Continuous Demographic and Health Survey (EDS-Continuous 2016)
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 NUMBER HOUSEHOLD
PLOT NUMBER
CLUSTER NUMBER CLUSTER
REGION
DEPARTMENT
SANITATION DISTRICT
MILIEU
URBAN/RURAL
RURAL 2
DAKAR/REGIONAL CAPITAL/OTHER CITY/RURAL
REGIONAL CAPITAL 2
OTHER CITY 3
RURAL 4
MAN'S NAME AND LINE NUMBER _________
Household selected for men's survey (DV)?
NO 2
INTERVIEWER VISITS
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
FINAL VISIT
DAY
MONTH
YEAR 201
INT. NUMBER
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT
DATE
TIME
LANGUAGE OF QUESTIONNAIRE
WOLOF 2
POULAR 3
SERER 4
MANDINGUE 5
DIOLA 6
OTHER 8
LANGUAGE OF INTERVIEW
WOLOF 2
POULAR 3
SERER 4
MANDINGUE 5
DIOLA 6
OTHER 8
NATIVE LANGUAGE OF RESPONDENT
WOLOF 2
POULAR 3
SERER 4
MANDINGUE 5
DIOLA 6
OTHER 8
TRANSLATOR USED
NO 2
LANGUAGE OF QUESTIONNAIRE: FRENCH
WOLOF 2
POULAR 3
SERER 4
MANDINGUE 5
DIOLA 6
OTHER 8
Hello. My name is ___. I am working with the National Agency for Statistics and Demography in collaboration with the Ministry of Health and Social Action. 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 to 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?
Signature of interviewer
Date
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
SECTION 1. RESPONDENT'S BACKGROUND
101) RECORD THE TIME
MINUTES
105) In what month and year were you born?
DON'T KNOW MONTH 98
YEAR
DON'T KNOW YEAR 9998
106) How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT
107) Have you ever attended school?
NO 2 (SKIP TO 111)
108) What is the highest level of school you attended: primary, secondary 1, secondary 2, or higher?
MIDDLE 2
SECONDARY 3
HIGHER 4
OTHER (SPECIFY) 6
109) What is the highest (grade/form/year) you completed at this level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD 00
MIDDLE, SECONDARY OR HIGHER (SKIP TO 113)
111) Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE:
Can you read any part of the sentence to me?
ABLE TO READ ONLY PART OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) 4
BLIND/VISUALLY IMPAIRED 5
111a) Have you ever participated in a literacy program or any other program that included learning how to read and right (not including primary school)?
NO 2 (SKIP TO 112)
111b) In what languages were these literacy programs?
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 (SKIP TO 114)
113) Do you read a newspaper or magazine at least once a week, less than once a week or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
114) Do you listen to the radio at least once a week, less than once a week or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
115) Do you watch television at least once a week, less than once a week, or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
116) Do you own a mobile telephone?
NO 2 (SKIP TO 118)
117) Do you use your mobile phone for any financial transactions?
NO 2
118) Do you have an account in a bank or other financial institution that you yourself use?
NO 2
119) Have you ever used the internet?
NO 2 (SKIP TO 122)
120) In the last 12 months, have you used the internet?
If necessary, probe for use from any location, with any device.
NO 2 (SKIP TO 122)
121) During the last one month, how often did you use the internet: almost every day, at least once a week, less than once a week, or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
CHRISTIAN 2
ANIMIST 3
NO RELIGION 4
OTHER (SPECIFY) 6
NO 2 (SKIP TO 201)
POULAR 02
SERER 03
MANDINGUE/SOCE 04
DIOLA 05
SONINKE 06
OTHER (SPECIFY) 96
201) Now I would like to ask about any children you have had during your life. I am interested in all of the children that are biologically yours, even if they are not legally yours or do not have your last name.
Have you ever fathered any children with any woman?
NO 2 (SKIP TO 206)
DON'T KNOW 8 (SKIP TO 206)
202) Do you have any sons or daughters that you have fathered who are now living with you?
NO 2 (SKIP TO 204)
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 (SKIP 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, who made any movement, sound or effort to breathe, or who showed any other signs of life even if for a very short time?
NO 2 (SKIP TO 208)
DON'T KNOW 8 (SKIP TO 208)
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 211)
HAS NOT HAD ANY CHILDREN (SKIP TO 301)
210) Did all of the children you have fathered have the same biological mother?
