UGANDA BUREAU OF STATISTICS
UGANDA DEMOGRAPHIC AND HEALTH SURVEYS
MAN'S QUESTIONNAIRE-ENGLISH
IDENTIFICATION
NAME OF HOUSEHOLD HEAD
HOUSEHOLD NUMBER
SAMPLED HOUSEHOLD NUMBER
NAME AND LINE NUMBER OF MAN
MAN SELECTED FOR VIOLENCE MODULE
NO=2
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NEXT VISIT
DATE
TIME
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT
NEXT VISIT
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT
FINAL VISIT
DAY __ __
MONTH __ __
YEAR __ __ __ __
INT. NUMBER __ __ __
RESULT __
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) _______________
LANGUAGE OF THE QUESTIONNAIRE __ __
LANGUAGE USED IN THE INTERVIEW __ __
NATIVE LANGUAGE OF RESPONDENT __ __
SOMETIMES=2
ALL THE TIME=3
02 LUGANDA
03 LUGBARA
04 LUO
05 RUNYANKOLE-RUKIGA
06 RUNYORO-RUTORO
07 NGAKARAMOJONG
08 ENGLISH
96 OTHER (SPECIFY) ______________
NAME ___________ __ __ __
FIELD EDITOR
NAME ___________ __ __ __
OFFICE EDITOR__ __
KEYED BY __ __
SECTION 1. RESPONDENT'S BACKGROUND
INTRODUCTION AND CONSENT
INFORMED CONSENT
Hello. My name is _______________________________________. I am working with UGANDA BUREAU OF STATISTICS. We are conducting a survey about health all over UGANDA. 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?
NO ___
May I begin the interview now?
NO ___
SIGNATURE OF INTERVIEWER: _______________________
DATE: ___________
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (GO TO 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 (GO TO 108)
105) What is the highest level of school you attended: primary, '0' level, 'A' level, or university or tertiary?
'O' LEVEL 2
'A' LEVEL 3
TERTIARY 4
UNIVERSITY 5
106) What is the highest (class/year) you completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'
SECONDARY OR HIGHER ___ (GO TO 110)
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 PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) ___________ 4
BLIND/VISUALLY IMPAIRED 5
CODE '1' OR '5' CIRCLED ___ (GO TO 111)
110) Do you read a newspaper or magazine, almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
111) Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
112) Do you watch television, almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
PROTESTANT 2
MUSLIM 3
PENTECOSTAL 4
SDA 5
OTHER (SPECIFY) ____________ 6
BANYANKOLE 2
BASOGA 3
BAKIGA 4
ITESO 5
OTHER (SPECIFY) ______________ 6
115) In the last 12 months, how many times have you been away from home for one or more nights?
NONE 00 (GO 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 (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 live with you?
IF NONE, RECORD '00'
DAUGHTERS AT HOME __ __
204) Do you have any sons or daughters that 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 did not survive?
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'
GIRLS DEAD __ __
208) SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL.
IF NONE, RECORD '00'.
HAS HAD ONLY ONE CHILD ___ (GO TO 212)
HAS NOT HAD ANY CHILDREN ___ (GO 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 ___ (GO TO 301)
214) How old is your (youngest) child?
OTHER ___ (GO 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 (GO TO 219)
DON'T KNOW 8 (GO 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 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
GAVE RUTF 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.
Have you ever heard of (METHOD)?
PROBE: Women can have an operation to avoid having any more children
NO 2
PROBE: Men can have an operation to avoid having any more children
NO 2
PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse
NO 2
PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months
NO 2
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
NO 2
PROBE: Women can take a pill every day to avoid becoming pregnant
NO 2
PROBE: Men can put a rubber sheath on their penis before sexual intercourse
NO 2
PROBE: Women can place a sheath in their vagina before sexual intercourse
NO 2
NO 2
PROBE: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant
NO 2
PROBE: Men can be careful and pull out before climax
NO 2
PROBE: As an emergency measure, within five days after they have unprotected sexual intercourse, intercourse, women can take special pills or loop/coil is placed inside them by a doctor or nurse to prevent pregnancy
NO 2
men can use to avoid pregnancy?
