FORMATTING DATE: 6 May 2016
ENGLISH LANGUAGE: 21 Mar 2016
2018 ZAMBIA DEMOGRAPHIC AND HEALTH SURVEY
MAN'S QUESTIONNAIRE
ZAMBIA MINISTRY OF HEALTH / CENTRAL STATISTICAL OFFICE
IDENTIFICATION (1)
PLACE NAME______
NAME OF HOUSEHOLD HEAD______
CLUSTER NUMBER
HOUSEHOLD NUMBER
NAME AND LINE NUMBER OF MAN
INTERVIEWER VISITS
DATE
INTERVIEWER'S NAME
RESULT*
NEXT VISIT
TIME
FINAL VISIT
MONTH
YEAR
INT. NO.
RESULT*
TOTAL NUMBER OF VISITS
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY)________
LANGUAGE OF QUESTIONNAIRE** 01 ENGLISH
LANGUAGE OF INTERVIEW**
NATIVE LANGUAGE OF RESPONDENT**
NO 2
02 BEMBA
03 KAONDE
04 LOZI
05 LUNDA
06 LUVALE
07 NYANJA
08 TONGA
NUMBER_____
Hello. My name is___________. I am working with the Ministry of Health in collaboration with Central Statistical Office (CSO). We are conducting a survey about health and other topics all over Zambia. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take 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?
DATE________
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (SKIP TO END)
SECTION 1: RESPONDENT'S BACKGROUND
101. RECORD THE TIME.
MINUTES______
102. How long have you been living continuously in (NAME OF CURRENT CITY, TOWN OR VILLAGE OF RESIDENCE)?
YEARS_________
ALWAYS 95 (SKIP TO 105)
VISITOR 96 (SKIP TO 105)
103. Just before you moved here, did you live in Lusaka, another city, in a town, or in a village?
TOWN 2
RURAL AREA 3
104. Before you moved here, which province did you live in?
COPPERBELT 02
EASTERN 03
LUAPULA 04
LUSAKA 05
MUCHINGA 06
NORTHERN 07
NORTHWESTERN 08
SOUTHERN 09
WESTERN 10
OUTSIDE OF ZAMBIA 96
105. In what month and year were you born?
DON'T KNOW MONTH 98
YEAR________
DON'T KNOW YEAR 9998
106. How old were you at your last birthday?
AGE IN COMPLETED YEARS___________
107. Have you ever attended school?
NO 2 (SKIP TO 111)
108. What is the highest level of school you attended: primary, secondary, or higher?
SECONDARY 2
HIGHER 3
109. What is the highest grade you completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.
HIGHER (SKIP TO 113)
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?
ABLE TO READ ONLY PART OF THE 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 (SKIP TO 114)
113. 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
114. 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
115. 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
116. Do you own a mobile telephone?
NO 2 (SKIP TO 118)
117. Do you use your mobile phone for any financial transactions?
NO 2
118. Do you have an account in a bank or other financial institution that you yourself use?
NO 2
119. Have you ever used the internet?
NO 2 (SKIP TO 122)
120. In the last 12 months, have you used the internet?
IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.
NO 2 (SKIP TO 122)
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?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
PROTESTANT 2
MUSLIM 3
OTHER (SPECIFY)________ 6
124. In the last 12 months, on how many separable occasions have you traveled away from your home community and slept away?
NONE 00 (SKIP TO 201)
125. In the last 12 months, have you been away from your home community for more than one month at a time?
NO 2
201. Now I would like to ask about any children you have had during your life. I am interested in all of the children that are biologically yours, even if they are not legally yours or do not have your last name. Have you ever fathered any children with any woman?
NO 2 (SKIP TO 206)
DON'T KNOW 8 (SKIP TO 206)
202. Do you have any sons or daughters that you have fathered who are now living with you?
NO 2 (SKIP TO 204)
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?
NO 2 (SKIP TO 206)
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?
NO 2 (SKIP TO 208)
DON'T KNOW 8 (SKIP TO 208)
IF NONE, RECORD '00'.
208. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'.
HAS HAD ONLY ONE CHILD (SKIP TO 211)
HAS NOT HAD ANY CHILDREN (SKIP TO 301)
210. Did all of the children you have fathered have the same biological mother?
NO 2
210A. In all, how many women have you fathered children with?
a) How old were you when your first child was born?
b) How old were you when your child was born?
NO LIVING CHILDREN (SKIP TO 301)
a) How old is your youngest child?
b) How old is your child?
(YOUNGEST) CHILD IS AGE 3 YEARS OR OLDER (SKIP TO 301)
a) What is the name of your youngest 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?
NO 2 (SKIP TO 218)
DON'T KNOW 8 (SKIP TO 218)
217. Were you ever present during any of those antenatal check-ups?
NOT PRESENT 2
218. Was (NAME) born in a hospital or health facility?
OTHER 2
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?
ABOUT THE SAME 2
LESS THAN USUAL 3
NOTHING TO DRINK 4
DON'T KNOW 8
301. Now I would like to talk about family planning -- the various ways or methods that a couple can use to delay or avoid a pregnancy. Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?
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.
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, nurse, or clinic officer which can prevent pregnancy for one or more years.
NO 2
PROBE: Women can have a loop or coil placed inside them by a doctor, nurse, or clinic officer 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
PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
NO 2
PROBE: A woman uses a string of colored beads to know the days she can get pregnant. On the days she can get pregnant, she uses a condom or does not have sexual intercourse.
NO 2
PROBE: Up to six months after childbirth, before the menstrual period has returned, women use a method requiring frequent breastfeeding day and night.
