MINISTRY OF PLANNING, DEVELOPMENT, AND COOPERATION
NATIONAL INSTITUTE OF STATISTICS, ECONOMIC STUDY, AND DEMOGRAPHY
SECOND DEMOGRAPHIC AND HEALTH SURVEY
MAN'S QUESTIONNAIRE
NAME OF LOCALITY: __
NAME OF HEAD OF HOUSEHOLD:__
DEPARTMENT:__
SUBPREFECTURE:__
MUNICIPALITY:__
CLUSTER NUMBER (EDST): __
STRUCTURE NUMBER: __
HOUSEHOLD NUMBER IN THE STRUCTURE: __
SEQUENTIAL NUMBER OF SELECTED HOUSEHOLD (01-24 URBAN; 01-33 RURAL): __
Urban/rural
RURAL 2
Residence:
ABECHE/MOUNDOU/SARH=2
OTHER DEPARTMENTAL ADMINISTRATIVE CENTER=3
OTHER SMALL CITIES=4
RURAL=5
Man's name and line number (from household questionnaire)
1 2 3
DATE___
INTERVIEWER'S NAME___
RESULT*
FINAL VISIT
DAY __
MONTH __
YEAR 200__
NAME _________
RESULT_________
NEXT VISIT
DATE____
TIME____
TOTAL NO. OF VISITS_____
2 No household member at home
3 Postponed
4 Refused
5 Partly completed
6 Incapacitated
7 Other (specify)
Language of Interview**
Interpreter
NO=2
CHADIAN ARABIC 02
SAR 03
BORNOU 04
GOR 05
GORANE 06
COULEY 07
KANEMBOU 08
LELE 09
MABA (OUADDAIEN) 10
MBAY 11
MOUDANG 12
MOUSSEYE 13
NGAMBAY 14
TOUPOURI 15
OTHER LANGUAGES 16
SUPERVISOR
NAME:_____
DATE:_____
FIELD EDITOR
NAME:____
DATE:____
OFFICE EDITOR:___
KEYED BY:___
Section 1. Respondent's Background
Informed consent
Hello. My name is ____ and I work with the National Institute of Statistics, Economic Study and Demographics. In collaboration with the Ministry of Public Healthy, we are conducting a national survey about the health of women and children. We would very much appreciate your participation in this survey. I would like to ask you about your health (and the health of your children). This information will help the government to plan health services. The survey usually takes between 10 and 20 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.
At this time, do you have any questions?
May I begin the interview now?
MINUTES __ __
105) What year and what month were you born in?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
106) How old were you at your last birthday?
Compare and correct 105 and/or 106 if inconsistent
If Respondent under age 15 or over age 59, stop the interview and make the appropriate corrections on the household questionnaire.
107) Have you ever attended school?
NO 2- SKIP TO 109
108) What is the highest level of school you attended: primary, secondary, or higher?
PRIMARY 2
SECONDARY 3
HIGHER 4
PROFESSIONAL SECONDARY LEVEL 5
PROFESSIONAL HIGHER LEVEL 6
109) What is the highest (grade/form/year) you completed at this level?*
109a) Can you read Arabic, French, French and Arabic, or can you not read at all?
FRENCH ONLY 2
ARABIC AND FRENCH 3
CANNOT READ AT ALL 4-SKIP TO 113
SECONDARY OR PROFESSIONAL SECONDARY, OR HIGHER OR PROFESSIONAL HIGHER -SKIP TO 112
111) Now I would like you to read this sentence to me out loud in French; read as much as you can.
Show card to respondent. If respondent cannot read whole sentence, PROBE:
Can you read any part of the sentence to me?
