UNITED REPUBLIC OF TANZANIA
BUREAU OF STATISTICS, PLANNING COMMISSION
TANZANIA DEMOGRAPHIC AND HEALTH SURVEY
INDIVIDUAL QUESTIONNAIRE
MALE
IDENTIFICATION
NAME OF HOUSEHOLD HEAD ______________________
TDHS CLUSTER ID ___
HOUSEHOLD NO. ___
REGION _____________________
DISTRICT ___________________
WARD ___________________
ENUMERATION AREA _______________
URBAN/RURAL ___
RURAL 2
LARGE CITY/SMALL CITY/TOWN/COUNTRYSIDE ___
SMALL CITY 2
TOWN 3
COUNTRYSIDE 4
NAME AND LINE NUMBER OF MALE RESPONDENT _____________ ___
NAME AND LINE NUMBER OF WIFE ___________________ ___
NAME AND LINE NUMBER OF WIFE ___________________ ___
NAME AND LINE NUMBER OF WIFE ___________________ ___
INTERVIEWER VISITS
INTERVIEWER VISIT 1
DATE ______________
INTERVIEWER'S NAME _______________
RESULT ______________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) _________ 6
INTERVIEWER VISIT 2
DATE ______________
INTERVIEWER'S NAME _______________
RESULT ______________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) _________ 6
INTERVIEWER VISIT 3
DATE ______________
INTERVIEWER'S NAME _______________
RESULT ______________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) _________ 6
NEXT VISIT:
DATE ______
TIME _____
FINAL VISIT
DAY ____
MONTH ____
YEAR ___
ID NO. ___
RESULT ____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) _________ 6
TOTAL NUMBER OF VISITS __
FIELD EDITED BY
NAME ________
DATE ________
OFFICE EDITED BY
NAME ________
DATE ________
KEYED BY
NAME ________
DATE ________
KEYED BY
SECTION 1. RESPONDENT'S BACKGROUND
M101. RECORD THE TIME
MINUTES _______
M102. First I would like to ask some questions about your background. For most of the time until you were 12 years old, did you live in Dar es Salaam city, another urban area, or in a rural area?
OTHER URBAN AREA 2
RURAL AREA/VILLAGE 3
M103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
ALWAYS 95 (GO TO M105)
VISITOR 96 (GO TO M105)
M104. Just before you moved here, did you live in Dar es Salaam city, another urban area, or in a rural area?
OTHER URBAN AREA 2
RURAL AREA/VILLAGE 3
M105. In what month and year were you born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 98
M106. How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.
M107. Can you read and write kiswahili easily, with difficulty, or not at all?
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO M109)
M108. Do you usually read a newspaper or magazine at least once a week?
NO 2
M109. Have you ever attended school?
NO 2 (GO TO M111)
M110. What is the highest formal school completed?
STANDARD 1 01
STANDARD 2 02
STANDARD 3 03
STANDARD 4 04
STANDARD 5 05
STANDARD 6 06
STANDARD 7 07
STANDARD 8 08
FORM 1 09
FORM 2 10
FORM 3 11
FORM 4 12
FORM 5 13
FORM 6 14
UNIVERSITY 15
OTHER (SPECIFY) ________________ 16
M111. Do you usually listen to a radio at least once a week?
NO 2
M112. Do you usually watch television at least once a week?
NO 2
M113. What kind of work do you mainly do?
DOES NOT WORK IN AGRICULTURE __ (GO TO M116)
M115. Do you work mainly on your own land or on family land, or do you rent land, or do you work on someone else's land?
RENT LAND 2
SOMEONE ELSE'S LAND 3
CATHOLIC 2
PROTESTANT 3
NONE 4
OTHER (SPECIFY) ______________ 5
M117. To which tribe do you belong?
M118. CHECK Q.5 IN THE HOUSEHOLD SCHEDULE:
THE RESPONDENT IS A USUAL RESIDENT OF THE HH __ (GO TO M201)
M119. Now I would like to ask about the place in which you usually live.
Do you usually live in Dar es Salaam City, another urban area, or in the rural area?
IF OTHER URBAN AREA: In which town do you live?*
LARGE URBAN AREA 2
SMALL URBAN AREA 3
RURAL AREA/VILLAGE 4
M120. In which region is that located?
