UNITED REPUBLIC OF TANZANIA
NATIONAL BUREAU OF STATISTICS

IDENTIFICATION

PLACE NAME _________________

NAME OF HOUSEHOLD HEAD __________________

CLUSTER NUMBER _____

HOUSEHOLD NUMBER _____

NAME AND LINE NUMBER OF MAN _____

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)

DATE _____
INTERVIEWER'S NAME __________
RESULT

NEXT VISIT

DATE _____
TIME _____

FINAL VISIT

DAY ____
MONTH _____
YEAR _____
INT. NO. _____
RESULT

TOTAL NUMBER OF VISITS ____

LANGUAGE OF QUESTIONNAIRE

LANGUAGE OF INTERVIEW

TRANSLATOR USED

SUPERVISOR

NAME __________
NUMBER ______

FIELD EDITOR

NAME __________
NUMBER _____

OFFICE EDITOR

NUMBER ____

KEYED BY

NUMBER ____

INTRODUCTION AND CONSENT

Hello. My name is _____________. I am working with the NATION BUREAU OF STATISTICS. We are conducting a survey about health and other topics all over the UNITED REPUBLIC OF TANZANIA. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 20 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 now?

SIGNATURE OF INTERVIEWER _________________________
DATE _____________

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME.

102. How long have you been living continuously in (NAME OF CURRENT CITY, TOWN OR VILLAGE OF RESIDENCE)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.

103. Just before you moved here, did you live in a city, in a town, or in a rural area?

104. Before you moved here, which region did you live in?

105. In what month and year were you born?

106. How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

107. Have you ever attended school?

108. What is the highest level of school you attended?

109. What is the highest grade you completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

110. CHECK 108:

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?

112. CHECK 111:

113. Do you read a newspaper or magazine at least one a week. less than once a week or not at all?

114. Do you listen to the radio at least once a week, less than once a week or not at all?

115. Do you watch/listen to television at least once a week, less than once a week or not at all?

116. Do you own a mobile telephone?

117. Do you use your mobile phone for any financial transactions?

117A. Do you use your mobile phone for any health related issues?

118. Do you have an account in a bank or other financial institution that you yourself use?

118A. Do you use VICOBA as financial scheme?

119. Have you ever used the internet?

120. In the last 12 months, have you used the internet?
IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.

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?

124. In the last 12 months, how many times have you been away from home for one or more nights?

125. In the last 12 months, have you been away from home for more than one month at a time?

SECTION 2. REPRODUCTION

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?

202. Do you have any sons or daughters that you have fathered who are now living with you?

203. a) How many sons live with you?
b) 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 alive but do not live with you?

205. a) How many sons are alive but do not live with you?
b) And how many daughters are alive but do not live with you?
IF NONE, RECORD '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, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?

207. a) How many boys have died?
b) 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'.

209. CHECK 208:

210. Did all of the children you have fathered have the same biological mother?

211. CHECK 208:

HAS HAD MORE THAN ONE CHILD:
a) How old were you when your first child was born?

HAS HAD ONLY ONE CHILD:
b) How old were you when you child was born?

212. CHECK 203 AND 205:

213. CHECK 203 AND 205:

MORE THAN ONE LIVING CHILD:
a) How old is your youngest child?

ONLY ONE LIVING CHILD:
b) How old is your child?

214. CHECK 213:

215. CHECK 203 AND 205:

MORE THAN ONE LIVING CHILD:
a) What is the name of your youngest child?

ONLY ONE LIVING CHILD:
b) What is the name of your child?

216. When (NAME)'s mother was pregnant with (NAME), did she have any antenatal check-ups?

217. Were you ever present during any of those antenatal check-ups?

218. Was (NAME) born in a hospital or health facility?

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?

SECTION 3. CONTRACEPTION

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)?

302. In the last few months have you:

a) Heard about family planning on the radio?
b) Seen anything about family planning on the television?
c) Read about family planning in a newspaper or magazine?
d) Received a voice or text message about family planning on a mobile phone?
e) Seen anything about family planning on a poster?
f) Seen anything about family planning on billboards?
g) Heard about family planning at community events?
h) Seen anything about family planning on a live drama?
i) Heard about family planning from a doctor or nurse?
j) Heard about family planning from a community health worker?
k) Read about family planning from internet?