ABLE TO READ CERTAIN PARTS 2
ABLE TO READ WHOLE SENTENCE 3
112) 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
113) 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
114) 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
PROTESTANT 2
ISLAM 3
ANIMIST 4
NO RELIGION 5
OTHER 6
ARAB 02
OUADDAI 03
BAGUIRMIEN 04
KANEM-BORNOU 05
FITRI-BATHA 06
HADJARAI 07
LAC IRO 08
SARA 09
TANDJILE 10
PEUL 11
MAYO KEBBI 12
OTHER CHADIAN ETHNICITIES 13
FOREIGNER 14
INDETERMINATE 98
117) Do you currently have a job of any kind for which you are paid in cash? Or do you work in agriculture?
NO 2
118) Have you had any kind of job in the last 12 months for which you earned money?
NO 2-SKIP TO 125
119) What is your occupation, that is, what kind of work do (did) you mainly do?
DOES NOT WORK IN AGRICULTURE-SKIP TO 122
121) Do you work mainly on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?
If fisher, circle code 6
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
FISHER 6
122) Do you do this work for a member of your family, for someone else, or are you self-employed?
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3
123) 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
124) On average, how much of your household's expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all?
ALMOST NONE 2
A PORTION 3
ALL/ALMOST ALL 4
ALL SKIP TO 201
125) Are you looking for a job?
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. Have you fathered any children?
NO 2 -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 who are 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, recode '00'
DAUGHTERS ELSEWHERE __ __
206) Have you ever had any sons or daughters who were born alive but later died?
If no, PROBE: Any baby who cried or showed signs of life at birth but did not survive?
NO 2- 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
209) Check 208:
Just to makes sure that I have this right: you have had in total ____children during your life. Is that correct?
NO-PROBE AND CORRECT 201-208 AS NECESSARY
HAS HAD ONLY ONE CHILD-SKIP TO 213
HAS NOT HAD ANY CHILDREN-SKIP TO 301
211) Do all of the children you have fathered have the same biological mother?
NO 2
212) In all, how many women have you fathered children with?
213) Check 208:
Has had only one child-In what month and what year was your child born?
Has had more than one child-In what month and what year was your (last) child born?
YEAR __ __ __ __
214) Check 208:
Has had only one child-When the mother of your child got pregnant, did you want to have a child then, did you want to wait until later, or did you not want to have any (more) children at all?
Has had more than one child- When the mother of your child got pregnant the last time, did you want to have a child then, did you want to wait until later, or did you not want to have any (more) children at all?
LATER 2
NOT AT ALL 3
DON'T KNOW 8
301) Now I would like to ask some questions about family planning-the various ways or methods that a couple can use to delay or avoid a pregnancy.
Circle code 1 in 301a for each method mentioned spontaneously. Then proceed down column 301a, reading the name and description of each method not mentioned spontaneously. Circle code 1 if method is recognized, and code 2 if not recognized. Then, for each method with code 1 circled in 301a, ask 302.
301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?
302) Have you ever heard of (METHOD)?
Women can have an operation to avoid having any more children
NO 2
302) Have you ever had a partner who had operation to avoid having any more children?
NO 2
Men can have an operation to avoid having any more children
302) Have you ever had an operation to avoid having any more children?
NO 2
301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?
NO 2
302) Have you ever heard of (METHOD)?
NO 2
04) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?
NO 2
302) Have you ever heard of (METHOD)?
NO 2
05) INJECTABLES
Women can have an injection by a heath provider which stops them from becoming pregnant for a month or more.
NO 2
302) Have you ever heard of (METHOD)?
NO 2
06) IMPLANTS
Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for a year or more.
NO 2
302) Have you ever heard of (METHOD)?
NO 2
07) CONDOM
Men can put a rubber sheath on their penis before sexual intercourse.
NO 2
302) Have you ever heard of (METHOD)?
NO 2
08) FEMALE CONDOM
Women can place a sheath in their vagina before sexual intercourse.
NO 2
302) Have you ever heard of (METHOD)?
NO 2
09) DIAPHRAGM
Women can place a thin flexible disk in their vagina before intercourse.
NO 2
302) Have you ever heard of (METHOD)?
NO 2
10) Suppository, jelly or vaginal tablets
Women can place a suppository, jelly, or cream in their vagina before intercourse.