IF USUAL RESIDENCE IS OUTSIDE OF TANZANIA, RECORD COUNTRY OF RESIDENCE.
M121. Does the household in which you usually live have:
NO 2
NO 2
NO 2
NO 2
M122. Could you describe the main material of the floor of your home?
WOOD PLANKS 21
PARQUET OR POLISHED WOOD 31
CERAMIC TILES 32
CEMENT 33
OTHER (SPECIFY) _____________ 41
M123. Does any member of your household own:
A bicycle?
A motorcycle?
A car?
NO 2
NO 2
NO 2
*M119 LARGE URBAN AREAS ARE MWANZA, ARUSHA, MOROGORO, DODOMA, MOSHI, TANGA, IRINGA, MBEYA, TABORA AND ZANZIBAR. SMALL URBAN AREAS ARE ALL OTHER TOWNS.
M201. Do you have any sons or daughters who are now living with you?
NO 2 (GO TO M203)
M202. How many sons live with you?
And how many daughters live with you?
IF NONE, ENTER '00'.
M203. Do you have any sons or daughters who do not live with you?
NO 2 (GO TO M205)
M204. 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, ENTER '00'
M205. Have you ever had a son or daughter who was born alive but later died?
NO 2 (GO TO M207)
M206. In all, how many boys have died?
And how many girls have died?
IF NONE, ENTER '00'.
M207. SUM ANSWERS TO M202, 204, AND 206, AND ENTER TOTAL.
IF NONE, ENTER '00'.
M208. CHECK M207:
Just to make sure that I have this right: you have had in TOTAL ____ children born alive during your life. Is that correct?
NO __ (PROBE AND CORRECT M201-M207 AS NEEDED)
M209. Between the first day of a woman's period and the first day of her next period, are there certain times when she has a greater chance of becoming pregnant than other times?
NO 2 (GO TO M301)
DON'T KNOW 8 (GO TO M301)
M210. During which time of the monthly cycle does a woman have the greatest chance of becoming pregnant?
RIGHT AFTER HER PERIOD HAS ENDED 2
IN THE MIDDLE OF THE CYCLE 3
JUST BEFORE HER PERIOD BEGINS 4
OTHER (SPECIFY) _________________ 5
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. Which ways or methods have you heard about?
CIRCLE CODE 1 IN M302 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.
CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED.
THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN M302, ASK M303 AND M304 BEFORE PROCEEDING TO THE NEXT METHOD.
M302. Have you ever heard of (METHOD)?
READ DESCRIPTION OF EACH METHOD.
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
NO 3
M303. Have you (or your wife/partner) ever used (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
Have you ever had an operation to avoid having any more children?
NO 2
NO 2
NO 2
NO 2
Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
NO 2
M304. Do you know where a person could go to get (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
Do you know where a person can obtain advice on how to use the calendar method?
NO 2
Do you know where a person can obtain advice on how to observe changes in the mucus?
NO 2
AT LEAST ONE 'YES' (EVER USED) __ (GO TO M308)
M306. Have you (or your wife/partner) ever used anything or tried in any way to delay or avoid having a child?
NO 2 (GO TO M321)
M307. What have you used or done?
CORRECT M303-M305 (AND M302 IF NECESSARY).
MAN STERILIZED ___ (GO TO M310A)
M309. Are you (or your wife/partner) currently doing something or using any method to delay or avoid having a child?
NO 2 (GO TO M315)
M310. Which method are you using?
M310A. CIRCLE '07' FOR FEMALE STERILIZATION.
IUD 02
INJECTIONS 03
DIAPHRAGM/FOAM/JELLY 04
CONDOM 05
FEMALE STERILIZATION 06
MALE STERILIZATION 07
CALENDAR 08 (GO TO M315)
MUCUS METHOD 09 (GO TO M315)
WITHDRAWAL 10 (GO TO M315)
OTHER (SPECIFY) _________ 11 (GO TO M315)
SHE/HE STERILIZED ___
Where did the sterilization take place?
USING ANOTHER METHOD ___
Where did you (or your wife/partner) obtain (METHOD) last time?