303. In the last few months, have you discussed family planning with a health worker or health professional?

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?

305. Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?

306. After the birth of a child, can a woman become pregnant before her menstrual period has returned?

307. I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.

a) Contraception is a woman's concern and a man should not have to worry about it.
b) Women who use contraception may become promiscuous.

SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

401. Are you currently married or living together with a woman as if married?

402. Have you ever been married or lived together with a woman as if married?

403. What is your marital status now: are you widowed, divorced, or separated?

404. Is your (wife/partner) living with you now or is she staying elsewhere?

405. Do you have other wives or do you live with other women as if married?

406. Altogether, how many wives or live-in partners do you have?

407. CHECK 405:

ONE WIFE/PARTNER
a) Please tell me the name of (your wife/the woman you are living with as if married).

MORE THAN ONE WIFE/PARTNER
b) 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.

408. How old was (NAME) on her last birthday?

409. CHECK 407:

410. Have you been married or lived with a woman only once or more than once?

411. CHECK 405 AND 410:

BOTH ARE CODE '2'
a) In what month and year did you start living with your (wife/partner)?

OTHER
b) Now I would like to ask about your first (wife/partner). In what month and year did you start living with her?

412. How old were you when you first started living with her?

413. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

414. I would like to ask 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?

415. I would like to ask you 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.

416. The last time you had sexual intercourse with this person, was a condom used?

435. 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.

436. From where did you/your partner obtain the condom the last time?
PROBE TO IDENTIFY TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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?

438. The last time you had sex did you or your partner use any method to avoid or prevent a pregnancy?

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.

440. Do you know of a place where you can obtain a method of family planning?

SECTION 5. FERTILITY PREFERENCES

501. CHECK 401:

502. CHECK 439:

503. CHECK 407:

504. Is your (wife/partner) currently pregnant?

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 to have any more children?

506. After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

507. CHECK 208:

HAS FATHERED CHILDREN:
a) Now I have some questions about the future. Would you like to have another child, or would you prefer not to have any more children?

HAS NOT FATHERED CHILDREN:
b) Now I have some questions about the future. Would you like to have a child, or would you prefer not have any children?

508. CHECK 208:

HAS FATHERED CHILDREN:
a) How long would you like to wait from now before the birth of another child?

HAS NOT FATHERED CHILDREN:
b) How long would you like to wait from now before the birth of a child?

509. Are any of your (wives/partners) currently pregnant?

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 to have any more children?

511. After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

512. CHECK 208:

HAS FATHERED CHILDREN:
a) Now I have some questions about the future. Would you like to have another child, or would you prefer not to have any more children?

HAS NOT FATHERED CHILDREN:
b) Now I have some questions about the future. Would you like to have a child, or would you prefer not have any children?

513. CHECK 208:

HAS FATHERED CHILDREN:
a) How long would you like to wait from now before the birth of another child?

HAS NOT FATHERED CHILDREN:
b) How long would you like to wait from now before the birth of a child?

514. CHECK 203 AND 205:

HAS LIVING CHILDREN:
a) 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:
b) 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.

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 it not matter if it's a boy or a girl?

SECTION 6. EMPLOYMENT AND GENDER ROLES

601. Have you done any work in the last seven days?

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?

603. Have you done any work in the last 12 months?

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?

606. Are you paid in cash or kind for this work or are you not paid at all?

607. CHECK 401:

608. CHECK 606:

609. Who usually decides how the money you earn will be used: you, your (wife/partner) or you and your (wife/partner) jointly?

610. Who usually makes decisions about health care for yourself: you, your (wife/partner), you and your (wife/partner) jointly, or someone else?

611. Who usually makes decisions about making major household purchases?

612. Do you own this or any other house either alone or jointly with someone else?

613. Do you have a title deed for any house you own?

615. Do you own any agricultural or non-agricultural land either alone or jointly with someone else?

616. Do you have a title deed for any land you own?

617. Is your name on the title deed?

618. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

a) If she goes out without telling him?
b) If she neglects the children?
c) If she argues with him?
d) If she refuses to have sex with him?
e) If she burns the food?

