MINISTRY OF PLANNING AND OF INTERNATIONAL COOPERATION
MINISTRY OF PUBLIC HEALTH, SOCIAL ACTION, AND NATIONAL SOLIDARITY
NATIONAL INSTITUTE OF STATISTICS, ECONOMIC AND DEMOGRAPHIC STUDIES (INSEED)
DEMOGRAPHIC AND HEALTH SURVEY WITH MULTIPLE INDICATORS 2014
MAN'S QUESTIONNAIRE
REGION NAME____________
LOCALITY NAME (NEIGHBORHOOD/VILLAGE)_____________
NAME OF HEAD OF HOUSEHOLD_____________
CLUSTER NUMBER __ __
HOUSEHOLD NUMBER
RURAL__
HOUSEHOLD NUMBER (SEQUENTIAL IN THE CLUSTER)__ __
URBAN/RURAL
RURAL 2
N'DJAMENA-MOUNDOU/SARH/ABECHE-OTHER CITY-RURAL
MOUNDOU/SARH/ABECHE 2
OTHER CITY 3
RURAL 4
MAN'S NAME AND LINE NUMBER__________________________ __ __
INTERVIEWER VISITS
1 2 3
DATE_____
INTERVIEWER'S NAME
RESULT*
FINAL VISIT
DAY__ __
MONTH__ __
YEAR 201__
INT. NUMBER__ __
CODE RESULT
NEXT VISIT
DATE_______
TIME________
TOTAL NO. OF VISITS___
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY)
CHADIAN ARABIC 02
SARA 03
GORANE 04
KANEMBOU 05
MABA (OUADDAIEN) 06
MOUDANG 07
MOUSSEYE 08
PEUL/FOULF/BODORE 09
LELE/MARBA 10
TOUPOURI 11
BOULALA 12
ZAGHAWA/BERI/BIDEYAT 13
OTHER CHADIAN LANGUAGE (SPECIFY) __________ 96
INTERPRETER
NO 2
SUPERVISOR
NAME____________
DATE_______
FIELD EDITOR
NAME____________
DATE_______
OFFICE EDITOR_______
KEYED BY_____
SECTION 1. RESPONDENT'S BACKGROUND
INTRODUCTION AND CONSENT
INFORMED CONSENT
Hello. My name is ___. I am working with the National Institute of Statistics, Economic and Demographic Study (INSEED). We are conducting a survey about health all over Chad. The information we collect will help the government to improve 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
MINUTES__ __
102) In what month and year were you born?
DON'T KNOW MONTH 98
YEAR__ __ __ __
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- SKIP TO 108
105) What is the highest level of education you attended: primary, secondary, technical secondary, professional secondary, higher, or professional higher?
SECONDARY 2
TECHNICAL SECONDARY 3
PROFESSIONAL SECONDARY 4
HIGHER 5
PROFESSIONAL HIGHER 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
107) CHECK 105:
PRIMARY
SECONDARY OR TECHNICAL SECONDARY OR PROFESSIONAL SECONDARY OR HIGHER OR PROFESSIONAL HIGHER?-SKIP TO 110
CODE FOR Q. 106
LEVEL
1=PRIMARY
2=SECONDARY
3=SECONDARY TECHNICAL
4=SECONDARY PROFESSIONAL
5=HIGHER
6=HIGHER PROFESSIONAL
8-DON'T KNOW
00=LESS THAN ONE YEAR COMPLETED
GRADE
01=CP1
02=CP2
03=CE1
04=CE2
05=CM1
06=CM2
98=DON'T KNOW
01=6TH
02=5TH
03=4TH
04=3RD
05=SECOND
06=1ST
07=FINAL
98=DON'T KNOW
01=1ST YEAR
02=2ND YEAR
03=3RD YEAR
04=4TH YEAR
05=5TH YEAR
06=6TH YEAR
07=7TH YEAR OR HIGHER
98=DON'T KNOW
01=6TH OR 1ST YEAR
02=5TH OR 2ND YEAR
03=4TH OR 3RD YEAR
04=3RD OR 4TH YEAR
05=SECOND OR 5TH YEAR
06=1ST OR 6TH YEAR
07=FINAL OR 7TH YEAR
98=DON'T KNOW
01=1ST YEAR
02=2ND YEAR
03=3RD YEAR
04=4TH YEAR
05=5TH YEAR
06=6TH YEAR
07=7TH YEAR OR HIGHER
98=DON'T KNOW
01=1ST YEAR
02=2ND YEAR
03=3RD YEAR
04=4TH YEAR
05=5TH YEAR
06=6TH YEAR OR HIGHER
98=DON'T KNOW
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
CODE 1 OR 5 CIRCLED-SKIP 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
PROTESTANT 2
ISLAM 3
ANIMIST 4
NO RELIGION 5
OTHER 6
114) What is your ethnicity?