REGIONAL HOSPITAL 12
DISTRICT HOSPITAL 13
HEALTH CENTRE 14
DISPENSARY 15
PARASTATAL HEALTH FACILITY 16
VILLAGE HEALTH POST/WORKER 17 (GO TO M314)
PRIV. DOCTOR/CLINIC/HOSPITAL 22
PHARMACY/MEDICAL STORE 23
UMATI CBD WORKER 24 (GO TO M314)
NEIGHBORS/RELATIVES 32 (GO TO M314)
DON'T KNOW 98 (GO TO M314)
M312. How long does it take to travel from your home to this place?
IF LESS THAN TWO HOURS, RECORD TRAVEL TIME IN MINUTES.
OTHERWISE, RECORD TRAVEL TIME IN HOURS.
HOURS 2 __
DON'T KNOW 9998
M313. Is it easy or difficult to get there?
DIFFICULT 2
USING CONDOM ___ (GO TO M316)
M315. Have you used a condom in the last four weeks?
NO 2 (GO TO M320)
M316. What is the brand name of the condom you last used?
DON'T KNOW 98
M317. How much did the condom you last used cost?
PARTNER OBTAINED 95
FREE 96
DON'T KNOW 98
M318. Do you use more condoms now than a year ago, about the same number, or fewer?
SAME NUMBER 2 (GO TO M320)
FEWER 3 (GO TO M320)
M319. What is the main reason you use more condoms now than a year ago?
FEAR OF GETTING OTHER STD 2
FAMILY PLANNING 3
LESS EXPENSIVE NOW 4
MORE AVAILABLE NOW 5
OTHER (SPECIFY) _______________ 6
DON'T KNOW 8
USING A METHOD___ (GO TO M331)
M321. Do you intend to use a method to delay or avoid having a child at any time in the future?
NO 2
DK 3 (GO TO M327)
M322. What is the main reason you do not intend to use a method?
LACK OF KNOWLEDGE 02 (GO TO M327)
PARTNER OPPOSED 03 (GO TO M327)
COST TOO MUCH 04 (GO TO M327)
SIDE EFFECTS 05 (GO TO M327)
HEALTH CONCERNS 06 (GO TO M327)
HARD TO GET METHODS 07 (GO TO M327)
RELIGION 08 (GO TO M327)
OPPOSED TO FAMILY PLANNING 09 (GO TO M327)
FATALISTIC 10 (GO TO M327)
OTHER PEOPLE OPPOSED 11 (GO TO M327)
INFREQUENT SEX 12 (GO TO M327)
WIFE/PARTNER INFECUND 13 (GO TO M327)
INCONVENIENT 15 (GO TO M327)
NOT MARRIED/NO PARTNER 16 (GO TO M327)
OTHER (SPECIFY) ______ 17 (GO TO M327)
DON'T KNOW 98 (GO TO M327)
M323. Do you intend to use a method within the next 12 months?
NO 2
DON'T KNOW 8
M324. When you use a method, which method would you prefer to use?
IUD 02
INJECTIONS 03
DIAPHRAGM/FOAM/JELLY 04
CONDOM 05
FEMALE STERILIZATION 06
MALE STERILIZATION 07
CALENDAR 08 (GO TO 327)
MUCUS METHOD 09 (GO TO 327)
WITHDRAWAL 10 (GO TO 327)
OTHER (SPECIFY) _________ 11 (GO TO 327)
UNSURE 98 (GO TO 327)
M325. Where can you get (METHOD MENTIONED IN M324)?
REGIONAL HOSPITAL 12 (GO T0 M329)
DISTRICT HOSPITAL 13 (GO T0 M329)
HEALTH CENTRE 14 (GO T0 M329)
DISPENSARY 15 (GO T0 M329)
PARASTATAL HEALTH FACILITY 16 (GO T0 M329)
VILLAGE HEALTH POST/WORKER 17 (GO TO M331)
PRIV. DOCTOR/CLINIC/HOSPITAL 22 (GO T0 M329)
PHARMACY/MEDICAL STORE 23 (GO T0 M329)
UMATI CBD WORKER 24 (GO TO M331)
NEIGHBORS/RELATIVES 32 (GO TO M331)
DON'T KNOW 98 (GO TO M327)
USING A MODERN METHOD __ (GO TO M331)
M327. Do you know of a place where you can obtain a method of family planning?
