Man's Questionnaire
Republic of Senegal
Ministry of the Economy, Finance, and Planning
Ministry of Health and Social Action
ICF International
PLACE NAME _______
NAME OF HEAD OF HOUSEHOLD _______
HOUSEHOLD NUMBER ____
PLOT NUMBER ____
CLUSTER NUMBER _____
REGION ____
URBAN/RURAL
RURAL 2
MILIEU
REGIONAL CAPITAL 2
OTHER CITY 3
RURAL 4
MILIEU (DETAIL) ________
MAN'S NAME AND LINE NUMBER ______
INTERVIEWER VISITS
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER'S NAME
RESULT*
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER _____ (SPECIFY)
FINAL VISIT
DAY ____
MONTH ____
YEAR _____
INT. NUMBER ____
RESULT ____
NEXT VISIT
DATE _____
TIME _____
2 WOLOF
3 POULAR
4 SERER
5 MANDINGUE
6 DIOLA
8 OTHER
LANGUAGE OF INTERVIEW
2 WOLOF
3 POULAR
4 SERER
5 MANDINGUE
6 DIOLA
8 OTHER
INTERPRETER
NO 2
SUPERVISOR
NAME ________
DATE _________
Informed consent
Hello. My name is ___. I am working with the ANSD. We are conducting a survey about health all over Senegal. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 30 and 60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.
In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.
Do you have any questions?
May I begin the interview?
DATE: _______________
RESPONDENT AGREES TO BE INTERVIEWED 1
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
MINUTES ________
SECTION 1. RESPONDENT'S BACKGROUND
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?
INTERMEDIATE 2
SECONDARY 3
HIGHER 4
OTHER (SPECIFY) ___________ 6
106) What is the highest (grade/form/year) you completed at this level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.
INTERMEDIATE, 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 PART OF SENTENCE 2
ABEL TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) 4
BLIND/VISUALLY IMPAIRED 5
108A) Have you ever participated in a literacy program or any other program that involved learning to read or write (not including primary school)?
NO 2 (GO TO 109)
108B) In what language was the literacy program in which you participated done?
Probe: any other?
RECORD ALL MENTIONED.
WOLOF B
POULAR C
SERER D
DIOLA E
MANDINGUE F
SONINKE G
OTHER (SPECIFY LANGUAGE) _____ X
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
111) Do you listen to the radio at least once a week, less than once a week or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
112) Do you watch television at least once a week, less than once a week, or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
CHRISTIAN 2
ANIMIST 3
NO RELIGION 4
OTHER (SPECIFY) _____ 6
NO 2 (GO TO 115)
POULAR 02
SERER 03
MANDINGUE 04
DIOLA 05
SONINKE 06
OTHER (SPECIFY) _____ 96
114b) Do you own a mobile telephone?
NO 2 (GO TO 110)
114c) Do you use your mobile phone for any financial transactions?
NO 2
114d) Do you have an account in a bank or other financial institution that you yourself use?
NO 2
114e) Have you ever used the internet?
NO 2 (GO TO 115)
114f) In the last 12 months, have you used the internet?
NO 2
114e) During the last 12 months, how often did you use the internet: almost every day, at least once a week, less than once a week, or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
115) In the last 12 months, how many times have you been away from 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 you have fathered who are now living with you?
NO 2 (GO TO 204)
203) How many sons live with you?
And how many daughters live with you?
IF NONE, RECORD '00'.
DAUGHTERS AT HOME _________
204) Do you have any sons or daughters that you have fathered who are not 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 ONLY HAD ONE CHILD-SKIP TO 212
HAS NOT HAD ANY CHILDREN-SKIP TO 301
210) Did all of the children you have fathered have the same biological mother?
NO 2
211) In all, how many women have you fathered children with?
212) How old were you when your (first) child was born?
NO LIVING CHILDREN (GO TO 301)
214) How old is your (youngest) child?
OTHER (GO TO 301)
216) What is the name of your (youngest) child? WRITE NAME OF (YOUNGEST) CHILD.
217) When (name)'s mother was pregnant with (name), did she have any antenatal check-ups?
NO 2 (GO TO 219)
DON'T KNOW 8 (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 a health facility?
OTHER 2
220) 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)?
PROBE: Women can have an operation to avoid having any more children
NO 2
PROBE: Men can have an operation to avoid having any more children
NO 2
PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse.
NO 2
PROBE: Women can have an injection by a heath provider that stops them from becoming pregnant for one or more months.
NO 2
PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
NO 2
PROBE: Women can take a pill every day to avoid becoming pregnant
NO 2
PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
NO 2
PROBE: Women can place a sheath in their vagina before sexual intercourse.