NO 2
HAS HAD MORE THAN ONE CHILD
How old were you when your child was born?
NO LIVING CHILDREN (SKIP TO 301)
MORE THAN ONE LIVING CHILD
ONLY ONE LIVING CHILD
(YOUNGEST) CHILD IS AGE 3 YEARS OR OLDER (SKIP TO 301)
MORE THAN ONE LIVING CHILD
ONLY ONE LIVING CHILD
216) When (name)'s mother was pregnant with (name), did she have any antenatal check-ups?
NO 2 (SKIP TO 218)
DON'T KNOW 8 (SKIP TO 218)
217) Were you ever present during any of those antenatal check-ups?
NOT PRESENT 2
218) Was (name) born in a hospital or a health facility?
OTHER 2
219) 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
302) In the last few months have you
NO 2
NO 2
NO 2
NO 2
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 (SKIP TO 306)
DON'T KNOW 8 (SKIP TO 306)
305) Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) 6
DON'T KNOW 8
306) After the birth of a child, can a woman become pregnant before her menstrual period has returned?
NO 2
DON'T KNOW 8
307) I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.
DISAGREE 2
DON'T KNOW 8
DISAGREE 2
DON'T KNOW 8
308) CHECK 301 (07): Know male condom
NO (SKIP TO 312)
309) Do you know a place where a person can get condoms?
NO 2 (SKIP TO 312)
310) 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
311) If you wanted, could you yourself get a condom?
NO 2
312) CHECK 301 (08): Knows female condom
NO (SKIP TO 401)
313) Do you know of a place where a person can get female condoms?
NO 2 (SKIP TO 401)
314) 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
315) 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 (SKIP 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 (SKIP TO 413)
403) What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2
SEPARATED 3
ALL (SKIP TO 410)
404) Is your (wife/partner) living with you now or is she staying elsewhere?
STAYING ELSEWHERE 2
405) Do you have other wives or do you live with other women as if married?
NO (ONLY ONE) 2 (SKIP 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 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
LINE NUMBER
408) How old was (name) on her last birthday?
MORE THAN ONE WIFE/PARTNER (SKIP TO 411)
410) Have you been married or lived with a woman only once or more than once?
MORE THAN ONCE 2 (SKIP TO 411)
BOTH ARE CODE 2
DON'T KNOW MONTH 98
YEAR (SKIP TO 413)
DON'T KNOW YEAR 9998
OTHER
DON'T KNOW MONTH 98
YEAR (SKIP 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 need to ask you some questions about sexual activity in order to gain a better understanding of some important life issues. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question. How old were you when you had sexual intercourse for the very first time?
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. 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 (SKIP TO 417)
MONTHS AGO 3 (SKIP TO 417)
YEARS AGO 4 (SKIP TO 427)
WEEKS AGO 2 (SKIP TO 417)
MONTHS AGO 3 (SKIP TO 417)
YEARS AGO 4 (SKIP TO 427)
WEEKS AGO 2 (SKIP TO 417)
MONTHS AGO 3 (SKIP TO 417)
YEARS AGO 4 (SKIP TO 427)
416) When was the last time you had sexual intercourse with this person?
WEEKS AGO 2
MONTHS AGO 3
417) The last time you had sexual intercourse (with this second/third) person, was a condom used?
NO 2 (SKIP TO 419)
418) Was a condom used every time you had sexual intercourse with this person in the last 12 months?
NO 2
419) 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/SEX WORKER 5
OTHER (SPECIFY) 6
420) How long ago did you first have sexual intercourse with this (second/third) person?
WEEKS AGO 2
MONTHS AGO 3
YEARS AGO 4
421) 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 OF PARTNER IS 95 OR MORE, RECORD 95.
DON'T KNOW 98
423) Apart from this person, have you had sexual intercourse with any other person in the last 12 months?
NO 2 (SKIP TO 425)
424) 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 SEX WORKERS (SKIP TO 427)
426) CHECK 420 AND 418 (ALL COLUMNS)
CONDOM USED WITH EVERY SEX WORKER (SKIP TO 431)
427) In the last 12 months, did you pay anyone in exchange for having sexual intercourse?
NO 2
428) Have you ever paid anyone in exchange for having sexual intercourse?
NO 2 (SKIP TO 431)
429) The last time you paid someone in exchange for having sexual intercourse, was a condom used?