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 (GO TO 306)
DON'T KNOW 8 (GO 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): KNOWS MALE CONDOM
NO ___ (GO TO 401)
308) Do you know of a place where a person can get/buy condoms?
NO 2 (GO TO 401)
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.
(NAME OF PLACE(S)) ____________________
GOVT HEALTH CENTER B
FAMILY PLANNING CLINIC C
OUTREACH SERVICES D
VILLAGE HEALTH TEAM E
OTHER PUBLIC (SPECIFY) ___________ F
PHARMACY/DRUG SHOP H
PRIVATE DOCTOR/NURSE/ MIDWIFE I
OUTREACH SERVICES J
NGO COMMUNITY BASED DISTRIBUTO K
OTHER PRIVATE MEDICAL (SPECIFY) ___________ L
RELIGIOUS INSTITUTION N
FRIENDS/RELATIVES O
STREET VENDOR P
LODGE Q
OTHER (SPECIFY) ____________ X
310) If you wanted to, could you yourself get a condom?
NO 2
SECTION 4. MARRIAGE AND SEXUAL ACTIVITY
401) Are you currently married or living together with a woman as if married?
YES, CUSTOMARY MARRIAGE 2 (GO TO 404)
YES, RELIGIOUS MARRIAGE 3 (GO TO 404)
YES, LIVING WITH A WOMAN 4 (GO TO 404)
NO, NOT IN UNION 5
402) Have you ever been married or lived together with a woman as if married?
YES, LIVED WITH A WOMAN 2
NO 3 (GO TO 413)
403) What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2 (GO TO 410)
SEPARATED 3 (GO 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 (GO TO 407)
406) Altogether, how many wives or live-in partners do you have?
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 ___ (GO TO 411A)
410) Have you been married or lived with a woman only once or more than once?
MORE THAN ONCE 2 (GO TO 411A)
411) In what month and year did you start living with your (wife/partner)?
DON'T KNOW MONTH 98
YEAR __ __ __ __ (GO TO 413)
DON'T KNOW YEAR 9998
411A) Now I would like to ask about your first (wife/partner). In what month and year did you start living with her?
DON'T KNOW MONTH 98
YEAR __ __ __ __ (GO TO 413)
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 __ __ (GO TO 430)
417) When was the last time you had sexual intercourse with this person?
[FOR SECOND-TO-LAST AND THIRD-TO-LAST SEXUAL PARTNERS]
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 (GO 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 (GO TO 423)
CASUAL ACQUAINTANCE 4 (GO TO 423)
PROSTITUTE 5 (GO TO 423)
OTHER (SPECIFY) _____________ 6 (GO TO 423)
MARRIED MORE THAN ONCE ___ (GO 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 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?
[FOR LAST AND SECOND-TO-LAST SEXUAL PARTNERS]
NO 2 (GO 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 ___ (GO TO 430)
429) CHECK 420 AND 418 (ALL COLUMNS):
OTHER ___ (GO TO 434)
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 (GO TO 434)
432) The last time you paid someone in exchange for having sexual intercourse, was a condom used?
NO 2 (GO 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
DON'T KNOW 8
434) In total, with how many different people have you had sexual intercourse in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS 95 OR MORE, WRITE '95'.
DON'T KNOW 98
435) CHECK 418, MOST RECENT PARTNER (FIRST COLUMN):
CONDOM USED ___
NO CONDOM USED ___ (GO 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.
LIFE GUARD 02
ENGABU 03
TRUST 04
OTHER (SPECIFY) ___________ 96
DON'T KNOW 98
437) From where did you 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.