NO 2
NO 2
PROBE: A woman uses a string of colored beads to know the days she can get pregnant.
NO 2
PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
NO 2
PROBE: Men can be careful and pull out before climax.
NO 2
PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
NO 2
(SPECIFY) __________
(SPECIFY) _________
NO 2
302) In the last few months have you
Heard about family planning on the radio?
NO 2
Seen anything about family planning on the television?
NO 2
Read about family planning in a newspaper or magazine?
NO 2
303) In the last few months, have you discussed family planning with a health worker or health professional?
NO 2
304) Now I would like to ask you about a woman's risk of pregnancy.
From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant when she 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.
a) Contraception is a woman's business and a man should not have to worry about it.
DISAGREE 2
DON'T KNOW 8
b) Women who use contraception may become promiscuous.
DISAGREE 2
DON'T KNOW 8
307) CHECK 301 (07): Knows male condom
NO (GO TO 311)
308) Do you know 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
HEALTH POST C
GOVT. FAMILY PLANNING CENTER D
RURAL MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
MOBILE CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) _____ I
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ N
CHURCH P
FRIENDS/RELATIVES Q
BAR R
310) If you wanted, 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
HEALTH POST C
GOVT. FAMILY PLANNING CENTER D
RURAL MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
MOBILE CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) _____ I
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ N
CHURCH P
FRIENDS/RELATIVES Q
BAR R
314) If you wanted, could you yourself get a female condom?
NO 2
SECTION 4. MARRIAGE AND SEXUAL ACTIVITY
401) Are you currently married or living with a woman as if married?
YES, LIVING WITH A WOMAN 2 (GO TO 404)
NO, NOT IN UNION 3
402) Have you ever been married or lived together with a woman as if married?
YES, LIVED WITH A WOMAN 2
NO 3 (GO TO 413)
403) What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2 (GO TO 410)
SEPARATED 3 (GO TO 410)
404) Is your (wife/partner) living with you now or is she staying elsewhere?
STAYING ELSEWHERE 2
405) Do you have other wives or do you live with other women as if married?
NO (ONLY ONE) 2 (GO TO 407)
406) Altogether, how many wives or live-in partners do you have?
407) CHECK 405:
RECORD THE NAME AND THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE AND LIFE-IN PARTNER.
IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.
ASK 408 FOR EACH PERSON
ONE WIFE/PARTNER
Line number _________
MORE THAN ONE WIFE/PARTNER
Line number _________
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 2 (GO TO 411A)
411) In what month and year did you start living with your (wife/partner)?
DON'T KNOW MONTH 98
YEAR _________ (GO TO 413)
DON'T KNOW YEAR 9998
411a) Now we are going to talk about your first (wife/partner). In what month and year did you start living with her?
DON'T KNOW MONTH 98
YEAR _________ (GO TO 413)
DON'T KNOW YEAR 9998
412) How old were you when you 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 question that you don't want to answer, just let me know and we will go to the next question.
416) When was the last time you 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 second/third) 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 (GO TO 423)
CASUAL ACQUAINTANCE 4 (GO TO 423)
CLIENT/PROSTITUTE 5 (GO TO 423)
OTHER (SPECIFY) _____ 6 (GO TO 423)
MARRIED MORE THAN ONCE OR BLANK (GO TO 423)
OTHER (GO TO 423)
423) How long ago did you first have sexual intercourse with this (second/third) 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?
DON'T KNOW 98
426) Apart from (this person/these two people), 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 life?
IF NON-NUMERIC NUMBER, PROBE TO GET AN ESTIMATE
IF THE NUMBER IF MORE THAN 95, 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) What is the brand name of the condom you currently use?
IF BRAND NOT KNOWN, ASK TO SEE THE PACKAGE.
FAGAROU 02
VISA 03
MANIX 04
PRESA 05
KAMA SUTRA 06
PROTEX 07
INNOTEX 08
CASANOVA 09
INTIMY 10
CONTEX 11
STAR 12
TROJAM 13
OTHER (SPECIFY) ______ 96
DON'T KNOW 98
437) From where did you obtain the condom the last time?
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
HEALTH POST 13
GOVT. FAMILY PLANNING CENTER 14
RURAL MATERNITY 15
HEALTH HUT 16
COMMUNITY PHARMACY 17
MOBILE CLINIC 18
OTHER PUBLIC SECTOR (SPECIFY) _____ 19
PHARMACY 22
PRIVATE DOCTOR 23
RELIGIOUS FREE CLINIC 24
PRIVATE LABORATORY 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____26
CHURCH 32
FRIENDS/RELATIVES 33
BAR 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
LAMA J
RHYTHM METHOD K
WITHDRAWAL L
OTHER MODERN METHOD X
OTHER TRADITIONAL METHOD Y
SECTION 5. FERTILITY PREFERENCES
501) CHECK 401:
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (GO to 509)
MAN STERILIZED (GO TO 509)
503) Is your (wife/partner)/Are any of your (wives/partners)) currently pregnant?