SECTION 8. OTHER HEALTH ISSUES

801. Some men are circumcised, that is the foreskin is completely removed from the penis. Are you circumcised?

802. How old were you when you got circumcised?

803. Who did the circumcision?

804. Where was it done?

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.

806. Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?
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.

807. The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

808. Do you currently smoke tobacco every day, some days, or not at all?

809. In the past, have you smoked tobacco ever day?

810. In the past, have you ever smoked tobacco every day, some days, or not at all?

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 REPORTS USING THE PRODUCT BUT NOT EVERY DAY, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.

a) Manufactured cigarettes?
b) Hand-rolled cigarettes?
c) Kreteks?
d) Pipes full of tobacco?
e) Cigars, cheroots, or cigarillos?
f) Number of water pipe sessions?
g) Any others? (SPECIFY) ________

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 REPORTS USING THE PRODUCT BUT NOT EVERY WEEK, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.

a) Manufactured cigarettes?
b) Hand-rolled cigarettes?
c) Kreteks?
d) Pipes full of tobacco?
e) Cigars, cheroots, or cigarillos?
f) Number of water pipe sessions?
g) Any others? (SPECIFY) ________

813. Do you currently use smokeless tobacco every day, some days, or not at all?

814. On average, how many times a day do you use the following products? Also, let me know if you use the product, but not every day.

IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY DAY, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.

a) Snuff, by mouth?
b) Snuff, by nose?
c) Chewing tobacco?
d) Betel quid with tobacco?
e) Any others? (SPECIFY) _____

814. On average, how many times a week do you use the following products? Also, let me know if you use the product, but not every week.

IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY WEEK, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.

a) Snuff, by mouth?
b) Snuff, by nose?
c) Chewing tobacco?
d) Betel quid with tobacco?
e) Any others? (SPECIFY) _____

815A. Have you ever consumed a drink that contains alcohol such as beer, wine, spirit, fermented cider or local brewers such as mbege, ulanzi, gongo/chang'aa etc?

815B. In the last 12 months, how frequently have you had at least one drink?

816. Are you covered by any health insurance?

817. What type of health insurance are you covered by.
RECORD ALL MENTIONED.

SECTION 10. MALARIA

1001. In your opinion, what is the most serious health problem in your community?

1002. Can you tell me the signs or symptoms of malaria in a young child?
RECORD ALL MENTIONED.

1003. Are there ways to avoid getting malaria?

1004. What are the ways to avoid getting malaria?
RECORD ALL MENTIONED.

1005. Can ACTs be obtained at your nearest health facility or pharmacy (duka la dawa muhimu)?

1006A. In the past year, have you seen or heard any messages about malaria prevention?

1006B. In the past year, have you seen or heard any messages about malaria treatment?

1007. LOCATION OF INTERVIEW:

1008A. In the past year, have you ever heard or seen the phrase "Malaria Haikubaliki"?

1008B. In the past year, have you ever heard or seen the phrase "Maliza Malaria"?

1009. Where did you hear or see this phrase?
RECORD ALL MENTIONED.

1010. In the past six months, were you visited by a health worker or volunteer who talked to you about malaria?

1011. Now I am going to read some statements and I would like you to tell me how much you agree or disagree with them. After I read each statement, please tell me whether you strongly agree with it, somewhat agree with it, somewhat disagree with it or strongly disagree.

1012. I can easily protect myself and my children from malaria. Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree?

1013. I can ensure that my children sleep under a treated net every single night of the year. Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree?

1014. I can easily hang my children's mosquito nets. Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree?

1015. It is important to sleep under a net every single night. Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree?

1016. Pregnant women are at high risk of getting malaria. Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree?

1017. Women should attend antenatal care early in their pregnancy. Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree?

INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT INTERVIEW: _________________________________

COMMENTS ON SPECIFIC QUESTIONS: _________________________________

ANY OTHER COMMENTS: _________________________________________

SUPERVISOR'S OBSERVATIONS: ____________________________________

EDITOR'S OBSERVATIONS: _____________________________________