IF YOU CANNOT CLASSIFY THE ETHNICITY DECLARED BY THE RESPONDENT AMONG THE CATEGORIES LISTED, RECORD IT IN THE SPACE PROVIDED.
(ETHNICITY DECLARED BY THE RESPONDENT)
ARAB 02
BAGUIRMI/BARMA 03
KANEMBOU/BORNOU/BOUDOUMA 04
BOULALA/MEDEGO/KOUKA 05
OUADDAI/MABA/MASSALIT/MIMI 06
ZAGHAWA/BIDEYAT/KOBE 07
DADJO/KIBET/MOURO 08
BIDIO/MIGAMI/KENGA/DANGLEAT 09
MOUNDANG 10
MASSA/MOUSSEYE/MOUSGOU,E 11
TOUPOURI/KERA 12
SARA (NGAMBAYE/SARA MADJIN-GAYE/MBAYE) 13
PEUL/FOULBE/BODORE 14
TAMA/ASSONGORI/MARARIT 15
GABRI/KABALAYE/NANGTCHERE/SOUMRAYE 16
MARBA/LELE/MESME 17
MESMEDJE/MASSALAT/KADJASKE 18
KARO/ZIME/PEVE 19
AOTHER CHADIAN ETHNICITIES (ACHIT/BADA/KIM) 20
OTHER FOREIGN ETHNICITIES (BAMBARA/HAOUSSA/TOWER) 21
OTHER NATIONALITIES 22
115) In the last 12 months, how many times have you been away from home for one or more nights?
NONE 00-SKIP 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-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'
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, RECODE '00'
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-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'
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-SKIP TO 301
214) How old is your (youngest) child?
OTHER-SKIP 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-SKIP TO 219
DON'T KNOW 8-SKIP 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)?
01) FEMALE STERILIZATION
PROBE: Women can have an operation to avoid having any more children
Have you ever heard of (METHOD)?
NO 2
02) MALE STERILIZATION
PROBE: Men can have an operation to avoid having any more children
Have you ever heard of (method)?
NO 2
03) IUD
PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse.
Have you ever heard of (method)?
NO 2
04) INJECTABLES
PROBE: Women can have an injection by a heath provider that stops them from becoming pregnant for one or more months.
Have you ever heard of (METHOD)?
NO 2
05) IMPLANTS
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.
Have you ever heard of (METHOD)?
NO 2
06) PILL
PROBE: Women can take a pill every day to avoid becoming pregnant
Have you ever heard of (method)?
NO 2
07) CONDOM
PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
Have you ever heard of (METHOD)?
NO 2
08) FEMALE CONDOM
Probe: Women can place a sheath in their vagina before sexual intercourse.
Have you ever heard of (method)?
NO 2
09) LACTATIONAL AMENORRHEA METHOD (LAM)
Have you ever heard of (METHOD)?
NO 2
10) RHYTHM METHOD
PROBE: To avoid pregnancy, women do not have sexual intercourse on days of the month they think they can get pregnant.
Have you ever heard of (METHOD)?
NO 2
11) WITHDRAWAL
PROBE: Men can be careful and pull out before climax.
Have you ever heard of (METHOD)?
NO 2
12) EMERGENCY CONTRACEPTION
PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
Have you ever heard of (METHOD)?
NO 2
13) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
(SPECIFY)___________
(SPECIFY)___________
NO 2
302) In the last few months have you
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) I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.
DISAGREE 2
DON'T KNOW 8
DISAGREE 2
DON'T KNOW 8
307) CHECK 301 (07): KNOW MALE CONDOM
NO --SKIP TO 311
308) Do you know a place where a person can get condoms?