NO 2 (GO TO 505)
DON'T KNOW 8 (GO TO 505)
504) Now I have some questions about the future. After the (child/children) you and your (wife(wives)/partner(s)) are expecting now, would you like to have another child, or would you prefer not 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
YEARS ______ 2 (GO TO 509)
SOON/NOW 993 (GO TO 509)
COUPLE INFECUND 994 (GO TO 509)
OTHER (SPECIFY) ______996 (GO TO 509)
DON'T KNOW 998 (GO TO 509)
WIFE/PARTNER PREGNANT
YEARS ______ 2 (GO TO 509)
SOON/NOW 993 (GO TO 509)
COUPLE INFECUND 994 (GO TO 509)
OTHER (SPECIFY) ______996 (GO TO 509)
DON'T KNOW 998 (GO TO 509)
508) How long would you like to wait from now before the birth of (a/another) child?
YEARS 2
SOON/NOW 993
HE/ALL HIS WIVES/PARTNERS ARE INFECUND 994
OTHER (SPECIFY) _____ 996
DON'T KNOW 998
509) CHECK 203 AND 205:
PROBE FOR A NUMERIC RESPONSE.
HAS LIVING CHILDREN
Number _____
Other (specify) ______ 96 (go to 601)
NO LIVING CHILDREN
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 the sex not matter?
NUMBER OF GIRLS _____
NUMBER OF EITHER ______
OTHER (SPECIFY) __________ 96
SECTION 6. EMPLOYMENT AND GENDER ROLES
601) Have you done any work in the last seven days?
NO 2
602) Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, or any other such reason?
NO 2
603) Have you done any work in the last 12 months?
NO 2 (GO TO 610)
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
CURRENTLY MARRIED OR LIVING WITH A PARTNER (GO TO 608)
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (GO TO 612)
CODE 1 OR 2 CIRCLED (GO TO 609)
OTHER (GO TO 610)
609) Who usually decides how the money you earn will be used: you, your (wife/partner), or you and your (wife/partner) jointly?
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
OTHER (SPECIFY) _____ 6
610) Who usually makes decisions about health care for yourself: you, your (wife/partner), you and your (wife/partner) jointly, or someone else?
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) _____ 6
611) Who usually makes decisions about making major household purchases?
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) ______ 6
612) Do you own this or any other house either alone or 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) How 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 means?
NO 2
DON'T KNOW 8
707) Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DON'T KNOW 8
708) Can the virus that causes AIDS be transmitted from a mother to a child?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
AT LEAST ONE YES (GO TO 710)
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 THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
712) Have you ever been tested for HIV?
NO 2 (GO TO 716)
713) How many months ago was your most recent HIV text?
TWO OR MORE YEARS 95
714) Did you get the results of the test?
NO 2
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER 12
HEALTH POST 13
GOVT. FAMILY PLANNING CENTER 14
RURAL MATERNITY 15
HEALTH HUT 16
COMMUNITY PHARMACY 17
MOBILE CLINIC 18
OTHER PUBLIC SECTOR (SPECIFY) _____ 19
PHARMACY 23
PRIVATE DOCTOR 24
RELIGIOUS FREE CLINIC 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ 26
CHURCH 32
FRIENDS/RELATIVES 33
BAR 34
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 THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
GOVT. HEALTH CENTER B
HEALTH POST C
GOVT. FAMILY PLANNING CENTER D
RURAL MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
MOBILE CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) _____ I
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)_____N
CHURCH P
FRIENDS/RELATIVES Q
BAR R
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 the virus that causes AIDS, would you be willing to care for her or him in your own household?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
721) In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in the school?
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8
722) Should children age 12-14 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?
NO 2
NOT HEARD ABOUT AIDS
Have you heard about infections that can be transmitted through sexual contact?
NO 2
HAS HAD SEXUAL INTERCOURSE (GO TO 725)
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 HAD AN INFECTION (ANY YES) (GO TO 730)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 732)
730) The last time you had (infection 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 THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER B
HEALTH POST C
GOVT. FAMILY PLANNING CENTER D
RURAL MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
MOBILE CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) _____ I
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ N
CHURCH P
FRIENDS/RELATIVES Q
BAR R
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 other women?