(NAME OF PLACE) _________________________
GOVT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
OUTREACH 14
GOVT COMMUNITY BASED DISTRIBUTOR 15
OTHER PUBLIC (SPECIFY) _____________ 16
PHARMACY/DRUG SHOP 22
PRIVATE DOCTOR/NURSE/MIDWIFE 23
OUTREACH 24
NGO COMMUNITY BASED DISTRIBUTOR 25
OTHER PRIVATE MEDICAL (SPECIFY) ____________ 26
RELIGIOUS INSTITUTION 32
FRIENDS/RELATIVES 33
STREET VENDOR 34
LODGE 35
OTHER (SPECIFY) ____________ 36
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 (GO TO 501)
DON'T KNOW 8 (GO 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/MOON BEADS K
WITHDRAWAL L
OTHER METHODS (SPECIFY) _____________ X
SECTION 5. FERTILITY PREFERENCES
501) CHECK 401:
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER ___ (GO TO 509)
MAN STERILIZED ___ (GO TO 509)
503) (Is your (wife/partner)/Are any of your (wives/partners)) currently pregnant?
NO 2 (GO TO 505)
DON'T KNOW 8 (GO 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 (GO TO 509)
UNDECIDED/DON'T KNOW 8 (GO 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 (GO TO 509)
SAYS COUPLE CAN'T GET PREGNANT 3 (GO TO 509)
WIFE (WIVES)/PARTNER(S) STERILIZED 4 (GO TO 509)
UNDECIDED/DON'T KNOW 8 (GO TO 509)
MORE THAN ONE WIFE/PARTNER ___ (GO TO 508)
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 like to wait before the birth of another child?
YEARS 2 __ __ (GO TO 509)
SOON/NOW 993 (GO TO 509)
COUPLE INFECUND 994
OTHER (SPECIFY) _______________ 996 (GO TO 509)
DON'T KNOW 998 (GO 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/PARTNERSARE INFECUND 994
OTHER (SPECIFY) ________________ 996
DON'T KNOW 998
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 (GO 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?
OTHER (SPECIFY) ________________ 96
OTHER (SPECIFY) ________________ 96
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 (GO 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 ___ (GO TO 612)
OTHER ___ (GO 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) Now I would like to talk about something else. Have you ever heard of an illness called AIDS?
NO 2 (GO 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 her baby:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
OTHER ___ (GO 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
DON'T KNOW 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 (GO TO 716)
713) How many months ago was your most recent HIV test?
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.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE) _______________________
GOVT HEALTH CENTER 12 (GO TO 718)
STAND-ALONE VCT CENTER 13 (GO TO 718)
FAMILY PLANNING CLINIC 14 (GO TO 718)
OUTREACH 15 (GO TO 718)
VILLAGE HEALTH TEAM 16 (GO TO 718)
OTHER PUBLIC (SPECIFY) ___________ 17(GO TO 718)
STAND-ALONE VCT CENTER 22 (GO TO 718)
PHARMACY/DRUG SHOP 23 (GO TO 718)
PRIVATE DOCTOR/NURSE/MIDWIFE 24 (GO TO 718)
OUTREACH 25 (GO TO 718)
TASO 26 (GO TO 718)
AIDS INFORMATION CENTER 27 (GO TO 718)
OTHER PRIVATE MEDICAL (SPECIFY) ______________ 28 (GO TO 718)
716) Do you know of a place where people can go to get tested for the AIDS virus?
NO 2 (GO TO 718)
717) 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.
(NAME OF PLACE) _______________________
GOVT HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
OUTREACH E
VILLAGE HEALTH TEAM F
OTHER PUBLIC (SPECIFY) ______________ G
STAND-ALONE VCT CENTER I
PHARMACY/DRUG SHOP J
PRIVATE DOCTOR/NURSE/MIDWIFE K
OUTREACH L
TASO M
AIDS INFORMATION CENTER N
OTHER PRIVATE (SPECIFY) ______________ O
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
DON'T KNOW/NOT SURE/DEPENDS 8
720) If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?
NO 2
DON'T KNOW/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 NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8
722) Should children age 12-14 be taught about using a condom to avoid getting AIDS?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
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 ___ (GO TO 732)
725) CHECK 723: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?
NO ___ (GO 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 ___ (GO TO 732)
730) The last time you had (PROBLEM FROM 726/727/728), did you seek any kind of advice or treatment?
NO 2 (GO TO 732)
731) Where did you go?
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.
