2000 UGANDA DEMOGRAPHIC AND HEALTH SURVEY MEN QUESTIONNAIRE
IDENTIFICATION
REGION __________
DISTRICT __________
COUNTY __________
SUBCOUNTY/TOWN __________
PARISH/LC2 NAME __________
EA NAME __________
UDHS NUMBER __________
RURAL 2
LARGE CITY/SMALL CITY/TOWN/COUNTRYSIDE
SMALL CITY 2
TOWN 3
COUNTRYSIDE 4
HOUSEHOLD NUMBER ___
NAME AND LINE NUMBER OF MAN __________
INTERVIEWER VISITS (FOR 1, 2, 3 AND FINAL VISITS)
DATE _____
INTERVIEWER'S NAME __________
RESULT __________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) __________ 7
TIME __________
DAY __________
MONTH __________
YEAR _____
NAME __________
RESULT __________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) __________ 7
NEXT VISIT:
DATE
TIME
TOTAL NUMBER OF VISITS:
LANGUAGE QUESTIONNAIRE: ENGLISH
LANGUAGE USED IN INTERVIEW
LUGANDA 2
LUGBARA 3
LUO 4
RUNY ANKOLE-RUKIGA 5
RUNYORO-RUTORO 6
ENGLISH 7
OTHER 8
RESPONDENT'S LOCAL LANGUAGE
LUGANDA 2
LUGBARA 3
LUO 4
RUNY ANKOLE-RUKIGA 5
RUNYORO-RUTORO 6
ENGLISH 7
OTHER 8
TRANSLATOR USED
SOMETIMES 2
ALL THE TIME 3
SUPERVISOR
NAME __________
DATE _____
FIELD EDITOR
NAME __________
DATE _____
OFFICE EDITOR ___
KEYED BY ___
SECTION 1. RESPONDENT'S BACKGROUND
Informed consent
Hello. My name is __________ and I am working with Uganda Bureau of Statistics. We are conducting a national survey about the health of men, women and children. We would very much appreciate your participation in this survey. I would like to ask you some questions about yourself and your family. This information will help the government to plan health services. The survey usually takes about 35 to 45 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 want to ask me anything about the survey?
May I begin the interview now?
Signature of interviewer: __________
Date: _____
RESPONDENT AGREES TO BE INTERVIEWED 1
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
MINUTES ___
102. For most of the time during the last five years, did you live in a city, in a town, or in the countryside?
TOWN 2
COUNTRYSIDE 3
103. How long have you been living continuously in (name of current place of residence)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)
104. Just before you moved here, did you live in a city, in a town, or in the countryside?
TOWN 2
COUNTRYSIDE 3
105. In the last 12 months, have you ever traveled away from your home community and slept away?
NO 2 (GO TO 108)
106. In the last 12 months, on how many separate occasions have you traveled away from your home community and slept away?
107. In the last 12 months, have you been away from your home community for more than 1 month at a time?
NO 2
108. In what month and year were you born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
109. How old were you at your last birthday?
COMPARE AND CORRECT 108 AND/OR 109 IF INCONSISTENT.
110. Have you ever attended school?
NO 2 (GO TO 114)
111. What is the highest level of school you attended: primary, secondary, or post-secondary?
SECONDARY 2
POST-SECONDARY 3
112. What is the highest (grade/form/year) you completed at that level?
112a. Did you ever receive any vocational training?
TEACHER TRAINING 2
PARAMEDICAL TRAINING 3
OTHER TRAINING 6
PRIMARY ___
SECONDARY OR POST-SECONDARY ___ (GO TO 117)
114. 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 PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) __________ 4
115. Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)?
NO 2
CODE '1' CIRCLED ___ (GO TO 118)
117. During the last four weeks, did 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
118. During the last four weeks, did 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
119. During the last four weeks, did 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
120. Are you currently working?
NO 2
121. Have you done any work in the last 12 months?
NO 2
122. What have you been doing for most of the time over the last 12 months?
LOOKING FOR WORK 2 (GO TO 129)
INACTIVE 3 (GO TO 129)
COULD NOT WORK/HANDICAPPED 4 (GO TO 129)
OTHER (SPECIFY) __________ 6 (GO TO 129)
123. What is your occupation, that is, what kind of work do you mainly do?
DOES NOT WORK IN AGRICULTURE ___ (GO TO 126)
125. 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?
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
PUBLIC LAND 5
COMMUNAL LAND 6
126. During the last 12 months, how many months did you work?
127. 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 (GO TO 129)
NOT PAID 4 (GO TO 129)
128. 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?
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL 5
NONE, HIS INCOME IS ALL SAVED 6
PROTESTANT 2
MUSLIM 3
OTHER (SPECIFY) __________ 6
SECTION 2. REPRODUCTION
201. Now I would like to ask about any children you have had. I am interested only in the children that are biologically yours. Have you ever fathered any children with any woman?
NO 2 (GO TO 206)
DON'T KNOW 8 (GO TO 206)
202. Do you have any sons or daughters that you have fathered who are now living with you?
NO 2 (GO TO 204)
203. How many sons live with you?
And how many daughters are alive but do not live with you?
IF NONE, RECORD '00'.
DAUGHTERS ELSEWHERE ___
204. Do you have any sons or daughters you have fathered who are alive but do not live with you?
NO 2 (GO TO 206)
205. How many sons are alive but do not live with you?
And how many daughters are alive but do not live with you?
IF NONE, RECORD '00'.
DAUGHTERS ELSEWHERE ___
206. Have you ever fathered a son or a daughter who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few hours or days?
NO 2 (GO TO 208)
DON'T KNOW 8 (GO TO 208)
207. How many boys have died?
And how many girls have died?
IF NONE, RECORD '00'.
BOYS DEAD ___
GIRLS DEAD ___
208. (In addition to the children that you have just told me about), have you ever fathered with any woman
a) Any sons or daughters who are alive?
b) Any sons or daughters who died?
OTHER ___ (PROBE AND CORRECT 201-207 AS NECESSARY)
209. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'.
HAS HAD ONLY ONE CHILD ___ (GO TO 213)
HAS NOT HAD ANY CHILDREN ___ (GO TO 301)
211. Do the children that you have fathered all have the same biological mother?
NO 2
212. In all how many women have you fathered children with?
213. How old were you when your (first) child was born?
214. At the time when this child was born, were you married to the child's mother?
NO 2
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. Circle code 1 in 301 for each method mentioned spontaneously. Then proceed down column 301, 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 301, ask 302 if applicable.
301. Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
302. Have you ever used (method)?
NO 2
NO 2
12 RHYTHM OR PERIODIC ABSTINENCE
YES 1
NO 2
DON'T KNOW 8
13 WITHDRAWAL
YES 1
NO 2
303. CHECK 301(01), 301(03), AND 301(04):
CODE '1' NOT CIRCLED FOR ANY METHOD ___ (GO TO 308)
304. READ BEFORE ASKING 305 FOR THE FIRST APPLICABLE METHOD: Now I want to talk to you about contraceptive methods that women can use to delay or avoid becoming pregnant.
A) CHECK 301(03):
Knows Pill?
NO ___ (GO TO 304 IN NEXT COLUMN)
B) CHECK 301(04):
Knows IUD/coil?