NO 2
DON'T KNOW 8
SECTION 8. FEMALE GENITAL CUTTING
801 Have you ever heard of female circumcision?
NO 2
802) In some countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard about this practice?
NO 2 (GO TO 900)
803) Do you believe that female circumcision is required by your religion?
NO 2
DON'T KNOW 8
804) Do you think that female circumcision should be continued, or should it be stopped?
STOPPED 2
DEPENDS 3
DON'T KNOW 8
900) Now, I would like to ask you a few questions about the usage of "smoked" tobacco, including cigarettes, cigars, pipes, and roll-ups.
IF AGE 60 OR MORE, START THE INTERVIEW WITH ALL THE "INDIVIDUAL CHARACTERISTICS" QUESTIONS, 401 TO 406 AND 601 TO 606, WHILE FOLLOWING THE SKIPS.
901) Do you currently smoke tobacco daily, less than once a day, or not at all?
LESS THAN ONCE A DAY 2
NOT AT ALL 3 (GO TO 903)
DON'T KNOW 7 (END OF INTERVIEW)
REFUSE TO RESPOND 8 (END OF INTERVIEW)
902) Have you ever smoked tobacco daily in the past?
NO 2 (GO TO 910)
DON'T KNOW 3 (GO TO 910)
REFUSE TO RESPOND 8 (GO TO 910)
903) In the "past," have you ever smoked tobacco daily, less than once a day, or not at all?
LESS THAN ONCE A DAY 2 (END OF INTERVIEW)
NOT AT ALL 3 (END OF INTERVIEW)
DON'T KNOW 7 (END OF INTERVIEW)
REFUSE TO RESPOND 8 (END OF INTERVIEW)
IF THE RESPONDENT SMOKED "DAILY" AND "LESS THAN ONCE A DAY" IN THE PAST, CHECK "DAILY".
904) How old were you when you first started smoking tobacco daily?
IF DON'T KNOW OR RESPONSE TO RESPOND, RECORD '99'.
IF Q904 IS 99, ASK QUESTION 905. OTHERWISE, SKIP TO QUESTION 906.
AGE IN COMPLETED YEARS _____
905) How many years ago did you start smoking tobacco daily?
IF REFUSE TO RESPOND, RECORD '99'.
906) On average, how many of the following products do you currently smoke every day? Also, tell me if you smoke this product, but not every day.
IF THE RESPONDENT SAYS THAT HE OR SHE SMOKE THE PRODUCT, BUT NOT EVERY DAY, RECORD '888'.
IF THE RESPONDENT PROVIDES THE NUMBER OF PACKETS OR CARTONS, ASK HOW MANY ARE IN EACH ONE, AND CALCULATE THE TOTAL NUMBER.
WEEKLY _____
WEEKLY _____
WEEKLY _____
WEEKLY _____
WEEKLY _____
WEEKLY _____
WEEKLY ______
WEEKLY ______
WEEKLY ______
WEEKLY ______
F2) [IF 906F=888] ON AVERAGE, HOW MANY [INDICATE THE PRODUCT] DO YOU CURRENTLY SMOKE EACH WEEK?
WEEKLY _____
907) How long do you typically wait after waking up before smoking? Would you say within 5 minutes, between 6 and 30 minutes, between 31 and 60 minutes, or over 60 minutes?
BETWEEN 6 AND 30 MINUTES 2
BETWEEN 31 AND 60 MINUTES 3
OVER 60 MINUTES 4
REFUSE TO RESPOND 8
FOR CURRENT SMOKERS SMOKING LESS THAN ONCE A DAY
908) What age were you when you started smoking tobacco daily?
IF DON'T KNOW OR REFUSE TO RESPOND, RECORD '99'.
IF 908=99, ASK QUESTION 909. IF NOT, SKIP TO QUESTION 910
909) How many years ago did you start smoking tobacco daily?
IF REFUSE TO RESPOND, RECORD '99'.
910) How many of the following products do you currently smoke over the course of a normal week?
IF THE RESPONDENT INDICATES THAT HE ENGAGES IN THE ACTIVITY OVER THE COURSE OF THE LAST 30 DAYS. IF THE RESPONDENT PROVIDES THE NUMBER OF PACKETS OR CARTONS, ASK HOW MANY ARE IN EACH ONE, AND CALCULATE THE TOTAL NUMBER.
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT RESPONDENT: ________
COMMENTS ON SPECIFIC QUESTIONS: ________
ANY OTHER COMMENTS: ________
SUPERVISOR'S OBSERVATIONS: ________________
NAME OF SUPERVISOR: ________
DATE: __________
EDITOR'S OBSERVATIONS: ________________
NAME OF EDITOR: __________
DATE: ___________