NO 2
302) Have you ever heard of (METHOD)?
NO 2
11) Lactational amenorrhea method (LAM)
Up to 6 months after childbirth, and when her menstrual period has not returned, a woman can use a method that requires that she breastfeeds frequently, day and night, without giving him any other food.
NO 2
302) Have you ever heard of (METHOD)?
NO 2
12) Rhythm or Periodic abstinence
Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
NO 2
302) Have you ever heard of (METHOD)?
NO 2
13) WITHDRAWAL
Men can be careful and pull out before climax.
NO 2
302) Have you ever heard of (METHOD)?
NO 2
14) EMERGENCY CONTRACEPTION
Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.
NO 2
302) Have you ever heard of (METHOD)?
NO 2
15) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
(SPECIFY)__________
(SPECIFY)__________
NO 2
AT LEAST ONE 'YES' (EVER USED)- SKIP TO 307
304) Have you or any of your partners ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2- SKIP TO 309
306) What have you used or done?
Correct 302 and 303 (and 301a if necessary)
307) Are you or your partner currently doing something or using any method to delay or avoid getting pregnant?
NO 2-SKIP TO 309
MAN STERILIZED-CIRCLE 02 FOR MALE STERILIZATION
MALE STERILIZATION 02
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
MOUSSE/JELLY/VAGINAL TABLETS 10
LACTATIONAL AMEN. METHOD 11
RHYTHM METHOD 12
WITHDRAWAL 13
OTHER (SPECIFY) 96
(All skip to 401)
309) What is the main reason for which you are not using a method to delay or avoid pregnancy?
WIFE/PARTNER MENOPAUSAL/HYSTERECTOMY 13
COUPLE SUBFECUND/INFECUND 14
WANTS AS MANY CHILDREN AS POSSIBLE 15
IT'S NOT MY RESPONSIBILITY 16
HUSBAND/PARTNER OPPOSED 22
OTHERS OPPOSED 23
RELIGIOUS PROHIBITION 24
KNOWS NO SOURCE 32
FEAR OF SIDE EFFECTS 42
LACK OF ACCESS/TOO FAR 43
COSTS TOO MUCH 44
INCONVENIENT TO USE 45
INTERFERES WITH BODY'S NORMAL PROCESSES 46
DON'T KNOW 98
SECTION 4. MARRIAGE AND SEXUAL ACTIVITY
401) Are you currently married or living with a woman?
YES, LIVING WITH A WOMAN 2-SKIP TO 402A
NO, NOT IN UNION 3-SKIP TO 404
402) How many wives do you have?
402a) With how many women do you live as if married?
403) Record the line number of his wife/wives/partner/partners from the household sheet.
If a woman isn't listed in the household (she doesn't live in the household), record 00
The number of spaces filled should be equal to the number of women in q. 402.
__ __ __ __ __ __ -SKIP TO 406
404) Have you ever been married or lived with a woman?
YES, HAS LIVED WITH A WOMAN 2-SKIP TO 406
NO 3-SKIP TO 410
405) What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2
SEPARATED 3
405a) Who initiated your divorce/separation?
WIFE/PARTNER 2
WOMAN AND HUSBAND/MUTUAL AGREEMENT 3
FAMILY OF MAN 4
FAMILY OF WIFE/PARTNER 5
405b) What was the main cause of your divorce/separation?
WOMAN'S STERILITY 02
WOMAN'S ILLNESS 03
FINANCIAL REASONS 04
WOMAN'S INFIDELITY 05
DOMESTIC CONFLICT 06
FAMILY PRESSURE 07
OTHER (SPECIFY) 08
406) Have you been married or have you lived with a woman only once or more than once?
MORE THAN ONCE 2
407) In total, how many women have been married to or have you lived with as if married?
408) Check 406:
Married/lived with woman only once --in what month and year did you start living with your wife/partner?
Married/lived with woman more than once --I would like to talk 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
409) How old were you when you started living with her?