NO ___ (GO TO 304 IN NEXT COLUMN)
C) CHECK 301(01):
Knows Female sterilization?
NO ___ (GO TO 308)
305. In your opinion, is (method) a good method for a couple to use if they want to plan their family?
YES 1
NO 2 (GO TO 307)
DEPENDS/UP TO THEM 3 (GO TO 304 IN NEXT COLUMN)
DON'T KNOW 8 (GO TO 304 IN NEXT COLUMN)
B) IUD/COIL:
YES 1
NO 2 (GO TO 307)
DEPENDS/UP TO THEM 3 (GO TO 304 IN NEXT COLUMN)
DON'T KNOW 8 (GO TO 304 IN NEXT COLUMN)
C) In your opinion, is female sterilization a good method for a couple to use if they do not want any more children?
YES 1
NO 2 (GO TO 307)
DEPENDS/UP TO THEM 3 (GO TO 308)
DON'T KNOW 8 (GO TO 308)
306. Why do you think (method) is a good method for a couple to use if they want to plan their family?
RECORD ALL REASONS MENTIONED.
A) PILL:
SIMPLE TO USE A (GO TO 304 IN NEXT COLUMN)
EFFECTIVE B (GO TO 304 IN NEXT COLUMN)
AFFORDABLE C (GO TO 304 IN NEXT COLUMN)
NO/FEW SIDE EFFECTS D (GO TO 304 IN NEXT COLUMN)
CAN STOP WHEN CHILDREN DESIRED E (GO TO 304 IN NEXT COLUMN)
NO NEED FOR MEDICAL PERSONNEL F (GO TO 304 IN NEXT COLUMN)
OTHER (SPECIFY) __________ X (GO TO 304 IN NEXT COLUMN)
DON'T KNOW Y (GO TO 304 IN NEXT COLUMN)
B) IUD/COIL:
EFFECTIVE B (GO TO 304 IN NEXT COLUMN)
AFFORDABLE C (GO TO 304 IN NEXT COLUMN)
NO/FEW SIDE EFFECTS D (GO TO 304 IN NEXT COLUMN)
CAN STOP WHEN CHILDREN DESIRED E (GO TO 304 IN NEXT COLUMN)
NO NEED FOR MEDICAL PERSONNEL F (GO TO 304 IN NEXT COLUMN)
OTHER (SPECIFY) __________ X (GO TO 304 IN NEXT COLUMN)
DON'T KNOW Y (GO TO 304 IN NEXT COLUMN)
AGAINST RELIGION B
MAY HARM WOMEN'S HEALTH C
HAS SIDE EFFECTS D
INCREASES PROMISCUITY E
CANNOT HAVE CHILDREN AGAIN F
METHOD CAN FAIL G
INVOLVES DOCTOR/MEDICAL PERSONNEL H
CAN LEAD TO MEDICAL COMPLICATIONS I
OTHER (SPECIFY) __________ X
DON'T KNOW Y
307. Why do you think (method) is not a good method for a couple to use if they want to plan their family?
RECORD ALL REASONS MENTIONED.
A) PILL:
AGAINST RELIGION B
MAY HARM WOMEN'S HEALTH C
HAS SIDE EFFECTS D
INCREASES PROMISCUITY E
CAN CAUSE STERILITY F
METHOD CAN FAIL G
BABY IN DANGER IF PREGNANCY OCCURS H
INVOLVES DOCTOR/MEDICAL PERSONNEL I
OTHER (SPECIFY) __________ X
DON'T KNOW Y
AGAINST RELIGION B
MAY HARM WOMEN'S HEALTH C
HAS SIDE EFFECTS D
INCREASES PROMISCUITY E
CAN CAUSE STERILITY F
METHOD CAN FAIL G
BABY IN DANGER IF PREGNANCY OCCURS H
INVOLVES DOCTOR/MEDICAL PERSONNEL I
OTHER (SPECIFY) __________ X
DON'T KNOW Y
AGAINST RELIGION B
MAY HARM WOMEN'S HEALTH C
HAS SIDE EFFECTS D
INCREASES PROMISCUITY E
CANNOT HAVE CHILDREN AGAIN F
METHOD CAN FAIL G
INVOLVES DOCTOR/MEDICAL PERSONNEL H
CAN LEAD TO MEDICAL COMPLICATIONS I
OTHER (SPECIFY) __________ X
DON'T KNOW Y
308. 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 if she has sexual relations?
NO 2 (GO TO 310)
DON'T KNOW 8 (GO TO 310)
309. 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
310. Do you think that a woman who is breastfeeding her baby can become pregnant?
NO 2
DON'T KNOW 8
311. CHECK 301(07) AND 302(07): Knowledge and use of condoms
HAS HEARD OF CONDOMS BUT HAS NEVER USED ___ (GO TO 323)
HAS NOT HEARD OF CONDOMS ___ (GO TO 323)
312. Now I want to talk to you about condoms.
How old were you when you used a condom for the first time?
DOES NOT REMEMBER 98 98
313. Why did you use a condom that first time?
PROBE: Any other reason?
RECORD ALL REASONS MENTIONED.
TO AVOID GETTING AIDS/HIV B
TO AVOID GETTING AN STD C
TO AVOID INFECTING PARTNER D
TO EXPERIMENT/TRY A CONDOM E
OTHER (SPECIFY) __________ X
314. Now when you have sex, do you use a condom every time, sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3 (GO TO 316)
NOT HAVING SEX 4 (GO TO 316)
315. When do you use a condom?
PROBE: Any other times?
RECORD ALL SITUATIONS MENTIONED.
ON PARTNER'S FERTILE DAYS A
DURING WIFE'S/PARTNER'S MENSTRUATION B
WHEN NOT USING SOME OTHER METHOD C
WITH A STRANGER D
WITH A COMMERCIAL, SEX WORKER E
WITH ANYONE OTHER THAN WIFE/REGULAR PARTNER F
WITH WIFE/REGULAR PARTNER G
OTHER (SPECIFY) __________ X
316. Have you ever experienced any problems with using condoms?
IF YES: What problems have you experienced?
PROBE: Any other problems?
RECORD ALL PROBLEMS MENTIONED.
EMBARRASSING TO BUY/OBTAIN B
DIFFICULT TO DISPOSE OF C
DIFFICULT TO PUT ON/TAKE OFF D
SPOILS THE MOOD E
DIMINISHES PLEASURE F
WIFE PARTNER OBJECTS/DOES NOT LIKE G
WIFE/PARTNER GOT PREGNANT H
INCONVENIENT TO USE/MESSY I
CONDOM BROKE J
OTHER (SPECIFY) __________ X
NO PROBLEM Y
317. CHECK 314: Current use of condoms
NOT AT ALL/NOT HAVING SEX ___ (GO TO 323)
318. What brand of condom do you usually use?
ASK TO SEE CONDOM PACKET IF BRAND NOT KNOWN.