NO 2-SKIP 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
MILITARY HOSPITAL/GARRISON B
HEALTH CENTER/FREE CLINIC C
POLYCLINIC D
PHARMACY OF HOSPITAL/HEALTH CENTER E
OTHER PUBLIC SECTOR (SPECIFY) F
CLINIC/DOCTOR'S OFFICE H
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING I
PRIVATE HEALTH CENTER J
BUSINESS HEALTH CENTER K
CARE OFFICE/INFIRMARY L
PHARMACY/PHARMACY DEPOT M
CHADIAN SOCIAL MARKETING ASSOCIATION N
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) O
SHOP/BAR/MARKET R
FIRST AID WORKER S
TRAVELING VENDOR T
FRIENDS/NEIGHBORS/RELATIVES U
OTHER (SPECIFY) X
310) If you wanted, could you yourself get a condom?
NO 2
311) CHECK 301 (08): KNOWS FEMALE CONDOM
NO-SKIP TO 401
312) Do you know of a place where a person can get female condoms?
NO 2-SKIP 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
MILITARY HOSPITAL/GARRISON B
HEALTH CENTER/FREE CLINIC C
POLYCLINIC D
PHARMACY OF HOSPITAL/HEALTH CENTER E
OTHER PUBLIC SECTOR (SPECIFY) F
CLINIC/DOCTOR'S OFFICE H
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING I
PRIVATE HEALTH CENTER J
BUSINESS HEALTH CENTER K
CARE OFFICE/INFIRMARY L
PHARMACY/PHARMACY DEPOT M
CHADIAN SOCIAL MARKETING ASSOCIATION N
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) O
SHOP/BAR/MARKET R
FIRST AID WORKER S
TRAVELING VENDOR T
FRIENDS/NEIGHBORS/RELATIVES U
OTHER (SPECIFY) X
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-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?
407) CHECK 405:
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 LIVE-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 411A
410) Have you been married or lived with a woman only once or more than once?
MORE THAN ONCE 2-SKIP TO 411A
411) In what month and year did you start living with your (wife/partner)?
411a) Now I would like to ask you a question about your first (wife/partner). In what month and year did you start living with her?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
412) How old were you when you first started living with her?
413) CHECK FOR THE PRESENCE OF OTHERS.
BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
414) Now I would like to ask some questions about sexual activity in order to gain a better understanding of some important life issues.
How old were you when you had sexual intercourse for the very first time?
AGE IN YEARS__ __
FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE/PARTNER 95
415) Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any 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-SKIP TO 430
SECOND-TO-LAST SEXUAL PARTNER
THIRD-TO-LAST SEXUAL PARTNER
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-SKIP TO 420
419) Was a condom used every time you had sexual intercourse with this person in the last 12 months?
NO 2
420) What was your relationship to this person with whom you had sexual intercourse?
IF GIRLFRIEND: Were you living together as if married?
IF YES, CIRCLE 2
IF NO, CIRCLE 3
LIVE-IN PARTNER 2
GIRLFRIEND NOT LIVING WITH RESPONDENT 3
CASUAL ACQUAINTANCE 4
CLIENT/PROSTITUTE 5
OTHER (SPECIFY) 6
3-6-SKIP TO 423
MARRIED MORE THAN ONCE OR 410 NOT ASKED-(SKIP TO 423)
OTHER
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?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF THE NUMBER OF TIMES IS 95 OR MORE, WRITE 95.
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-(SKIP 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-SKIP TO 430
429) Check 420 and 418 (all columns)
Other-skip to 434
Condom used with every prostitute-skip to 433
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-SKIP TO 434
432) The last time you paid someone in exchange for having sexual intercourse, was a condom used?
NO 2-SKIP 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
DK 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
NUMBER OF PARTNERS IN LIFETIME
DON'T KNOW 98
435) CHECK 418, MOST RECENT PARTNER (FIRST COLUMN):
NOT ASKED-SKIP TO 438
NO CONDOM USED-SKIP TO 438
436) You told me that a condom was used the last time you had sex. What is the brand name of the condom used at that time?
IF BRAND NOT KNOWN, ASK TO SEE THE PACKAGE.