410) Now I need to ask you some questions about your sexual activity in order to gain a better understanding of some family life issues.
How old were you when you first had sexual intercourse (if ever)?
AGE IN YEARS __ __
FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE/PARTNER 95
AGE 25-59-SKIP TO 413
412) Was a condom used the first time you had sexual intercourse?
NO 2
DON'T KNOW/FORGOT 8
413) When was the last time you had sexual intercourse?
Record in Number of years only if the last time was over a year ago.
If 12 months of more, the answer should be recorded in years
WEEKS AGO 2
MONTHS AGO 3
YEARS AGO 4-SKIP TO 425
414) The last time you had sexual intercourse, was a condom used?
NO 2
415) What was your relationship to this person with whom you had sexual intercourse?
If girlfriend or fiancé, ask:
Were you living together when you last had sexual intercourse with her?
If yes, circle 01
If no, circle 02
GIRLFRIEND/FIANCÉ 02
ANOTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
PROSTITUTE 06
OTHER (SPECIFY) 96
416) In the last 12 months, have you had sexual intercourse with anyone else?
NO 2-SKIP TO 425
417) The last time you had sexual intercourse with this other person, was a condom used?
NO 2
418) What was your relationship to this person with whom you had sexual intercourse?
If girlfriend or fiancé, ask:
Were you living together when you last had sexual intercourse with her?
If yes, circle 01
If no, circle 02
GIRLFRIEND/FIANCÉ 02
ANOTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
PROSTITUTE 06
OTHER (SPECIFY) 96
419) Other than these two people, have you had sexual intercourse with anyone else in the last 12 months?
NO 2-SKIP TO 425
420) The last time you had sexual intercourse with this third person, was a condom used?
NO 2
421) What was your relationship to this person?
If girlfriend or fiancé, ask:
Were you living together when you last had sexual intercourse with her?
If yes, circle 01
If no, circle 02
GIRLFRIEND/FIANCÉ 02
ANOTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
PROSTITUTE 06
OTHER (SPECIFY) 96
422) In total, with how many people have you had sexual intercourse in the last 12 months?
423) In the last 12 months, did you pay anyone in exchange for having sexual intercourse?
NO 2 --SKIP TO 425
424) The last time you paid someone in exchange for having sexual intercourse, was a condom used?
NO 2
425) In total, with how many different people have you had sex in your lifetime?
PROBE to obtain an exact number
If the number if more than 95, write '95'
426) Do you know of a place where a person can get condoms?
NO 2-SKIP TO 501
427) Where is that?
Any other place?
Record all mentioned
MILITARY HOSPITAL/GARRISON B
HEALTH CENTER/FREE CLINIC/GARRISON C
POLYCLINIC D
HOSPITAL/HEALTH CENTER PHARMACY E
AMASOT/MASOCOT F [##TRANSLATOR NOTE: BOTH ARE ACRONYMS FOR AGENCIES THAT ADVOCATE CONDOMS]
OTHER PUBLIC G
CLINIC/OFFICE I
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING J
PRIVATE HEALTH CENTER K
COMPANY HEALTH CENTER L
CARE OFFICE/NURSE M
PHARMACY/PHARMACY DEPOT N
OTHER PRIVATE MEDICAL O
FIRST AID WORKER R
MOBILE VENDOR S
FRIENDS/NEIGHBORS/RELATIVES T
SECTION 5. FERTILITY PREFERENCES
501) CHECK 401: Marital status
NOT CURRENTLY MARRIED/NOT CURRENTLY LIVING WITH A WOMAN-SKIP TO 505A
503) Is your wife (live-in partner)/Are any of your wives (live-in partners)) currently pregnant?
NO 2-SKIP TO 505A
DK 8-SKIP TO 505A
504) At the time she became pregnant did you want her to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?
LATER 2
NOT AT ALL 3
ALL SKIP TO 505B
505) CHECK 501 AND 503:
A) Wife/partner not pregnant or not sure or not in union- Now I have some question about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?