NO 2 (GO TO M331)
REGIONAL HOSPITAL 12
DISTRICT HOSPITAL 13
HEALTH CENTRE 14
DISPENSARY 15
PARASTATAL HEALTH FACILITY 16
VILLAGE HEALTH POST/WORKER 17 (GO TO M331)
PRIV. DOCTOR/CLINIC/HOSPITAL 22
PHARMACY/MEDICAL STORE 23
UMATI CBD WORKER 24 (GO TO M331)
NEIGHBORS/RELATIVES 32 (GO TO M331)
M329. How long does it take to travel from your home to this place?
IF LESS THAN ONE HOUR, RECORD TRAVEL TIME IN MINUTES.
OTHERWISE, RECORD TRAVEL TIME IN HOURS.
HOURS 2 __
DON'T KNOW 9998
M330. Is it easy or difficult to get there?
DIFFICULT 2
M331. In the last month, have you heard or seen a message about family planning:
on the radio?
on television?
from a Rural Medical aide?
from an MCN aide?
from neighbors/relatives?
on posters?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
M332. Is it acceptable or not acceptable to you for family planning information to be provided on the radio or television?
NOT ACCEPTABLE 2
DON'T KNOW 8
DOES NOT KNOW CONDOM ___ (GO TO M401)
M334. Do you agree or disagree with the following statements:
READ AND OBTAIN A RESPONSE FOR EACH STATEMENT.
DISAGREE 2
DISAGREE 2
DISAGREE 2
DISAGREE 2
DISAGREE 2
DISAGREE 2
DISAGREE 2
DISAGREE 2
DISAGREE 2
M401. Have you ever been married or lived with a woman?
NO 2 (GO TO M405)
M402. Are you now married or living with a partner, or are you now widowed, or divorced or no longer living together?
LIVING TOGETHER 2
WIDOWED 3 (GO TO M404)
DIVORCED/NO LONGER LIVING TOGETHER 4 (GO TO M404)
M403. How many wives do you have?
M404. How old were you when you started living your (first) wife of partner?
M405. IF EVER MARRIED OR LIVED WITH A WOMAN:
Have you ever had sexual intercourse?
NO 2 (GO TO M413)
M406. Now we need some details about your sexual activity in order to get a better understanding of family planning and health.
How many times did you have sexual intercourse in the last four weeks?
M407. How many times in a month do you usually have sexual intercourse?
ZERO TIMES ___ (GO TO M411)
M409. With how many different women did you have sex in the last four weeks?
M410. Did you use a condom with any of these women?
NO 2
M411. When was the last time you had sexual intercourse?
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __
M412. How old were you when you first had sexual intercourse?
FIRST TIME WHEN MARRIED 96
M413. PRESENCE OF OTHERS AT THIS POINT.
NO 2
NO 2
NO 2
NO 2
M501. Now I have a few questions about a very important topic.
Have you heard of an illness called AIDS?
NO 2 (GO TO M601)
M502. From which sources of information or persons have you heard about AIDS in the last month?
RECORD ALL MENTIONED.
TV B
NEWSPAPERS C
HEALTH WORKERS D
MOSQUES/CHURCHES E
FRIENDS/RELATIVES F
SCHOOLS/QURAN TEACHERS G
SLOGANS/PAMPHLETS/POSTERS H
COMMUNITY MEETINGS I
CCM OFFICE J
OTHER (SPECIFY) __________________ K
NONE L
M503. How is AIDS transmitted?
RECORD ALL MENTIONED.
NEEDLES/BLADES/SKIN PUNCTURES B
MOTHER TO CHILD C
TRANSFUSION OF INFECTED BLOOD D
OTHER (SPECIFY) __________________ E
DON'T KNOW F
M504. Do you think that you can get AIDS from:
shaking hands with someone who has AIDS?
hugging someone who has AIDS?
kissing someone who has AIDS?
wearing the clothes of someone who has AIDS?
sharing eating utensils with someone who has AIDS?
stepping on the urine or stool of someone who has AIDS?
mosquito, flea or bedbug bites?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
M505. Is it possible for a healthy looking person to have AIDS?