GOVT HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
OUTREACH E
VILLAGE HEALTH TEAM F
OTHER PUBLIC (SPECIFY) ______________ G
STAND-ALONE VCT CENTER I
PHARMACY/DRUG SHOP J
PRIVATE DOCTOR/NURSE/MIDWIFE K
OUTREACH L
TASO M
AIDS INFORMATION CENTER N
OTHER PRIVATE (SPECIFY) ______________ O
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 women other than his wives?
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 (GO TO 805)
DON'T KNOW 8 (GO TO 805)
802) How old were you when you got circumcised?
DURING CHILDHOOD (UNDER 5 YEARS) 95
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 2 (GO TO 808)
805A) Who administered the last injection you got?
NURSE/MIDWIFE 12
MEDICAL ASSISTANT/CLINICAL OFFICER 13
NURSING AIDE 14
NON-MEDICAL PERSONNEL 15
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?
NO 2
DON'T KNOW 8
807A) Did you develop any complications as a result of an injection?
NO 2
808) Do you currently smoke cigarettes?
NO 2 (GO TO 810)
809) In the last 24 hours, how many cigarettes did you smoke?
810) Do you currently smoke or use any (other) type of tobacco?
NO 2 (GO TO 812)
811) What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.
CHEWING TOBACCO B
SNUFF C
OTHER (SPECIFY) _____________ X
812) Are you covered by any health insurance?
NO 2 (GO TO 900)
813) What type of health insurance are you covered by?
RECORD ALL MENTIONED.
PRIVATE COMMERCIAL HEALTH INSURANCE B
OTHER (SPECIFY) _____________ X
900) CHECK FRONT COVER: MAN SELECTED FOR THIS SECTION?
MAN NOT SELECTED ___ (GO TO 934)
901) CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.
PRIVACY NOT POSSIBLE 2 (GO TO 931)
READ TO THE RESPONDENT
Now I would like to ask you questions about some other important aspects of a man's life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of men in Uganda. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in your household will know that you were asked these questions.
FORMERLY MARRIED/LIVED WITH A WOMAN (READ IN PAST TENSE AND USE 'LAST' WITH WIFE/PARTNER) ___
NEVER MARRIED/NEVER LIVED WITH A WOMAN ___ (GO TO 916)
903) First, I am going to ask you about some situations which happen to some men. Please tell me if these apply to your relationship with your (last) wife/partner?
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
904) Now I need to ask some more questions about your relationship with your (last) wife/partner
A) Did your (last) wife/partner ever:
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
905) Did your (last) wife/partner ever do any of the following things to you:
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
NOT A SINGLE 'YES' ___ (GO TO 909)
907) How long after you first got married/started living together with your (last) wife/partner did (this/any of these things) first happen?
IF LESS THAN ONE YEAR, RECORD '00'.
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95
908) Did the following ever happen as a result of what your (last) wife/partner did to you:
NO 2
NO 2
NO 2
909) Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) wife/partner at times when she was not already beating or physically hurting you?
NO 2 (GO TO 911)
910) In the last 12 months, how often have you done this to your (last) wife/partner: often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
911) Does (did) your (last) wife/partner drink alcohol?
NO 2 (GO TO 913)
912) How often does (did) your wife/partner get drunk: often, only sometimes, or never?
SOMETIMES 2
NEVER 3
913) Are (were) you afraid of your (last) wife/partner: most of the time, sometimes, or never?
SOMETIMES AFRAID 2
NEVER AFRAID 3
MARRIED ONLY ONCE ___ (GO TO 916)
915) A) So far we have been talking about the behavior of your current/last wife/partner Now I want to ask you about the behavior of any previous wife/partner .
B) How long ago did this last happen?
12+ MONTHS AGO 2
DON'T REMEMBER 3
B) How long ago did this last happen?
12+ MONTHS AGO 2
DON'T REMEMBER 3
EVER MARRIED/EVER LIVED WITH A WOMAN ____
From the time you were 15 years old has anyone other than your/any wife/partner hit you, slapped you, kicked you, or done anything else to hurt you physically?
NEVER MARRIED/ NEVER LIVED WITH A WOMAN ____
From the time you were 15 years old has anyone hit you, slapped you, kicked you, or done anything else to hurt you physically?