B) Wife/partner pregnant- Now I have some questions about the future. After the child your wife/partner is expecting now, would you like to have another child, or would you prefer not to have any more children?
NO MORE/NONE 2-SKIP TO 507
WIFE/PARTNER CAN'T GET PREGNANCY 3-SKIP TO 507
SAYS HE DOESN'T WANT ANY MORE CHILDREN 4-SKIP TO 507
UNDECIDED/DON'T KNOW 8-SKIP TO 507
506) Check 501 and 503:
A) Wife/partner not pregnant or not sure or not in union- How long would you like to wait from now before the birth of (a/another) child?
B) 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
SOON/NOW 993
SAYS WIFE CAN'T GET PREGNANT 994
AFTER MARRIAGE 995
OTHER (SPECIFY) 996
DON'T KNOW 998
507) CHECK 307: Currently using a contraceptive method
NOT ASKED-SKIP TO 508
NO: NOT CURRENTLY USING-SKIP TO 508
508) Do you think you will use a method to delay or avoid pregnancy in the next 12 months?
NO 2
DON'T KNOW 8
509) Do you think you will use a method to delay or avoid pregnancy at any time in the future?
NO 2-SKIP TO 511
DON'T KNOW 8-SKIP TO 511
510) Which method would you prefer to use?
MALE STERILIZATION 02
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM/FOAM/JELLY 09
LACTATIONAL AMEN. METHOD 10
RHYTHM METHOD 11
WITHDRAWAL 12
OTHER (SPECIFY)__________96
ALL SKIP TO 512
511) What is the main reason that you think you will never use a contraceptive method at any time in the future?
WIFE/PARTNER MENOPAUSAL/HYSTERECTOMY 23
COUPLE SUBFECUND/INFECUND 24
WANTS AS MANY CHILDREN AS POSSIBLE 25
SPOUSE/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
KNOWS NO SOURCE 42
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COSTS TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
DON'T KNOW 98
512) CHECK 202 AND 204:
Has living children
If you could go 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?
PROBE FOR A NUMERIC RESPONSE.
OTHER (SPECIFY) 96-SKIP TO 514
513) 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?
NUMBER OF GIRLS __ __
EITHER __ __
OTHER (SPECIFY) 96
514) Would you say that you approve or disapprove of couples using a contraceptive method to avoid getting pregnant?
DISAPPROVE 2
NO OPINION 8
515) In the last few months have you heard about family planning:
NO 2
NO 2
NO 2
NO 2
NO 2
515a) Do you think it's acceptable or unacceptable to talk about family planning:
UNACCEPTABLE 2
UNACCEPTABLE 2
UNACCEPTABLE 2
UNACCEPTABLE 2
UNACCEPTABLE 2
516) CHECK 401: Marital status
NOT CURRENTLY MARRIED/NOT CURRENTLY LIVING WITH A WOMAN-SKIP TO 601
516a) CHECK 402: Number of spouses/partners
TWO OR MORE SPOUSES/PARTNERS-SKIP TO 601
517) Now I want to ask you about your spouse/live-in partner's views on family planning.
Do you think your spouse approves or disapproves of couples using a contraceptive method to avoid pregnancy?
DISAPPROVE 2
INDIFFERENT 3
DON'T KNOW 8
518) How often have you talked to your spouses/live-in partners about family planning in the last twelve months?
ONCE OR TWICE 2
MORE OFTEN 3
519) Does your spouse want the same number of children that you want, or does she want more or fewer than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8
SECTION 6. AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS
601) How I would like to talk about something else.
Have you ever heard of an illness called AIDS?
NO 2-SKIP TO 617
601a) How can you get AIDS?
Any other way?