NO 2
DON'T KNOW 8
M506. Is it possible for a woman who has the AIDS virus to give birth to a child with the AIDS virus?
NO 2
DON'T KNOW 8
M507. What do you suggest is the most important thing the government should do for people who have AIDS?
HELP RELATIVES PROVIDE CARE 2
ISOLATE/QUARANTINE/JAIL 3
NOT BE INVOLVED 4
OTHER (SPECIFY) ___________________ 5
M508. If your relative is suffering with AIDS, who would you prefer to care for him/her?
GOVERNMENT 2
RELIGIOUS ORG./MISSION 3
NOBODY/ABANDON 4
OTHER (SPECIFY) ________________ 5
SECTION 6. FERTILITY PREFERENCES
M601. CHECK M310:
HE OR SHE STERILIZED __ (GO TO M605)
NOT MARRIED/NOT LIVING TOGETHER __ (GO TO M609)
M603.Now I have some questions about the future. Would you like to have a (another) child or would you prefer not to have any more children?
NO MORE/NONE 2 (GO TO M608)
SAYS WIFE CAN'T GET PREGNANT 3 (GO TO M608)
UNDECIDED OR DON'T KNOW 8 (GO TO M608)
M604. How long would you like to wait from now before the birth of a (another) child?
YEARS 2 ___ (GO TO M608)
SOON/NOW 995 (GO TO M608)
OTHER (SPECIFY) _____ 996 (GO TO M608)
DON'T KNOW 998
M605. Given your present circumstances, if you had to do it over again, do you think you would make the same decision to have an operation not to have any more children?
NO 2
M606. Do you regret that you (your wife) had the operation not to have any (more) children?
NO 2 (GO TO M609)
PARTNER WANTS ANOTHER CHILD 2 (GO TO M609)
SIDE EFFECTS 3 (GO TO M609)
OTHER REASON (SPECIFY) ____________ 4 (GO TO M609)
M608. Do you think that your wife(wives)/partner(s) approves or disapproves of couples using a method to avoid pregnancy?
DISAPPROVES 2
DON'T KNOW 8
M609. How long should a couple wait before starting sexual intercourse after the birth of a baby?
YEARS 2 __
OTHER (SPECIFY) ________ 996
M610. Should a mother wait until she has completely stopped breastfeeding before starting to have sexual relations again, or doesn't it matter?
DOESN'T MATTER 2
M611. In general, do you approve or disapprove of couples using a method to avoid pregnancy?
DISAPPROVE 2
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?
RECORD SINGLE NUMBER OR OTHER ANSWER.
OTHER ANSWER (SPECIFY) ____________96 (GO TO M614)
M613. How many of those children would be sons?
And how many would be daughters?
NUMBER OF DAUGHTERS ___
NO SEX PREFERENCE 95
OTHER ANSWER (SPECIFY) ________________ 96
M614. What do you think is the best number of months or years between the birth of one child and the birth of the next child?
YEARS 2 __
OTHER (SPECIFY) ______ 996
DON'T KNOW 998
MINUTES ___
SECTION 7. LANGUAGE INFORMATION
M701. IN WHAT LANGUAGE DID YOU CONDUCT THE INTERVIEW?
OTHER _______________ ___
M702. FOR HOW MUCH OF THE INTERVIEW DID YOU DEPEND ON A THIRD PERSON TO INTERPRET FOR YOU?
SOME OF THE INTERVIEW 2
MOST OF THE INTERVIEW 3
ALL OF THE INTERVIEW 4
OTHER (SPECIFY) __________________ 5
M703. IF AN INTERPRETER WAS USED, INDICATE THE SEX AND APPROXIMATE AGE OF INTERPRETER.
TEENAGE FEMALE 2
ADULT MALE 3
TEENAGE MALE 4
OTHER (SPECIFY) ______________ 5
INTERVIEWER'S OBSERVATIONS
(To be filled in after completing interview)
Comments About Respondent:
________________________________
Comments on Specific Questions:
_________________________________
Any Other Comments:
_________________________________
SUPERVISOR'S OBSERVATIONS
_________________________________
Name of Supervisor: ________________
Date: _________________
EDITOR'S OBSERVATIONS
_________________________________
Name of Field Editor: ________________
Date: _________________