NO 2 (GO TO 919)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 919)
917) Who has hurt you in this way?
Anyone else?
RECORD ALL MENTIONED
FATHER/STEP-FATHER B
SISTER/BROTHER C
DAUGHTER/SON D
OTHER RELATIVE E
CURRENT GIRLFRIEND F
FORMER GIRLFRIEND G
MOTHER-IN-LAW H
FATHER-IN-LAW I
OTHER IN-LAW J
TEACHER K
EMPLOYER/SOMEONE AT WORK L
POLICE/SOLDIER M
OTHER (SPECIFY) _____________ X
918) In the last 12 months, how often has this person/have these persons physically hurt you: often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
Now I want to ask you about things that may have been done to you by someone other than your/any wife/partner.
At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?
NEVER MARRIED/NEVER LIVED WITH A WOMAN ___
At any time in your life, as a child or adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?
NO 2 (GO TO 926)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 926)
923) How old were you the first first time you were forced to have sexual intercourse or perform any other sexual acts?
DON'T KNOW 98
924) Who was the person who was forcing you at that time?
FORMER WIFE/PARTNER 02
CURRENT/FORMER GIRLFRIEND 03
MOTHER/STEP-MOTHER 04
SISTER/STEP-SISTER 05
OTHER RELATIVE 06
IN-LAW 07
OWN FRIEND/ACQUAINTANCE 08
FAMILY FRIEND 09
TEACHER 10
EMPLOYER/SOMEONE AT WORK 11
POLICE/SOLDIER 12
PRIEST/RELIGIOUS LEADER 13
STRANGER 14
OTHER (SPECIFY) _______________ 96
In the last 12 months, has anyone other than your/any wife/partner physically forced you to have sexual intercourse when you did not want to?
NEVER MARRIED/NEVER LIVED WITH A WOMAN ___
In the last 12 months has anyone physically forced you to have sexual intercourse when you did not want to?
NO 2
926) CHECK 905A (a-j),915, 916 922, AND 925
NOT A SINGLE 'YES' (GO TO 930)
927)Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?
NO 2 (GO TO 930)
928) From whom have you sought help?
Anyone else?
RECORD ALL MENTIONED.
WIFE'S/PARTNER'S FAMILY B (GO TO 930)
CURRENT/FORMER WIFE/PARTNER C (GO TO 930)
CURRENT/FORMER GIRLFRIEND D (GO TO 930)
FRIEND E (GO TO 930)
NEIGHBOR F (GO TO 930)
RELIGIOUS LEADER G (GO TO 930)
DOCTOR/MEDICAL PERSONNEL H (GO TO 930)
POLICE I (GO TO 930)
LAWYER J (GO TO 930)
SOCIAL SERVICE ORGANIZATION K (GO TO 930)
OTHER (SPECIFY) ____________ X (GO TO 930)
929) Have you ever told any one about this?
NO 2
930) As far as you know, did your father ever beat your mother?
NO 2
DON'T KNOW 8
931) CHECK IF CODE 1 IS CIRCLED IN 922
CODE "1" NOT CIRCLED ___ (GO TO 932)
931A) After being forced to have sexual intercourse or to perform a sexual act, have you ever sought help from a doctor or medical personnel?
NO 2 (GO TO 932)
931B) How long after you were forced to have a sexual intercourse did you seek help?
AFTER 3 DAYS OR MORE 2
931C) Were you offered drugs to prevent you from getting the AIDS virus?
NO 2
931D) Were you offered a test for the AIDS virus after the violence?
NO 2
THANK THE RESPONDENT FOR HIS COOPERATION AND REASSURE HIM ABOUT THE CONFIDENTIALITY OF HIS ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.
932) DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?
YES, MORE THAN ONCE 2
NO 3
YES, MORE THAN ONCE 2
NO 3
YES, MORE THAN ONCE 2
NO 3
933) INTERVIEWER'S COMMENTS / EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE
__________________________________________________
MINUTES __ __
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 EDITOR: __________________________
DATE: ______________