RECORD ALL MENTIONED
NOT USING A CONDOM B
SEXUAL RELATIONS WITH MULTIPLE PARTNERS C
SEXUAL RELATIONS WITH PROSTITUTES D
HOMOSEXUAL RELATIONS E
BLOOD TRANSFUSIONS F
MOTHER TO CHILD G
KISSING H
MOSQUITO BITES I
LIVING WITH SOMEONE WITH AIDS J
DIRTY BLADES, SCISSORS, KNIVES, CUTTING OBJECTS K
FEMALE GENITAL CUTTING/CIRCUMCISION/EAR PIERCING L
EATING/DRINKING FROM SAME DISHES AS SOMEONE WITH AIDS M
OTHER (SPECIFY) X
DON'T KNOW Z
601b) 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
601c) Can people get the AIDS virus from mosquito bites?
NO 2
DON'T KNOW 8
601d) 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
601e) Can people get the AIDS virus by sharing food with a person who has AIDS?
NO 2
DON'T KNOW 8
601f) Can people reduce their chance of getting the AIDS virus by not having sexual intercourse at all?
NO 2
DON'T KNOW 8
601g) Can people get the AIDS virus because of witchcraft?
NO 2
DON'T KNOW 8
601h) Can people get the AIDS virus through contact with sharp-edged objects contaminated with blood, used, for example, during circumcisions, female genital cutting, scarification?
NO 2
DON'T KNOW 8
601i) Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?
NO 2-SKIP TO 609
DON'T KNOW 8-SKIP TO 609
601j) What can a person do?
Anything else?
RECORD ALL WAYS MENTIONED.
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS INTRAVENOUSLY H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING RAZORS/BLADES K
AVOID CIRCUMCISION/FEMALE GENITAL CUTTING/SCARIFICATION L
AVOID KISSING M
AVOID MOSQUITO BITES N
SEEK PROTECTION FROM TRADITIONAL PRACTITIONER O
OTHER (SPECIFY) W
OTHER (SPECIFY) X
DON'T KNOW Z
609) Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DON'T KNOW 8
610) Do you know someone personally who has the virus that causes AIDS or someone who died of AIDS?
NO 2
611) Can the virus that causes AIDS be transmitted from a mother to a child?
NO 2-SKIP TO 613
DON'T KNOW 8-SKIP TO 613
612) Can the virus that causes AIDS be transmitted from a mother to a child:
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO, NOT IN UNION/NOT LIVING WITH A WOMAN- SKIP TO 616A
614) Have you ever talked about ways to prevent getting the virus that causes AIDS with (your wife/the woman you are living with)?
NO 2
614A) 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
615) 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 8
616) If a relative of yours 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
616a) 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 BE ALLOWED 2
DK/NOT SURE/DEPENDS 8
616aa) do you think that sex education can contribute to AIDS prevention?
NO 2
DON'T KNOW 8
616ab) Do you think it is acceptable or not to teach sex education at school?
NOT ACCEPTABLE 2
DON'T KNOW 8
616b) Should children age 12-14 be taught about using a condom to avoid getting AIDS?
NO 2
DK/NOT SURE/DEPENDS 8
616j) I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?
NO 2 --SKIP TO 616O
616k) When was the last time you were tested?
12-23 MONTHS AGO 2
2 OR MORE YEARS AGO 3
616l) The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?
OFFERED AND ACCEPTED 2
REQUIRED 3
616m) I don't want to know the results, but did you get the results of the test?
NO 2
616n) Where was the test done?
You only have to circle one code
HOSPITAL/MATERNITY 12
MILITARY HOSPITAL/GARRISON 13
HEALTH CENTER/FREE CLINIC/GARRISON 14
NATIONAL PROGRAM FIGHTING AIDS (PNLS) 15 [##TRANSLATOR NOTE: THIS IS AN OFFICIAL LOCATION NAME]
POLYCLINIC 16
HOSPITAL/HEALTH CENTER PHARMACY 17
OTHER PUBLIC 18
CLINIC/OFFICE 22
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING 23
PRIVATE HEALTH CENTER 24
COMPANY HEALTH CENTER 25
CARE OFFICE/NURSE 26
PHARMACY/PHARMACY DEPOT 27
OTHER PRIVATE MEDICAL 28
ALL SKIP TO 617
616o) Would you like to have an AIDS test?