NO 2 (SKIP TO 431)
430) 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
DK 8
431) In the past 12 months have you given any gifts or other goods in order to have sex or to become sexually involved with anyone?
NO 2
432) Have you ever given any gift or other goods in order to have sex or to become sexually involved with anyone?
NO 2
433) 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
434) CHECK 417, MOST RECENT PARTNER (FIRST COLUMN): Condom used
NO CONDOM USED (SKIP TO 438)
435) You told me that a condom was used the last time you had sex. What is the brand name of the condom you used at that time?
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
436) 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
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 26
CHURCH 32
FRIENDS/RELATIVES 33
BAR 34
437) 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 (SKIP TO 440)
DON'T KNOW 8 (SKIP TO 440)
438) The last time you had sex did you or your partner use any method to avoid or prevent a pregnancy?
NO 2 (SKIP TO 440)
DON'T KNOW 8 (SKIP TO 440)
439) What method did you or your partner use?
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
EMERGENCY CONTRACEPTION I
STANDARD DAYS METHOD J
LACTATIONAL AMEN. METHOD K
RHYTHM METHOD L
WITHDRAWAL M
OTHER MODERN METHOD X
OTHER TRADITIONAL METHOD Y
440) Do you know of a place where you can obtain a method of family planning?
NO 2
SECTION 5. FERTILITY PREFERENCES
501) CHECK 401:
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (SKIP TO 514)
MAN STERILIZED (SKIP TO 514)
MORE THAN ONE WIFE/PARTNERS (SKIP TO 509)
504) Is your (wife/partner) currently pregnant?
NO 2 (SKIP TO 507)
DK 8 (SKIP TO 507)
505) Now I have some questions about the future. After the child you and your (wife/partner) are expecting now, would you like to have another child, or would you prefer not have any more children?
NO MORE 2 (SKIP TO 514)
UNDECIDED/DON'T KNOW 8 (SKIP TO 514)
506) After the birth of the child you are expecting now, how long would you wait before the birth of another child?
YEARS 2
SOON/NOW 993
OTHER (SPECIFY) 996
DON'T KNOW 998
ALL SKIP TO 514
HAS FATHERED CHILDREN
NO MORE/NONE 2 (SKIP TO 514)
SAYS COUPLE CAN'T GET PREGNANT 3 (SKIP TO 514)
WIFE/PARTNER STERILIZED 4 (SKIP TO 514)
UNDECIDED/DON'T KNOW 8 (SKIP TO 514)
HAS NOT FATHERED CHILDREN
NO MORE/NONE 2 (SKIP TO 514)
SAYS COUPLE CAN'T GET PREGNANT 3 (SKIP TO 514)
WIFE/PARTNER STERILIZED 4 (SKIP TO 514)
UNDECIDED/DON'T KNOW 8 (SKIP TO 514)
HAS FATHERED CHILDREN
YEARS 2
SOON/NOW 993
SAYS COUPLE CAN'T GET PREGNANT 994
OTHER (SPECIFY) 996
DON'T KNOW 998
ALL (SKIP TO 514)
HAS NOT FATHERED CHILDREN
YEARS 2
SOON/NOW 993
SAYS COUPLE CAN'T GET PREGNANT 994
OTHER (SPECIFY) 996
DON'T KNOW 998
ALL (SKIP TO 514)
509) Are any of your (wives/partners) currently pregnant?
NO 2 (SKIP TO 512)
DON'T KNOW 8 (SKIP TO 512)
510) Now I have some questions about the future. After the (child/children) you and your (wives/partners) are expecting now, would you like to have another child, or would you prefer not have any more children?
NO MORE 2 (SKIP TO 514)
UNDECIDED/DON'T KNOW 8 (SKIP TO 514)
511) After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?
YEARS 2
SOON/NOW 993
OTHER (SPECIFY) 996
DON'T KNOW 998
ALL (SKIP TO 514)
HAS FATHERED CHILDREN
NO MORE/NONE 2 (SKIP TO 514)
SAYS COUPLE CAN'T GET PREGNANT 3 (SKIP TO 514)
WIFE (WIVES)/PARTNER(S) STERILIZED 4 (SKIP TO 514)
UNDECIDED/DON'T KNOW 8 (SKIP TO 514)
HAS NOT FATHERED CHILDREN
NO MORE/NONE 2 (SKIP TO 514)
SAYS COUPLE CAN'T GET PREGNANT 3 (SKIP TO 514)
WIFE (WIVES)/PARTNER(S) STERILIZED 4 (SKIP TO 514)
UNDECIDED/DON'T KNOW 8 (SKIP TO 514)
HAS FATHERED CHILDREN
How long would you wait before the birth of another child?