PRUDENCE 02
LOVERS + 03
PROMESSE 04
MANIX 05
KAMASUTRA 06
SUPRATEX 07
SECURITE PLUS 08
CADEAU 09
DUEL 10
AMI3 MASULIN 11
SUPER DELUX 12
CAREZ 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
MILITARY HOSPITAL/GARRISON 12
HEALTH CENTER/FREE CLINIC 13
POLYCLINIC 14
PHARMACY OF HOSPITAL/HEALTH CENTER 15
OTHER PUBLIC SECTOR (SPECIFY) 16
CLINIC/DOCTOR'S OFFICE 22
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING 23
PRIVATE HEALTH CENTER 24
BUSINESS HEALTH CENTER 25
CARE OFFICE/NURSE'S OFFICE 26
PHARMACY/PHARMACY DEPOT 27
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 24
FIRST AID WORKER 42
TRAVELING VENDOR 43
FRIENDS/NEIGHBORS/RELATIVES 44
DON'T KNOW 98
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-SKIP TO 501
DON'T KNOW 8-SKIP TO 501
439) What method did you or your partner use?
PROBE: Did you or your partner use any other method to prevent pregnancy?
RECORD ALL MENTIONED
MALE STERILIZATION B
IUD C
INJECTABLES D
IMPLANTS E
PILL F
FEMALE CONDOM G
DIAPHRAGM H
FOAM/JELLY I
LAM J
RHYTHM METHOD K
WITHDRAWAL L
OTHER MODERN METHOD X
OTHER TRADITIONAL METHOD Y
SECTION 5. FERTILITY PREFERENCES
501) CHECK 401:
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER-SKIP TO 509
MAN STERILIZED-SKIP TO 509
503) (Is your (wife/partner)/Are any of your (wives/partners)) currently pregnant?
NO 2-SKIP TO 505
DK 8-SKIP 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-SKIP TO 509
UNDECIDED/DON'T KNOW 8-SKIP 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-SKIP TO 509
SAYS COUPLE CAN'T GET PREGNANT 3-SKIP TO 509
WIFE (WIVES)/PARTNER(S) STERILIZED 4-SKIP TO 509
UNDECIDED/DON'T KNOW 8-SKIP TO 509
MORE THAN ONE WIFE/PARTNER --SKIP TO 508
507) CHECK 503:
WIFE/PARTNER NOT PREGNANT OR DON'T KNOW-How long would you like to wait from now before the birth of (a/another) child?
WIFE/PARTNER PREGNANT-After the birth of the child you are expecting now, how long would you wait before the birth of another child?
YEARS 2
SOON/NOW 993
COUPLE INFECUND 994
OTHER (SPECIFY) 996
DON'T KNOW 998
ALL SKIP 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:
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.
NUMBER
OTHER (SPECIFY) 96-SKIP TO 601
510) How many of these children would you like to be boys, how many would you like to be girls, and for how many would it not matter if it's a boy or a girl?
NUMBER OF GIRLS__ __
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
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-SKIP 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
OTHER-SKIP 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
DK 8
711) Check for presence of others. Before continuing, make every effort to ensure privacy
712) I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?
NO 2-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.
HOSPITAL/MATERNITY 12
MILITARY HOSPITAL/GARRISON 13
HEALTH CENTER/FREE CLINIC 14
SECTOR-SPECIFIC PROGRAM FOR THE FIGHT AGAINST AIDS 15
POLYCLINIC 16
PHARMACY OF HOSPITAL/HEALTH CENTER 17
OTHER PUBLIC SECTOR (SPECIFY) 18
CLINIC/DOCTOR'S OFFICE 22
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING 23
PRIVATE HEALTH CENTER 24
BUSINESS HEALTH CENTER 25
CARE OFFICE/INFIRMARY 26
PHARMACY/PHARMACY DEPOT 27
CHADIAN SOCIAL MARKETING ASSOCIATION 28
DIOCESAN CENTER FOR MEDICAL ACTION (CEDIAM) 29
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 30
COMMUNITY VOLUNTEER TESTING CENTER 40
ALL SKIP TO 718
716) Do you know of a place where people can go to get tested for the AIDS virus?