NO 2
DON'T KNOW 8
616p) Do you know a place where you can be tested for AIDS?
NO 2-SKIP TO 617
616q) Where can you go for this test?
Anywhere else?
RECORD ALL MENTIONED
HOSPITAL/MATERNITY B
MILITARY HOSPITAL/GARRISON C
HEALTH CENTER/FREE CLINIC/GARRISON D
NATIONAL PROGRAM FIGHTING AIDS (PNLS) E [##TRANSLATOR NOTE: THIS IS AN OFFICIAL LOCATION NAME]
POLYCLINIC F
HOSPITAL/HEALTH CENTER PHARMACY G
OTHER PUBLIC H
CLINIC/OFFICE J
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING K
PRIVATE HEALTH CENTER L
COMPANY HEALTH CENTER M
CARE OFFICE/NURSE N
PHARMACY/PHARMACY DEPOT O
OTHER PRIVATE MEDICAL P
VILLAGE PHARMACY/HEALTH CENTER Q
NOT CURRENTLY IN A UNION-SKIP TO 619
618) Have you ever talked about ways to prevent getting the virus that causes AIDS with your wife/partner?
NO 2
619) Do you think it's acceptable or unacceptable to talk about AIDS:
NOT ACCEPTABLE 2
NOT ACCEPTABLE 2
NOT ACCEPTABLE 2
NOT ACCEPTABLE 2
NOT ACCEPTABLE 2
619a) Do you think there are some segments of the population who have a higher risk of getting age because of, for example, their behavior or their job?
NO 2-SKIP TO 619D
DON'T KNOW 8-SKIP TO 619D
619b) Do you think that you are part of an at-risk group?
NO 2
DON'T KNOW 8
619c) What segments of the population do you think are more at risk of getting AIDS?
Any other group?
Record all mentioned
HOMOSEXUAL B
DRUG ADDICTS C
TRUCKER D
MILITARY/POLICE E
MIGRANT F
REFUGEE G
OTHER (SPECIFY) X
619d) Is there treatment for people with AIDS?
NO 2-SKIP TO 620
DON'T KNOW 8-SKIP TO 620
619e) What treatments do you know?
Any other treatment?
RECORD ALL MENTIONED
OTHER MODERN DRUGS B
OTHER TRADITIONAL DRUGS C
OTHER (SPECIFY) X
619f) Do you know where a person with AIDS can go for treatment?
If yes, where can he/she go?
Any other place?
RECORD ALL MENTIONED.
HOSPITAL/MATERNITY B
MILITARY HOSPITAL/GARRISON C
HEALTH CENTER/FREE CLINIC/GARRISON D
NATIONAL PROGRAM FIGHTING AIDS (PNLS) E [##TRANSLATOR NOTE: THIS IS AN OFFICIAL LOCATION NAME]
POLYCLINIC F
HOSPITAL/HEALTH CENTER PHARMACY G
OTHER PUBLIC H
CLINIC/OFFICE J
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING K
PRIVATE HEALTH CENTER L
COMPANY HEALTH CENTER M
CARE OFFICE/NURSE N
PHARMACY/PHARMACY DEPOT O
OTHER PRIVATE MEDICAL P
TRADITIONAL PRACTITIONER/MARABOU R
NOWHERE/NO ONE Y
620) Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?
NO 2-SKIP TO 622A
621) If a man has a sexually transmitted disease, what symptoms might he have?
Any other sign or symptom?
RECORD ALL SYMPTOMS MENTIONED
GENITAL DISCHARGE B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
IMPOTENCE L
OTHER (SPECIFY) W
OTHER (SPECIFY) X
NO SYMPTOMS Y
DON'T KNOW Z
622) If a woman has a sexually transmitted disease, what symptoms might she have?
Any other sign or symptom?