ENGABU 2
LIFE GUARD 3
ROUGH RIDER 4
PLEASURE 5
OTHER 6
DON'T KNOW 8
319. From where do you usually obtain the condoms?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
NAME OF PLACE __________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
OUTREACH 14
GOVERNMENT COMMUNITY-BASED DISTRIBUTOR 15
OTHER PUBLIC (SPECIFY) __________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY/DRUG SHOP 22
PRIVATE DOCTOR/NURSE/MIDWIFE 23
OUTREACH 24
NGO COMMUNITY-BASED DISTRIBUTOR 25
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
OTHER SOURCE
SHOP 31
RELIGIOUS INSTITUTION 32
FRIEND/RELATIVE 33
STREET VENDOR 34
LODGE 35
OTHER (SPECIFY) __________ 96
320. How much do you usually pay for a packet of condoms?
FREE 9995 (GO TO 323)
DON'T KNOW 9998 (GO TO 323)
321. How many condoms are in each packet?
322. Do you think that at this price condoms are inexpensive, just affordable, or too expensive?
JUST AFFORDABLE 2
TOO EXPENSIVE 3
323. I will now read you some statements about condom use that other men have made. Please tell me if you agree or disagree with each.
a) Condoms diminish a man's sexual pleasure.
DISAGREE 2
DON'T KNOW 8
b) A condom is very inconvenient to use.
DISAGREE 2
DON'T KNOW 8
c) A condom can be reused.
DISAGREE 2
DON'T KNOW 8
d) A condom protects against disease.
DISAGREE 2
DON'T KNOW 8
e) A woman has no right to tell a man to use a condom.
DISAGREE 2
DON'T KNOW 8
401. Are you currently married or living with a woman?
YES, LIVING WITH A WOMAN 2 (GO TO 404)
NO, NOT IN UNION 3 (GO TO 405)
402. Do you have one wife or more than one wife?
IF ONLY ONE WIFE, ENTER '01.
IF MORE THAN ONE, ASK: How many wives do you currently have?
403. Are there any other women with whom you live as if married?
NO 2 (GO TO 409)
404. Are you living with one (other) woman or more than one (other) woman as if married?
IF ONE LIVE-IN PARTNER, ENTER '01'.
IF MORE THAN ONE, ASK: How many women are you living with as if married?
405. Do you currently have regular, occasional, or no sexual partners?
OCCASIONAL PARTNER(S) ONLY 2 (GO TO 407)
REGULAR AND OCCASIONAL PARTNERS 3
NO SEXUAL PARTNER 4 (GO TO 407)
406. Do you have one or more than one regular partner?
MORE THAN ONE REGULAR PARTNER 2
407. Have you ever been married or lived with a woman?
YES, LIVED WITH A WOMAN 2 (GO TO 411)
NO 3 (GO TO 416)
408. What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2 (GO TO 411)
SEPARATED 3 (GO TO 411)
409. WRITE THE LINE NUMBERS FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE/PARTNER. IF A WIFE/PARTNER DOES NOT LIVE IN THE HOUSEHOLD, ENTER '00' IN THE LINE NUMBER BOXES. THE NUMBER OF LINES FILLED IN MUST BE EQUAL TO THE NUMBER OF WIVES AND PARTNERS. IF RESPONDENT HAS MORE THAN FIVE WIVES/PARTNERS USE ADDITIONAL QUESTIONNAIRE(S).
CHECK 402 AND 404:
SUM OF 402 AND 404 = 1 ___
Please tell me the name of your wife/partner.
SUM OF 402 AND 404 > 1 ___
Please tell me the name of each wife/partner that you live with as if married, starting with the one you lived with first.
WIFE/PARTNER
A) NUMBER
2 __________
3 __________
4 __________
5 __________
B) LINE NUMBER IN HOUSEHOLD QUESTIONNAIRE
1 ___
2 ___
3 ___
4 ___
5 ___
C) WIFE OR PARTNER?
1
WIFE 1
PARTNER 2
1
WIFE 1
PARTNER 2
2
WIFE 1
PARTNER 2
3
WIFE 1
PARTNER 2
4
WIFE 1
PARTNER 2
5
WIFE 1
PARTNER 2
MORE THAN ONE WIFE/PARTNER ___ (GO TO 412)
411. Have you been married or lived with a woman only once, or more than once?
MORE THAN ONCE 2 (GO TO 413)
412. Have you ever been married to or lived as if married to any woman other than those you have just mentioned?
NO 2 (GO TO 414)
413. In total, how many women have you been married to or lived with as if married in your whole life?
ONLY ONE WIFE/PARTNER AND 411 = 1 ___
In what month and year did you start living with your wife/partner?
OTHER ___
Now we will 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
415. How old were you when you started living with her?
416. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues.
How old were you when you first had sexual intercourse with a woman (if ever)?
AGE IN YEARS ___
FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE/PARTNER 95
417. When was the last time you had sexual intercourse with a woman?
RECORD 'YEARS AGO' ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO.
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___
418. The last time you had sexual intercourse, was a condom used?
NO 2 (GO TO 420)
419. What was the main reason you used a condom on that occasion?
RESPONDENT WANTED TO PREVENT PREGNANCY 02 (GO TO 424)
RESPONDENT WANTED TO PREVENT BOTH STD/HIV AND PREGNANCY 03 (GO TO 424)
DID NOT TRUST PARTNER/FEELS PARTNER HAS OTHER PARTNERS 04 (GO TO 424)
PARTNER INSISTED 05 (GO TO 424)
OTHER (SPECIFY) __________ 96 (GO TO 424)
DON'T KNOW 98
RESPONDENT STERILIZED ___ (424)
421. The last time you had sexual intercourse with a woman, did you or she do something or use any method to avoid a pregnancy?
NO 2 (GO TO 423)
UNSURE/DON'T KNOW 8 (GO TO 424)
422. What method was used?
IF MORE THAN ONE METHOD USED, RECORD THE HIGHEST METHOD ON THE LIST.
PILL 03 IUD/COIL 04 (GO TO 424)
INJECTABLES 05 (GO TO 424)
IMPLANTS 06 (GO TO 424)
FEMALE CONDOM 08 (GO TO 424)
DIAPHRAGM 09 (GO TO 424)
FOAM/JELLY 10 (GO TO 424)
LACTATIONAL AMENORRHEA 11 (GO TO 424)
PERIODIC ABSTINENCE 12 (GO TO 424)
WITHDRAWAL 13 (GO TO 424)
OTHER (SPECIFY) __________ 96 (GO TO 424)
DON'T KNOW 98 98 (GO TO 424)
423. WHAT IS THE MAIN REASON A METHOD WAS NOT USED?
CASUAL SEX PARTNER 11
FERTILITY-RELATED REASONS
WIFE/PARTNER MENOPAUSAL/HAD HYSTERECTOMY 23
COUPLE SUBFECUND/INFECUND 24
WIFE/PARTNER WAS PREGNANT 25
WIFE/PARTNER WAS POSTPARTUM AMENORRHEIC 26
WIFE/PARTNER WAS BREASTFEEDING 27
WANTED (MORE) CHILDREN 28
OPPOSITION TO USE
RESPONDENT OPPOSED 31
WIFE/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
DON'T KNOW 98
424. What is your relationship to the woman with whom you last had sex?
IF WOMAN IS 'GIRLFRIEND' OR 'FIANCÉE', ASK: Was your girlfriend/fiancée living with you when you last had sex with her?
