORKER K
OTHER PRIVATE (SPECIFY) _____L
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 became 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
625. If a teacher has the AIDS virus but is not sick, should s/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/NOT SURE/IT DEPENDS 8
635. Do you think that young men should wait until marriage to have sexual intercourse?
NO 2
DOESN'T KNOW/NOT SURE/IT DEPENDS 8
636. Do you think that young women should wait until marriage to have sexual intercourse?
NO 2
DOESN'T KNOW/NOT SURE/ IT DEPENDS 8
637. Do you think that married men should only have sexual intercourse with their wives?
NO 2
DOESN'T KNOW/NOT SURE/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/NOT SURE/IT DEPENDS 8
639. Do you think that married women should only have sexual intercourse with their husband?
NO 2
DOESN'T KNOW/NOT SURE/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/NOT SURE/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(s) 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(s) 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
DIFFICULTY GETTING PREGNANT/HAVING A CHILD K
IMPOTENCE 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 penile discharge. During the last 12 months, have you had 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 (GO TO 652)
651. Where did you go?
Was there another place?
RECORD ALL MENTIONED.
GOVERNMENT HEALTH CENTER B
HEALTH POST C
RURAL MATERNITY D
HEALTH HUT E
COMMUNITY PHARMACY F
STRAT. AVANCÉE/EQU. MOBILE G
HEALTH AGENT H
OTHER PUBLIC (SPECIFY) _____I
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
HEALTH CARE WORKER N
OTHER PRIVATE (SPECIFY) _____O
TRADITIONAL HEALER Q
RELATIVES/FRIENDS R
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)
PARTNER NOT INFORMED 3 (GO TO 654)
DOESN'T KNOW 8 (GO TO 654)
653. Where did she go?
Was there another place?
RECORD ALL MENTIONED.
GOVERNMENT HEALTH CENTRE B
HEALTH POST C
RURAL MATERNITY D
HEALTH HUT E
COMMUNITY PHARMACY F
STRAT. AVANCÉE/EQU. MOBILE G
HEALTH AGENT H
OTHER PUBLIC (SPECIFY) _____I
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
HEALTH CARE WORKER N
OTHER PRIVATE (SPECIFY) _____O
TRADITIONAL HEALER Q
RELATIVES/FRIENDS R
654. Some men are circumcised. Are you circumcised?
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 711)
703. What are the advantages to circumcising a girl?
PROBE: Are there other advantages?
RECORD ALL MENTIONED.
SOCIAL RECOGNITION B
BETTER CHANCE 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 are 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 on the contrary, do you think 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
708A. Do you think that this practice is required by your tradition or your customs?
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 on the contrary, do you think they favor abandoning it?
ABANDONED 2
IT DEPENDS 3
DOESN'T KNOW 8
TO BE FILLED OUT AFTER ENDING THE INTERVIEW.
COMMENTS ABOUT THE RESPONDENT _____
COMMENTS ON PARTICULAR QUESTIONS _____
OTHER COMMENTS _____
SUPERVISOR'S OBSERVATIONS _____
NAME_____
DATE_____