RECORD ALL SYMPTOMS MENTIONED
GENITAL DISCHARGE B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
HARD TO GET PREGNANT/HAVE A CHILD L
OTHER (SPECIFY) W
OTHER (SPECIFY) X
NO SYMPTOMS Y
DON'T KNOW Z
HAS NOT HAD SEXUAL INTERCOURSE (IF 00 IS CIRCLED) -SKIP TO 701
HAS NOT HEARD OF SEXUALLY TRANSMITTED INFECTIONS-SKIP TO 622D
622c) Now I would like to ask you some questions about your health. During the last 12 months, have you had a disease which you got through sexual contact?
NO 2
DON'T KNOW 8
622d) Sometimes men have abnormal discharge from their penis. Have you had any abnormal discharge from your penis in the last 12 months?
NO 2
DON'T KNOW 8
622e) 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
622f) Check 622c, 622d, and 622e:
NO TO Q. 622C, D OR E, HAS NOT HAD AN INFECTION-SKIP TO 622L
622g) The last time you had (infection from 622c, 622d, and/or 622e), did you seek any kind of advice or treatment from a health professional?
NO 2-SKIP TO 622I
622h) The last time you had (infection from 622C, 622D, and/or 622E), did you do any other following? Did you?
NO 2
NO 2
NO 2
NO 2
622i) When you had (infection from 622C, 622D, and/or 622E), did you inform the people were you having sexual intercourse with?
NO 2
SOME PEOPLE/NOT ALL 3
622j) When you had (infection from 622C, 622D, and/or 622E), did you do something to avoid infecting your sexual partner(s)?
NO 2
PARTNER(S) ALREADY INFECTED 3
DIDN'T HAVE PARTNER 4
2-8 SKIP TO 622L
622k) What did you do to prevent infection in your partner(s)? Did you?
NO 2
NO 2
NO 2
622l) Husband and wives do not always agree in everything. Please tell me if you think a woman is justified refusing to have sex with her husband when:
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
622m) 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
SECTION 7. FEMALE GENITAL CUTTING
701) Have you ever heard of female circumcision?
NO 2
702) In a number of countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard of this practice?
NO 2-SKIP TO 711
703) What benefits do girls get if they undergo this genital cutting?
PROBE: Other benefits?
RECORD ALL MENTIONED
SOCIAL ACCEPTANCE B
BETTER MARRIAGE PROSPECTS C
APPEASES WOMAN'S SEXUAL DESIRE D
MORE SEXUAL PLEASURE FOR THE MAN E
RELIGIOUS APPROVAL F
OTHER (SPECIFY) X
NO BENEFITS Y
704) What benefits do girls get if they do not undergo this genital cutting?
PROBE: Anything else?
RECORD ALL MENTIONED
FEWER CHILDBIRTH PROBLEMS B
AVOIDING PAIN C
MORE SEXUAL PLEASURE FOR HER D
MORE SEXUAL PLEASURE FOR THE MAN E
FOLLOWS RELIGION F
OTHER (SPECIFY) X
NO ADVANTAGES Y
CODE 'D' CIRCLED FOR Q. 703 OR Q. 704 -SKIP TO 707
706) Would you say that this practice is a way to appease women's sexual desire or does it have no effect?
NO EFFECT 2
DON'T KNOW 8
CODE 'F' CIRCLED FOR Q. 703 OR Q. 704 -SKIP TO 709
708) Do you believe that this practice is required by your religion?
NO 2
DON'T KNOW 8
709) Do you think that this practice should be continued, or should it be discontinued?
DISCONTINUED 2
DEPENDS 3
DON'T KNOW 8
710) Do you think that women want this practice to be continued, or discontinued?
DISCONTINUED 2
DEPENDS 3
DON'T KNOW 8
711) Some men are not circumcised. Are you circumcised?
NO 2
MINUTES __ __
To be filled in after completing interview
Comments about respondent:
________________________
________________________
Comments on specific questions:
________________________
________________________
Any other comments:
________________________
________________________
________________________
________________________
Name of supervisor__________
Date ______
Editor's observations
________________________
________________________
Name of editor___________
Date________