IF YES, CIRCLE '01'.
IF NO, CIRCLE '02'.
SPOUSE/COHABITING PARTNER 01 (GO TO 426)
WOMAN IS GIRLFRIEND/FIANCÉE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX CUSTOMER 06
OTHER (SPECIFY) __________ 96
425. For how long have you had sexual relations with this woman?
WEEKS 2 ___
MONTHS 3 ___
YEARS 4 ___
426. Have you had sex with any other woman in the last 12 months?
NO 2 (GO TO 445)
427. The last time you had sexual intercourse with another woman, was a condom used?
NO 2 (GO TO 445)
428. What was the main reason you used a condom on that occasion?
RESPONDENT WANTED TO PREVENT A PREGNANCY 02 (GO TO 433)
RESPONDENT WANTED TO PREVENT BOTH STD/HIV AND PREGNANCY 03 (GO TO 433)
DID NOT TRUST PARTNER/FEELS PARTNER HAS OTHER PARTNERS 04 (GO TO 433)
PARTNER INSISTED 05 (GO TO 433)
OTHER (SPECIFY) __________ 96 (GO TO 433)
DON'T KNOW 98
RESPONDENT STERILIZED ___ (GO TO 433)
430. The last time you had sexual intercourse with this woman, did you or she do something or use any method to avoid a pregnancy?
NO 2 (GO TO 432)
UNSURE/DON'T KNOW 8 (GO TO 433)
430. The last time you had sexual intercourse with this woman, did you or she do something or use any method to avoid a pregnancy?
NO 2 (GO TO 432)
UNSURE/DON'T KNOW 8 (GO TO 433)
431. What method was used?
IF MORE THAN ONE METHOD USED, RECORD THE HIGHEST METHOD ON THE LIST.
PILL 03 (GO TO 433)
IUD/COIL 04 (GO TO 433)
INJECTABLES 05 (GO TO 433)
IMPLANTS 06 (GO TO 433)
FEMALE CONDOM 08 (GO TO 433)
DIAPHRAGM 09 (GO TO 433)
FOAM/JELLY 10 (GO TO 433)
LACTATIONAL AMENORRHEA 11 (GO TO 433)
PERIODIC ABSTINENCE 12 (GO TO 433)
WITHDRAWAL 13 (GO TO 433)
OTHER (SPECIFY) __________ 96 (GO TO 433)
DON'T KNOW 98 (GO TO 433)
432. What is the main reason a method was not used?
WIFE/PARTNER MENOPAUSAL/HAD HYSTERECTOMY 23
COUPLE SUBFECUND/INFECUND 24
WIFE/PARTNER WAS PREGNANT 25
WIFE/PARTNER WAS BREASTFEEDING 27
WANTED (MORE) CHILDREN 28
OPPOSITION TO USE
RESPONDENT OPPOSED 31
WIFE/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) __________ 96
DON'T KNOW 98
433. What is your relationship to this woman?
IF WOMAN IS "GIRLFRIEND" OR "FIANCÉE", ASK: Was your girlfriend/fiancée living with you when you last had sex with her?
IF YES, CIRCLE '01'.
IF NO, CIRCLE '02'.
WOMAN IS GIRLFRIEND/FIANCÉE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX CUSTOMER 06
OTHER (SPECIFY) __________ 96
434. For how long have you had sexual relations with this woman?
WEEKS 2 ___
MONTHS 3 ___
YEARS 4 ___
435. Other than these two women, have you had sex with any other woman in the last 12 months?
NO 2 (GO TO 445)
436. The last time you had sexual intercourse with this third woman, was a condom used?
NO 2 (GO TO 438)
437. What was the main reason you used a condom on that occasion?
RESPONDENT WANTED TO PREVENT A PREGNANCY 02 (GO TO 442)
RESPONDENT WANTED TO PREVENT BOTH STD/HIV AND PREGNANCY 03 (GO TO 442)
DID NOT TRUST PARTNER/FEELS PARTNER HAS OTHER PARTNERS 04 (GO TO 442)
PARTNER INSISTED 05 (GO TO 442)
OTHER (SPECIFY) __________ 96 (GO TO 442)
DON'T KNOW 98
RESPONDENT STERILIZED ___ (GO TO 442)
439. The last time you had sexual intercourse with this woman, did you or she do something or use any method to avoid a pregnancy?
NO 2 (GO TO 441)
UNSURE/DON'T KNOW 8 (GO TO 442)
440. What method was used?
IF MORE THAN ONE METHOD USED, RECORD THE HIGHEST METHOD ON THE LIST.
PILL 03 (GO TO 442)
IUD/COIL 04 (GO TO 442)
INJECTABLES 05 (GO TO 442)
IMPLANTS 06 (GO TO 442)
FEMALE CONDOM 08 (GO TO 442)
DIAPHRAGM 09 (GO TO 442)
FOAM/JELLY 10 (GO TO 442)
LACTATIONAL AMENORRHEA 11 (GO TO 442)
PERIODIC ABSTINENCE 12 (GO TO 442)
WITHDRAWAL 13 (GO TO 442)
OTHER (SPECIFY) __________ 96 (GO TO 442)
DON'T KNOW 98 (GO TO 442)
441. What is the main reason a method was not used?
FERTILITY-RELATED REASONS
WIFE/PARTNER MENOPAUSAL/HAD HYSTERECTOMY 23
COUPLE SUBFECUND/INFECUND 24
WIFE/PARTNER WAS PREGNANT 25
WIFE/PARTNER WAS POSTPARTUM AMENORRHEIC 26
WIFE/PARTNER WAS BREASTFEEDING 27
WANTED (MORE) CHILDREN 28
OPPOSITION TO USE
RESPONDENT OPPOSED 31
WIFE/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH A BODY'S NORMAL PROCESSES 56
DON'T KNOW 98
442. What is your relationship to this woman?
IF WOMAN IS "GIRLFRIEND" OR "FIANCÉE", ASK: Was your girlfriend/fiancée living with you when you last had sex with her?
IF YES, CIRCLE '01'.
IF NO, CIRCLE '02'.
WOMAN IS GIRLFRIEND/FIANCÉE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX CUSTOMER 06
OTHER (SPECIFY) ___________ 96
443. For how long have you had sexual relations with this woman?
WEEKS 2 ___
MONTHS 3 ___
YEARS 4 ___
444. In total, with how many different women have you had sex in the last 12 months?
445. Have you ever paid for sex?
NO 2 (GO TO 448)
446. How long ago was the last time you paid for sex?
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___
447. The last time that you paid for sex, was a condom used on that occasion?
NO 2
448. CHECK 319: Source of condoms:
SOURCE CIRCLED ___ (GO TO 451)
449. Do you know of a place where a person can get condoms?
NO 2 (GO TO 452)
450. Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
NAME OF PLACE __________
ANY OTHER PLACE?
RECORD ALL PLACES MENTIONED.