YEARS 2
SOON/NOW 993
SAYS COUPLE CAN'T GET PREGNANT 994
OTHER (SPECIFY) 996
DON'T KNOW 998
HAS NOT FATHERED CHILDREN
How long would you wait before the birth of a child?
YEARS 2
SOON/NOW 993
SAYS COUPLE CAN'T GET PREGNANT 994
OTHER (SPECIFY) 996
DON'T KNOW 998
514) CHECK 203 AND 205:
PROBE FOR A NUMERIC RESPONSE.
HAS LIVING CHILDREN
NUMBER
OTHER (SPECIFY) 96 (SKIP TO 601)
NO LIVING CHILDREN
NUMBER
OTHER (SPECIFY) 96 (SKIP TO 601)
515) How many of these children would you like to be boys, how many would you like to be girls, and for how many would the sex not matter?
NUMBER GIRLS
NUMBER EITHER
OTHER (SPECIFY) 96
SECTION 6. EMPLOYMENT AND GENDER ROLES
601) Have you done any work in the last seven days?
NO 2
602) Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, or any other such reason?
NO 2
603) Have you done any work in the last 12 months?
NO 2 (SKIP TO 607)
604) What is your occupation, that is, what kind of work do you mainly do?
605) Do you usually work throughout the year, or do you work seasonally, or only once in a while?
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3
606) Are you paid in cash or kind for this work or are you not paid at all?
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (SKIP TO 612)
OTHER (SKIP TO 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 (SKIP TO 615)
613) Do you have a title deed for any house you own?
NO 2 (SKIP TO 615)
DON'T KNOW 8 (SKIP TO 615)
614) Is your name on the title deed?
NO 2
DON'T KNOW 8
615) Do you own any agricultural or non-agricultural land either alone or jointly with someone else?
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4 (SKIP TO 618)
616) Do you have a title deed for any land you own?
NO 2 (SKIP TO 618)
DON'T KNOW 8 (SKIP TO 618)
617) Is your name on the title deed?
NO 2
DON'T KNOW 8
618) In your opinion, is a husband justified in hitting or beating his wife in the following situations:
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
701) Now I would like to talk about something else.
Have you ever heard of an HIV or AIDS?
NO 2 (SKIP TO 727)
702) HIV is the virus that can lead to AIDS. Can people reduce their chance of getting 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 HIV by using a condom every time they have sex?
NO 2
DON'T KNOW 8
705) Can people get HIV by sharing food with a person who has AIDS?
NO 2
DON'T KNOW 8
706) Can people get HIV because of witchcraft or other supernatural means?
NO 2
DON'T KNOW 8
707) Is it possible for a healthy-looking person to have HIV?
NO 2
DON'T KNOW 8
708) Can the virus that causes HIV be transmitted from a mother to a child?
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
OTHER (SKIP TO 711)
710) Are there any special drugs that a doctor or a nurse can give to a woman infected with HIV to reduce the risk of transmission to the baby?
NO 2
DK 8
711) CHECK FOR THE PRESENCE OF OTHERS.
BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
712) I don't want to know the results, but have you ever been tested for HIV?
NO 2 (SKIP TO 716)
713) How many months ago was your most recent HIV text?
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
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 an HIV test?
NO 2 (SKIP 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) Have you ever heard of test kits people can use to test themselves for HIV?
NO 2 (SKIP TO 720)
719) Have you ever tested yourself for HIV using a self-testing kit?
NO 2
720) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?
NO 2
DON'T KNOW 8
720a) If a member of your family got infected with the AIDS virus, would you want it to remain a secret or not?
NO 2
DK/NOT SURE/DEPENDS 8
720b) 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
DK/NOT SURE/DEPENDS 8
721) Do you think children living with HIV should be allowed to attend school with children who do not have HIV?
NO 2
DK/NOT SURE/DEPENDS 8
722) Do you think people hesitate to take an HIV test because they are afraid of how other people will react if the test results is positive for HIV?