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
HOSPITAL/MATERNITY B
MILITARY HOSPITAL/GARRISON C
HEALTH CENTER/FREE CLINIC D
SECTOR-SPECIFIC PROGRAM FOR THE FIGHT AGAINST AIDS E
POLYCLINIC F
PHARMACY OF HOSPITAL/HEALTH CENTER G
AL NADJMA CENTER [##TRANSLATOR NOTE: HIV/AIDS TESTING CENTER] H
OTHER PUBLIC SECTOR (SPECIFY) I
CLINIC/DOCTOR'S OFFICE K
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING L
PRIVATE HEALTH CENTER M
BUSINESS HEALTH CENTER N
CARE OFFICE/INFIRMARY O
PHARMACY/PHARMACY DEPOT P
CHADIAN SOCIAL MARKETING ASSOCIATION Q
DIOCESAN CENTER FOR MEDICAL ACTION (CEDIAM) R
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) S
COMMUNITY VOLUNTEER TESTING CENTER U
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
DK/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
DK/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 BE ALLOWED 2
DK/NOT SURE/DEPENDS 8
722) Should children age 12-14 be taught about using a condom to avoid getting AIDS?
NO 2
DK/NOT SURE/DEPENDS 8
723) CHECK 701:
HEARD ABOUT AIDS- Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?
NOT HEARD ABOUT AIDS- Have you heard about infections that can be transmitted through sexual contact?
NO 2
HAS NOT HAD SEXUAL INTERCOURSE-SKIP TO 732
725) CHECK 723: Heard about other sexually transmitted infections?
NO-SKIP TO 727
726) Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?
NO 2
DON'T KNOW 8
727) Sometimes men experience an abnormal discharge from their penis. During the last 12 months, have you had an abnormal discharge from your penis?
NO 2
DON'T KNOW 8
728) Sometimes men have a sore or ulcer near their penis. During the last 12 months, have you had a sore or ulcer near your penis?
NO 2
DON'T KNOW 8
HAS NOT HAD AN INFECTION OR DOES NOT KNOW --SKIP TO 732
730) The last time you had (infection from 726/727/728), did you seek any kind of advice or treatment?
NO 2-SKIP TO 732
731) Where did you go?
Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
MILITARY HOSPITAL/GARRISON B
HEALTH CENTER/FREE CLINIC C
POLYCLINIC D
PHARMACY OF HOSPITAL/HEALTH CENTER E
OTHER PUBLIC SECTOR (SPECIFY) F
CLINIC/DOCTOR'S OFFICE H
PRIVATE HEALTH CENTER I
BUSINESS HEALTH CENTER J
CARE OFFICE/INFIRMARY K
PHARMACY/PHARMACY DEPOT L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) M
TRADITIONAL PRACTITIONER P
FIRST AID WORKER Q
FRIENDS/RELATIVES 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 (another woman/women other than his spouse(s))?
NO 2
DON'T KNOW 8
SECTION 8. OTHER HEALTH ISSUES
801) Some men are circumcised, that is, the foreskin is completely removed from the penis. Are you circumcised?
NO 2-SKIP TO 805
DON'T KNOW 8-SKIP TO 805
802) How old were you when you got circumcised?
DURING CHILDHOOD (LESS THAN 5 YEARS) 96
DON'T KNOW 98
803) Who did the circumcision?
HEALTH WORKER/PROFESSIONAL 2
OTHER 3
DON'T KNOW 8
HOME OF A HEALTH WORKER/PROFESSIONAL 2
CIRCUMCISION DONE AT HOME 3
RITUAL SITE 4
OTHER HOME/PLACE 5
DON'T KNOW 8
805) Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD 90
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00-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) Are you covered by any health insurance?
NO 2-SKIP TO 810
809) What type of health insurance are you covered by?
RECORD ALL MENTIONED
HEALTH INSURANCE THROUGH EMPLOYER B
SOCIAL SECURITY C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
OTHER (SPECIFY) X
MINUTES__ __
TO BE FILLED IN AFTER COMPLETING INTERVIEW:
COMMENTS ABOUT RESPONDENT:
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COMMENTS ON SPECIFIC QUESTIONS:
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ANY OTHER COMMENTS:
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DATE_______
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NAME OF EDITOR_______________
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