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
OUTREACH D
GOVERNMENT COMMUNITY BASED DISTRIBUTOR E
OTHER PUBLIC (SPECIFY) __________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY/DRUG SHOP H
PRIVATE DOCTOR/NURSE/MIDWIFE I
OUTREACH J
NGO COMMUNITY BASED DISTRIBUTOR K
OTHER PRIVATE MEDICAL (SPECIFY) __________ L
OTHER SOURCE
SHOP M
CHURCH N
FRIENDS/RELATIVES O
451. If you wanted to, could you yourself get a condom?
NO 2
DON'T KNOW/UNSURE 8
YES ___ (MARK BOX AND GO TO 459)
NO ___
YES ___ (MARK BOX AND GO TO 458)
NO ___
YES ___ (MARK BOX AND GO TO 458)
NO ___
YES ___ (MARK BOX AND GO TO 458)
NO ___
YES ___ (MARK BOX AND GO TO 458)
NO ___
YES ___ (MARK BOX AND GO TO 458)
NO ___
HAS USED A CONTRACEPTIVE METHOD ___
SECTION 5. FERTILITY PREFERENCES
CURRENTLY MARRIED/LIVING WITH A WOMAN ___
NOT IN UNION ___ (GO TO 516)
RESPONDENT STERILIZED ___ (GO TO 520)
503. COPY THE NAMES OF WIVES/PARTNERS FROM 409. ASK QUESTIONS FOR ONE WIFE/PARTNER AT A TIME. IF THERE ARE MORE THAN FIVE WIVES/PARTNERS, USE ADDITIONAL QUESTIONNAIRE(S).
Is (name) currently pregnant?
NO 2 (GO TO 505)
DON'T KNOW/UNSURE 8 (GO TO 505)
504. When (NAME) became pregnant, did you want her to become pregnant then, did you want to wait until later, or did you not want her to have a child at all?
LATER 2 (GO TO 506)
NOT AT ALL 3 (GO TO 506)
505. In the next few weeks, if you discovered that (NAME) was pregnant, would that be a big problem, a small problem or no problem for you?
SMALL PROBLEM 2
NO PROBLEM 3
STERILIZED/HAD HYSTERECTOMY 4 (GO TO 507)
506. Do you think (NAME) wants the same number of children that you want to have with her, or does she want more or fewer than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8
507. How often have you talked to (name) about family planning in the past year?
ONCE OR TWICE 2
MORE OFTEN 3
508. Do you think that (NAME) approves or disapproves of couples using a contraceptive method to avoid pregnancy?
DISAPPROVES 2 (GO TO 503 FOR NEXT WIFE/PARTNER. IF NO MORE WIVES/PARTNERS GO TO 509)
DON'T KNOW 8 (GO TO 503 FOR NEXT WIFE/PARTNER. IF NO MORE WIVES/PARTNERS GO TO 509)
509. CHECK 503 FOR ALL WIVES/PARTNERS:
ONE OR MORE WIVES/PARTNERS PREGNANT ___
Now I have some questions about the future. After the child(ren) your wife/wives/partner(s) is/are expecting now, would you like to have another child or would you prefer not to have any more children at all?
NO WIFE/PARTNER PREGNANT ___
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 at all?
NOT HAVE A/ANOTHER CHILD 2 (GO TO 514)
WIFE/WIVES INFECUND/STERILIZED 3 (GO TO 514)
UNDECIDED/DON'T KNOW 8 (GO TO 511)
510. How long would you like to wait from now before the birth of (a/another) child?
YEARS 2 ___
SOON/NOW 993
AFTER MARRIAGE 995
DON'T KNOW 998
HAS ONLY ONE WIFE/PARTNER ___ (GO TO 514)
512. You say you (may) want to have a/another child. Which of your wives would you prefer to have your next child with?
ANY WIFE/PARTNER 0 (GO TO 514)
513. Are you planning to have any more children with any of your other wives?
NO 2 (GO TO 516)
UNSURE/DEPENDS 3
514. Do you plan to take another wife at any time in the near future?
NO 2 (GO TO 516)
UNSURE/DEPENDS 3
515. What is the main reason you think you will/may take another wife in the near future?
TO HELP IN THE HOME/COMPOUND 02
TO HELP IN THE FAMILY FARM/BUSINESS 03
WANT A YOUNGER WIFE 04
CURRENT WIFE/WIVES TOO SICK/OLD 05
CURRENT WIFE/WIVES NOT FERTILE/BARREN 06
WIFE/WIVES DIED 07
OTHER (SPECIFY) __________ 96
516. CHECK 302: Contraceptive method use:
HAS USED A CONTRACEPTIVE METHOD ___ (GO TO 520)
517. Do you think you will use a contraceptive method to avoid pregnancy at any time in the future?
NO 2
DON'T KNOW/UNSURE 8 (GO TO 519)
518. Which contraceptive method would you prefer to use?
MALE STERILIZATION 02
PILL 03
IUD/COIL 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMENORRHEA 11
PERIODIC ABSTINENCE 12
WITHDRAWAL 13
OTHER (SPECIFY) __________ 96
UNSURE 98
519. What is the main reason that you think you will not use a contraceptive method at any time in the future?
WIFE(VES)/PARTNER(S) MENOPAUSAL/HAD HYSTERECTOMY 23
COUPLE SUBFECUND/INFECUND 24
WANTS AS MANY CHILDREN AS POSSIBLE 25
OPPOSITION TO USE
RESPONDENT OPPOSED 31
WIFE(WIVES)/PARTNER(S) OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
DON'T KNOW 98
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?
OTHER (SPECIFY) __________ 96 (GO TO 522)
521. How many of these children would you like to be boys, how many would you like to be girls, and for how many would the sex not matter?
NUMBER OF GIRLS ___
EITHER ___
OTHER (SPECIFY) __________ 96
522. Would you say that you approve or disapprove of couples using a contraceptive method to avoid getting pregnant?
DISAPPROVE 2
DON'T KNOW/UNSURE 8
523. In the last six months have you heard/read about family planning:
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
524. In the last few months, have you discussed the practice of family planning with your wife/partner, friends, neighbors, or relatives?
NO 2 (GO TO 526)
525. With whom?
Anyone else?
RECORD ALL PERSONS MENTIONED.
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
SON G
MOTHER-IN-LAW H
FATHER-IN-LAW I
FRIENDS/NEIGHBORS J
OTHER (SPECIFY) __________ X
526. In the last few months, have you discussed the practice of family planning with a health worker or health professional?
NO 2
527. How interested would you be in opportunities to learn about the following topics: very interested, somewhat interested or not interested
a) How men can avoid causing an unwanted pregnancy?
SOMEWHAT INTERESTED 2
NOT INTERESTED 3
b) How a man can help their partner have safe and healthy pregnancies?
SOMEWHAT INTERESTED 2
NOT INTERESTED 3
c) How men can help to care for their new born infants?
SOMEWHAT INTERESTED 2
NOT INTERESTED 3
SECTION 6. PARTICIPATION IN HEALTH CARE
HAS NOT HAD ANY CHILDREN ___ (GO TO 628)
602. PLEASE TELL ME THE NAME AND SEX OF YOUR CHILD (WHO WAS BORN MOST RECENTLY).
NAME OF CHILD __________
GIRL 2
603. IN WHAT MONTH AND YEAR WAS (NAME OF CHILD) BORN?
YEAR _____
604. Is (NAME OF CHILD) still living?
NO 2
605. How old was (NAME OF CHILD) when he/she died?
IF '1 YEAR', PROBE: How many months old was (name)?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.