NO 2
DK/NOT SURE/DEPENDS 8
723) Do people talk badly about people living with HIV, or who are thought to be living with HIV?
NO 2
DK/NOT SURE/DEPENDS 8
724) Do people living with HIV, or thought to be living with HIV, lose the respect of other people?
NO 2
DK/NOT SURE/DEPENDS 8
725) Do you agree or disagree with the following statement: I would be ashamed if someone in my family had HIV.
DISAGREE 2
DK/NOT SURE/DEPENDS 8
726) Do you fear that you could get HIV if you come into contact with the saliva of a person living with HIV?
NO 2
DK/NOT SURE/DEPENDS 8
HEARD ABOUT HIV OR AIDS
No 2
NOT HEARD ABOUT HIV OR AIDS
No 2
HAS NOT HAD SEXUAL INTERCOURSE (SKIP TO 736)
729) CHECK 727: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?
NO (SKIP TO 731)
730) Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?
NO 2
DON'T KNOW 8
731) Sometimes men experience an abnormal discharge from their penis. During the last 12 months, have you had an abnormal discharge from your penis?
NO 2
DON'T KNOW 8
731) 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 (SKIP TO 736)
734) The last time you had (infection from 730/731/732), did you seek any kind of advice or treatment?
NO 2 (SKIP TO 736)
735) Where did you go?
Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE 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
736) 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
737) 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. OTHER HEALTH ISSUES
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 (SKIP TO 808)
806) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or another healthcare worker?
IF THE NUMBER OF INJECTIONS IS OVER 90 OR IF THERE WERE DAILY INJECTIONS IN THE LAST 3 MONTHS OR LONGER, RECORD 90.
IF THE RESPONSE IS NOT NUMERIC, PROBE TO OBTAIN AN ESTIMATE.
NONE 00 (SKIP TO 808)
807) The last time you got an injection from a health worker, did he/she take the syringe and needle form a new, unopened package?
NO 2
DON'T KNOW 8
808) Do you currently smoke tobacco every day, some days, or not at all?
SOME SAYS 2
NOT AT ALL 3 (SKIP TO 810)
809) In the past, have you smoked tobacco every day?
NO 2 (SKIP TO 812)
810) In the past, have you ever smoked tobacco every day, some days, or not at all?
SOME SAYS 2 (SKIP TO 813)
NOT AT ALL 3 (SKIP TO 813)
811) On average, how many of the following products do you currently smoke each day? Also, let me know if you use the product, but not every day.
IF RESPONDENT REPORT USING THE PRODUCT BUT NOT EVERY DAY, RECORD "888." IF THE PRODUCT IS NOT USED AT ALL, RECORD "000."
812) On average, how many of the following products do you currently smoke each week? Also, let me know if you use the product, but not every week.
IF RESPONDENT REPORT USING THE PRODUCT BUT NOT EVERY WEEK, RECORD "888." IF THE PRODUCT IS NOT USED AT ALL, RECORD "000."
813) Do you currently use smokeless tobacco every day, some days, or not at all?
SOME DAYS 2 (SKIP TO 815)
NOT AT ALL 3 (SKIP TO 901)
814) On average, how many of the following products do you currently use each day? Also, let me know if you use the product, but not every day.
IF RESPONDENT REPORT USING THE PRODUCT BUT NOT EVERY DAY, RECORD "888." IF THE PRODUCT IS NOT USED AT ALL, RECORD "000."
815) On average, how many of the following products do you currently use each week? Also, let me know if you use the product, but not every week.
IF RESPONDENT REPORT USING THE PRODUCT BUT NOT EVERY WEEK, RECORD "888." IF THE PRODUCT IS NOT USED AT ALL, RECORD "000."
SECTION 9. FEMALE CIRCUMCISION
901) Have you ever heard of female circumcision?
NO 2
902) 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 (SKIP TO 905)
903) Do you believe that female circumcision is required by your religion?
NO 2
NO RELIGION 3
DON'T KNOW 8
904) Do you think that female circumcision should be continued, or should it be stopped?
STOPPED 2
DEPENDS 3
DON'T KNOW 8
MINUTES
TO BE FILLED IN AFTER COMPLETING INTERVIEW
Comments about respondent:
Comments on specific questions:
Any other comments:
SUPERVISOR'S OBSERVATIONS
EDITOR'S OBSERVATIONS