MONTHS 2 ___
YEARS 3 ___
606. What is the name of (NAME OF CHILD)'s mother?
WRITE THE CHILD'S MOTHER'S NAME AND HER LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE.
IF THE MOTHER IS DECEASED, RECORD '95'.
IF THE MOTHER IS NOT A HOUSEHOLD MEMBER, RECORD '00'.
NAME OF CHILD'S MOTHER __________
(LAST) CHILD BORN BEFORE JANUARY 1995 ___ (GO TO 628)
608. What is your relationship with (NAME OF CHILD'S MOTHER)?
FORMER SPOUSE 02
CURRENT LIVE-IN PARTNER 03
FORMER LIVE-IN PARTNER 04
REGULAR SEXUAL PARTNER 05
WOMAN IS GIRLFRIEND/FIANCÉE 06
OCCASIONAL SEXUAL PARTNER 07
FRIEND/ACQUAINTANCE 08
OTHER (SPECIFY) __________ 96
609. What is your relationship with (NAME OF CHILD'S MOTHER)?
FORMER SPOUSE 02
CURRENT LIVE-IN PARTNER 03
FORMER LIVE-IN PARTNER 04
REGULAR SEXUAL PARTNER 05
WOMAN IS GIRLFRIEND/FIANCÉE 06
OCCASIONAL SEXUAL PARTNER 07
FRIEND/ACQUAINTANCE 08
OTHER (SPECIFY) __________ 96
610. When (NAME OF CHILD'S MOTHER) became pregnant with (NAME OF CHILD), did you want her to become pregnant then, did you want to wait until later, or did you not want her to have a child at all?
LATER 2
NOT AT ALL 3 (GO TO 612)
611. How much longer would you like to have waited?
YEARS 2 ___
UNDECIDED/DON'T KNOW 998
612. ASK QUESTIONS 612-615 FIRST FOR PREGNANCY, THEN FOR DELIVERY, AND THEN FOR THE SIX WEEKS AFTER DELIVERY. ALL QUESTIONS REFER TO THE LAST BIRTH.
Did (NAME OF CHILD'S MOTHER) receive any advice or care from a doctor or any health care provider during the (PREGNANCY/DELIVERY/SIX WEEKS AFTER DELIVERY)?
YES 1
NO 2 (GO TO 615)
DON'T KNOW 8 (GO TO 612 IN NEXT COLUMN)
DELIVERY
YES 1
NO 2 (GO TO 615)
DON'T KNOW 8 (GO TO 612 IN NEXT COLUMN)
SIX WEEKS AFTER DELIVERY
NO 2 (GO TO 615)
DON'T KNOW 8 (GO TO 616)
613. Was this care provided free, was it completely covered by insurance, or did it have to be paid for in money or goods or services?
FREE 1 (GO TO 612 IN NEXT COLUMN)
INSURANCE (GO TO 612 IN NEXT COLUMN)
HAD TO BE PAID FOR 3
DELIVERY
FREE 1 (GO TO 612 IN NEXT COLUMN)
INSURANCE (GO TO 612 IN NEXT COLUMN)
HAD TO BE PAID FOR 3
SIX WEEKS AFTER DELIVERY
INSURANCE 2 (GO TO 616)
HAD TO BE PAID FOR 3
614. Who mainly provided the money/goods/services to pay for this care?
RESPONDENT 1 (GO TO 612 IN NEXT COLUMN)
CHILD'S MOTHER 2 (GO TO 612 IN NEXT COLUMN)
RESPONDENT AND CHILD'S MOTHER 3 (GO TO 612 IN NEXT COLUMN)
RESPONDENT'S FAMILY 4 (GO TO 612 IN NEXT COLUMN)
MOTHER'S FAMILY 5 (GO TO 612 IN NEXT COLUMN)
OTHER (SPECIFY) __________ 6 (GO TO 612 IN NEXT COLUMN)
DELIVERY
RESPONDENT 1 (GO TO 612 IN NEXT COLUMN)
CHILD'S MOTHER 2 (GO TO 612 IN NEXT COLUMN)
RESPONDENT AND CHILD'S MOTHER 3 (GO TO 612 IN NEXT COLUMN)
RESPONDENT'S FAMILY 4 (GO TO 612 IN NEXT COLUMN)
MOTHER'S FAMILY 5 (GO TO 612 IN NEXT COLUMN)
OTHER (SPECIFY) __________ 6 (GO TO 612 IN NEXT COLUMN)
SIX WEEKS AFTER DELIVERY
CHILD'S MOTHER 2 (GO TO 616)
RESPONDENT AND CHILD'S MOTHER 3 (GO TO 616)
RESPONDENT'S FAMILY 4 (GO TO 616)
MOTHER'S FAMILY 5 (GO TO 616)
OTHER (SPECIFY) __________ 6 (GO TO 616)
615. What was the main reason (NAME OF CHILD'S MOTHER) did not receive any advice or care from a doctor or other health care provider during (PREGNANCY/DELIVERY/THE SIX WEEKS AFTER DELIVERY)?
NOT NECESSARY 01 (GO TO 612 IN NEXT COLUMN)
NOT CUSTOMARY 02 (GO TO 612 IN NEXT COLUMN)
RESPONDENT DIDN'T ALLOW 03 (GO TO 612 IN NEXT COLUMN)
TOO COSTLY 04 (GO TO 612 IN NEXT COLUMN)
TOO FAR/NO TRANSPORT 05 (GO TO 612 IN NEXT COLUMN)
POOR SERVICE 06 (GO TO 612 IN NEXT COLUMN)
LACK OF KNOWLEDGE 07 (GO TO 612 IN NEXT COLUMN)
OTHER (SPECIFY) __________ 96 (GO TO 612 IN NEXT COLUMN)
DELIVERY
NOT NECESSARY 01 (GO TO 612 IN NEXT COLUMN)
NOT CUSTOMARY 02 (GO TO 612 IN NEXT COLUMN)
RESPONDENT DIDN'T ALLOW 03 (GO TO 612 IN NEXT COLUMN)
TOO COSTLY 04 (GO TO 612 IN NEXT COLUMN)
TOO FAR/NO TRANSPORT 05 (GO TO 612 IN NEXT COLUMN)
POOR SERVICE 06 (GO TO 612 IN NEXT COLUMN)
LACK OF KNOWLEDGE 07 (GO TO 612 IN NEXT COLUMN)
OTHER (SPECIFY) __________ 96 (GO TO 612 IN NEXT COLUMN)
SIX WEEKS AFTER DELIVERY
NOT CUSTOMARY 02
RESPONDENT DIDN'T ALLOW 03
TOO COSTLY 04
TOO FAR/NO TRANSPORT 05
POOR SERVICE 06
LACK OF KNOWLEDGE 07
OTHER (SPECIFY) __________ 96
616. Sometimes a pregnancy can have complications that lead to miscarriage or even death. What are some of the signs and symptoms that indicate that a pregnancy may be in danger?
PROBE: Any other signs or symptoms?
RECORD ALL SIGNS AND SYMPTOMS MENTIONED.
VAGINAL BLEEDING A
HIGH FEVER B
ABDOMINAL PAIN C
SWELLING OF HANDS AND FEET D
DIFFICULT LABOR FOR MORE THAN 12 HOURS E
CONVULSIONS F
OTHER (SPECIFY) __________ X
DON'T KNOW ANY SIGNS OR SYMPTOMS Y
617. At any time while (NAME OF CHILD'S MOTHER) was pregnant with (NAME OF CHILD), did you yourself talk with a doctor or any other health care provider about the health of the mother or of the pregnancy?
NO 2 (GO TO 619)
618. Did the health provider talk to you about:
a) What foods (NAME OF CHILD'S MOTHER) should eat during pregnancy?
NO 2
DON'T RECALL 3
b) How much rest she should have during pregnancy?
NO 2
DON'T RECALL 3
c) What you should do to prepare for the delivery?
NO 2
DON'T RECALL 3
d) The types of health problems for which she should get mediate medical attention?
NO 2
DON'T RECALL 3
NAME OF (LAST) CHILD __________
(LAST) CHILD NOT LIVING ___ (GO TO 628)
620. Now I want to talk to you about vaccinations given to young children to immunize them against different diseases. CIRCLE CODE 1 IN 620 FOR EACH VACCINE MENTIONED SPONTANEOUSLY. THEN, FOR EACH VACCINE WITH CODE 1 OR CODE 2 CIRCLED IN 620, ASK 621.
What vaccinations have you heard about that are given to young children to protect them against disease?
FOR VACCINATIONS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (name of vaccine)?
620A. BCG: An injection in the arm or shoulder that usually causes a scar.
PROBED YES 2
NO 3
DON'T KNOW 8
620B. POLIO VACCINE: Given in the form of drops in the mouth.
PROBED YES 2
NO 3
DON'T KNOW 8
620C. DPT VACCINE: An injection in the thigh or buttocks, sometimes given at the same time as polio drops.
PROBED YES 2
NO 3
DON'T KNOW 8
620D. MEASLES VACCINE: An injection to prevent measles.
Probed yes 2
No 3
Don't know 8
621. Has (NAME OF CHILD) received (NAME OF VACCINE)?
YES 1
NO 2
DON'T KNOW
YES 1
NO 2
DON'T KNOW
YES 1
NO 2
DON'T KNOW
YES 1
NO 2
DON'T KNOW
AT LEAST ONE YES ___ (GO TO 624)
623. What is the main reason why (NAME OF CHILD) has not received any of these vaccinations?
DOES NOT KNOW WHERE TO GET THEM 02
NOT AVAILABLE 03
NOT IMPORTANT/NOT NEEDED 04
NOT GOOD FOR CHILD'S HEALTH 05
CHILD TOO YOUNG 06
TOO FAR/NO TRANSPORT 07
OTHER (SPECIFY) __________ 96
DON'T KNOW ANY VACCINE 99
DON'T KNOW WHY 98
624. Does (NAME OF CHILD) live with you in your household?
NO 2 (GO TO 626)
625. In your household who usually decides what to do if the (NAME OF CHILD) is ill?
RECORD ALL PERSONS MENTIONED.
CHILD'S MOTHER B
WIFE/PARTNER WHO IS NOT CHILD'S MOTHER C
FEMALE RELATIVE D
MALE RELATIVE E
OTHER (SPECIFY) __________ X
CHILD HAS NEVER BEEN ILL Y
MOTHER NOT ALIVE (CODED '95') ___ (GO TO 628)
627. Please tell me if you would be angry with (NAME OF CHILD'S MOTHER) if she ever did the following:
NO, NOT ANGRY 2
DON'T KNOW 8
NO, NOT ANGRY 2
DON'T KNOW 8
628. Now I want to talk to you about some common childhood illnesses.
When a child was diarrhea, should he/she be given less to drink than usual, about the same amount, or more than usual?
ABOUT THE SAME 2
MORE 3
DON'T KNOW 8
629. When a child is sick with diarrhea, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
PROBE: Any other signs?
RECORD ALL SIGNS MENTIONED.
ANY WATERY STOOLS B
REPEATED VOMITING C
ANY VOMITING D
BLOOD IN STOOLS E
FEVER F
MARKED THIRST G
NOT EATING/NOT DRINKING WELL H
NOT GETTING BETTER I
OTHER (SPECIFY) __________ X
DON'T KNOW ANY SIGNS Y
630. When a child is sick with a cough, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
PROBE: Any other signs?
RECORD ALL SIGNS MENTIONED.
DIFFICULT BREATHING B
NOISY BREATHING C
FEVER D
UNABLE TO DRINK/SWALLOW E
NOT EATING/NOT DRINKING WELL F
NOT GETTING BETTER G
OTHER (SPECIFY) __________ X
DON'T KNOW ANY SIGNS Y
631. ASK 631, THEN FOLLOW SKIP PATTERN TO 632 AND 633 FOR EACH ILLNESS.
Now tell me about your own health. Have you ever, at any time in your life, had...
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
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
632. Have you had (NAME OF PROBLEM) in the last 3 months?
NO 2
633. Have you ever sought treatment for (NAME OF PROBLEM)?
NO 2
634. CHECK 632 (HEALTH PROBLEMS IN THE LAST 3 MONTHS):
OTHER ___ (GO TO 639)
635. At any time during the last 3 months, did (this/these) health problem(s) prevent you from doing your work or other regular activities?
NO 2 (GO TO 637)
636. For how many days in the last 3 months were you unable to do your work or regular activities due to this (these) health problem(s)?
637. CHECK 633 (TREATMENT FOR ALL HEALTH PROBLEMS):
OTHER ___ (GO TO 639)
638. Where did you go for treatment for this (these) health problem(s)?
IF SOURCE IS HOSPITAL, HEALTH CENTER OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
NAME OF PLACE __________
PROBE: Did you go anywhere else for treatment?
RECORD ALL PLACES MENTIONED.
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
FIELD WORKER E
OTHER PUBLIC (SPECIFY) __________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
FIELD WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) __________ L
OTHER SOURCE
SHOP M
TRADITIONAL PRACTITIONER M
OTHER (SPECIFY) __________ X
639. Have you had any kind of injection in the last 3 months?
NO 2 (GO TO 642)
640. How many times did you have an injection in the last 3 months?
EVERY DAY 95
641. The last time you had an injection, who was the person who gave you the injection?
TRADITIONAL HEALER 2
FRIEND/RELATIVE 3
SELF 4
OTHER (SPECIFY) __________ 6
642. Do you currently smoke cigarettes or tobacco?
IF YES: What type of tobacco do you smoke?
RECORD ALL TYPES MENTIONED.
YES, PIPES B
YES, OTHER (SPECIFY) __________ C
NO Y
644. In the last 24 hours, how many cigarettes did you smoke?
645. Have you ever drunk an alcohol-containing beverage?
NO 2 (GO TO 701)
646. In the last 30 days, on how many days did you drink an alcohol-containing beverage?
NONE 95
647. Have you ever gotten "drunk" from drinking an alcohol-containing beverage?
NO 2 (GO TO 701)
NONE ___ (GO TO 701)
649. In the last 30 days, on how many occasions did you get "drunk"?
NONE 95
SECTION 7. AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES
701. Now I would like to talk about something else. Have you ever heard of an illness called AIDS?
NO 2 (GO TO 724)
702. Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?
NO 2 (GO TO 709)
DON'T KNOW 8 (GO TO 709)
703. 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 KISSING K
AVOID MOSQUITO BITES L
SEEK PROTECTION FROM TRADITIONAL PRACTITIONER M
AVOID SKIN PIERCING/CUTTING INSTRUMENTS N
SHARING SYRINGE O
SHARING A TOILET P
AVOID TOUCHING A PERSON WITH AIDS Q
AVOID SHARING FOOD R
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
DON'T KNOW Z
704. Can people reduce their chances of getting the AIDS virus by having just one sex partner who has no other partners?
NO 2
DON'T KNOW 8
705. Can a person get the AIDS virus from mosquito bites?
NO 2
DON'T KNOW 8
706. Can people reduce their chances of getting the AIDS virus by using a condom every time they have sex?
NO 2
DON'T KNOW 8
707. Can a person get the AIDS virus by sharing food with a person who has AIDS?
NO 2
DON'T KNOW 8
709. Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DON'T KNOW 8
710. Do you know someone personally who has the virus that causes AIDS or someone who died of AIDS?
NO 2
711. Can the virus that causes AIDS be transmitted from a mother to a child?
NO 2 (GO TO 713)
DON'T KNOW 8 (GO TO 713)
712. Can the virus that causes AIDS be transmitted from a mother to her child...
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO, NOT IN UNION ___ (GO TO 715)
714. Have you ever talked with (YOUR WIFE/THE WOMAN YOU ARE LIVING WITH) about ways to prevent getting the virus that causes AIDS?
IF MORE THAN ONE WIFE/PARTNER, ASK ABOUT ANY OF HIS WIVES/PARTNERS
NO 2
715. In your opinion, is it acceptable or unacceptable for AIDS to be discussed:
NOT ACCEPTABLE 2
NOT ACCEPTABLE 2
NOT ACCEPTABLE 2
716. If a person learns that he/she is infected with the virus that causes AIDS, should the person be allowed to keep this fact private or should this information be available to the community?
AVAILABLE TO COMMUNITY 2
DON'T KNOW/UNSURE 8
717. 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
DON'T KNOW/UNSURE/DEPENDS 8
718. If a female teacher has the AIDS virus, should she be allowed to continue teaching in the school?
SHOULD NOT CONTINUE 2
DON'T KNOW/UNSURE/DEPENDS 8
719. Should children age 12-14 years be taught about using a condom to avoid AIDS?
NO 2
DON'T KNOW/UNSURE/DEPENDS 8
720. Have you ever been tested to see if you have the AIDS virus?
NO 2 (GO TO 721)
720a. Where did you go for the test the last time?
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
OTHER PUBLIC (SPECIFY) __________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
720b. Did you get the results?
DO NOT ASK FOR THE RESULT.
NO 2 (GO TO 724)
721. Would you want to be tested for the AIDS virus?
NO 2
DON' T KNOW/UNSURE/DEPENDS 8
722. Do you know a place where you could Go to get an AIDS test?
NO 2 (GO TO 724)
723. Where can you go for the test?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
NAME OF PLACE __________
ANY OTHER PLACE?
RECORD ALL MENTIONED.
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
OTHER PUBLIC (SPECIFY) __________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
OTHER PRIVATE MEDICAL (SPECIFY) __________ L
724. (Apart from AIDS), have you heard about (other) infections that can be transmitted through sexual contact?
NO 2 (GO TO 727)
724a. What infections do you know?
RECORD ALL MENTIONED.
GONORRHEA B
GENITAL WARTS/CONDYLOMATA C
CHANCROID D
CHLAMYDIA E
CANDIDA F
OTHER (SPECIFY) __________ X
724b. Infections that are transmitted through sexual contact can cause problems if left untreated. What are some of these problems?
RECORD ALL MENTIONED.
MISCARRIAGE/STILLBIRTH B
EASIER TO GET HIV C
BABY BORN SICK D
MADNESS E
DON'T KNOW Y
725. If a man has a asexually transmitted disease, what symptoms might he have?
Any others?
PROBE: Do not read out the options.
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
IMPOTENCY/STERILITY L
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
NO SYMPTOMS Y
DON'T KNOW Z
726. If a woman has a sexually transmitted disease, what symptoms might she have?
Any others?
PROBE: Do not read out the options.
RECORD ALL MENTIONED.
ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWILLING 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 ___ (GO TO 801)
728. 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 sexually-transmitted infection?
NO 2 (GO TO 729)
DON'T KNOW 8 (GO TO 729)
728a. Which one?
Any other?
RECORD ALL MENTIONED.
GONORRHEA B
GENITAL WARTS/CONDYLOMATA C
CHANCROID D
CHLAMYDIA E
CANDIDA F
OTHER (SPECIFY) __________ X
DON'T KNOW Z
729. Sometimes, men experience a discharge from their penis. During the last 12 months, have you had a discharge from your penis?
NO 2
DON'T KNOW 8
730. Sometimes men have a sore or ulcer on or near their penis. During the last 12 months, have you had a sore or ulcer on or near your penis?
NO 2
DON'T KNOW 8
HAS NOT HAD AN INFECTION ___ (GO TO 801)
732. The last time you had (INFECTION(S) FROM 728/729/730), did you seek any kind of advice or treatment?
NO 2 (GO TO 734)
733. The last time you had (INFECTION(S) FROM 728/729/730), did you do any of the following? Did you...
a) Seek advice from a health worker in a clinic or hospital?
YES 1
NO 2
b) Seek advice or medicine from a traditional healer?
YES 1
NO 2
c) Seek advice or buy medicine in a shop or pharmacy?
YES 1
NO 2
d) Ask for advice from friends or relatives?
YES 1
NO 2
d) Do self medication?
YES 1
NO 2
734. When you had (INFECTION(S) FROM 728/729/730), did you inform the person(s) with whom you were having sex?
NO 2
SOME/NOT AT ALL 3
DID NOT HAVE A PARTNER 4 (GO TO 801)
735. When you had (INFECTION(S) FROM 728/729/730), did you do anything to avoid infecting your sexual partner(s)?
NO 2 (GO TO 801)
PARTNER(S) ALREADY INFECTED 3 (GO TO 801)
736. What did you do to avoid infecting your partner(s)? Did you...
NO 2
NO 2
NO 2
NO 2
SECTION 8. ATTITUDES TOWARD WOMEN
801. Who in your family usually has the final say on each of the following decisions:
RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
802. Sometimes a husband is annoyed or angered by things which his wife does. 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
803. Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband if...
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
804. Do you think that if a woman refuses to have sex with her husband when he wants her to, he has the right to...
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
MINUTES ___
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT RESPONDENT:
__________
__________
COMMENTS ON SPECIFIC QUESTIONS:
__________
__________
ANY OTHER COMMENTS:
__________
__________
SUPERVISOR'S OBSERVATIONS
__________
DATE _____
__________
DATE _____