NO 2
PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
NO 2
PROBE: Men can be careful and pull out before climax.
NO 2
YES, TRADITIONAL METHOD (SPECIFY)________B
NO Y
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 if she has sexual relations?
NO 2 (SKIP TO 306)
DON'T KNOW 8 (SKIP TO 306)
305. Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY)_______ 6
DON'T KNOW 8
306. After the birth of a child, can a woman become pregnant before her menstrual period has returned?
NO 2
DON'T KNOW 8
306A. Do you think that a woman who is breastfeeding her baby can become pregnant?
NO 2
DON'T KNOW 8
307. 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
SECTION 4: MARRIAGE AND SEXUAL ACTIVITY
401. Are you currently married or living together with a woman as if married?
YES, LIVING WITH A WOMAN (SKIP TO 404)
NO, NOT IN UNION 3
402. Have you ever been married or lived together with a woman as if married?
YES, LIVED WITH A WOMAN 2
NO 3 (SKIP TO 413)
403. What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2 (SKIP TO 410)
SEPARATED 3 (SKIP TO 410)
404. Is your (wife / partner) living with you now or is she staying elsewhere?
STAYING ELSEWHERE 2
405. Do you have other wives or do you live with other women as if married?
NO (ONLY ONE WIFE) 2 (SKIP TO 407)
406. Altogether, how many wives or live-in partners do you have?
a) Please tell me the name of (your wife / the woman you are living with as if married).
LINE NUMBER_______
b) Please tell me the name of each of your wives or each woman you are living with as if married.
LINE NUMBER________
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'.
408. ASK 408 FOR EACH PERSON.
How old was (NAME) on her last birthday?
MORE THAN ONE WIFE / PARTNER (SKIP TO 411)
410. Have you been married or lived with a woman only once or more than once?
ONLY ONCE 2
a) In what month and year did you start living with your (wife / partner)?
DON'T KNOW MONTH 98
YEAR_______ (SKIP TO 413)
DON'T KNOW YEAR 9998
b) 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_______ (SKIP TO 413)
DON'T KNOW YEAR 9998
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?
AGE IN YEARS_________ (SKIP TO 414C)
AGE 25-59 (SKIP TO 501)
414B. Do you intend to wait until you get married to have sexual intercourse for the first time?
NO 2 (SKIP TO 501)
DON'T KNOW / UNSURE 8 (SKIP TO 501)
AGE 25-49 (GO TO 415)
414D. The first time you had sexual intercourse, was a condom used?
NO 2
DON'T KNOW / UNSURE 8
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.
WEEKS AGO_______ 2 (SKIP TO 417)
MONTHS AGO_______ 3 (SKIP TO 417)
YEARS AGO_______ 4 (SKIP TO 427)
416. When was the last time you had sexual intercourse with this person?
WEEKS AGO 2________
MONTHS AGO 3________
WEEKS AGO 2________
MONTHS AGO 3________
417. The last time you had sexual intercourse with this person, was a condom used?
NO 2 (SKIP TO 419)
418. Was a condom used every time you had sexual intercourse with this person in the last 12 months?
NO 2
419. What was your relationship to this person with whom you had sexual intercourse?
IF GIRLFRIEND: Were you living together as if married?
IF YES, RECORD '2'.
IF NO, RECORD '3'.
LIVE-IN PARTNER 2
GIRLFRIEND NOT LIVING WITH RESPONDENT 3
CASUAL AQUAINTANCE 4
CLIENT / SEX WORKER 5
OTHER (SPECIFY)_______ 6
420. How long ago did you first have sexual intercourse with this person?
WEEKS AGO 2________
MONTHS AGO 3________
YEARS AGO 4________
421. 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, RECORD '95'.
DON'T KNOW 98
422A. The last time you had sexual intercourse with this person did you or this person drink alcohol?
NO 2 (SKIP TO 423)
422B. Were you or your partner drunk at that time?
IF YES: Who was drunk?
PARTNER ONLY 2
BOTH, RESPONDENT AND PARTNER 3
NEITHER 4
423. Apart from this person, have you had sexual intercourse with any other person in the last 12 months?
NO 2 (SKIP TO 425)
424. 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, RECORD '95'.
DON'T KNOW 98
NO PARTNERS ARE SEX WORKERS (SKIP TO 427)
426. CHECK 419 AND 417 (ALL COLUMNS):
OTHER (SKIP TO 431)
427. In the last 12 months, did you pay anyone in exchange for having sexual intercourse?
NO 2
428. Have you ever paid anyone in exchange for having sexual intercourse?
NO 2 (SKIP TO 431)
429. The last time you paid someone in exchange for having sexual intercourse, was a condom used?
NO 2 (SKIP TO 431)
430. 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
431. In the past 12 months have you given any gifts or other goods in order to have sex or to become sexually involved with anyone?
NO 2
432. Have you ever given any gifts or other goods in order to have sex or to become sexually involved with anyone?
NO 2
433. 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, RECORD '95'.
DON'T KNOW 98
434. CHECK 417: MOST RECENT PARTNER (FIRST COLUMN)
NO CONDOM USED (SKIP TO 438)
NOT ASKED (SKIP TO 438)
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.
MAXIMUM SCENTED 02
ROUGH RIDER 03
DUREX 04
REALITY 05
PUBLIC SECTOR: UNBRANDED (WHITE COLOUR FO##NOTE:CUT OFF IN SURVEY 06
OTHER (SPECIFY)__________ 96
DON'T KNOW 98
436. 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 OR THE PLACE.
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT HEALTH POST 12
MOBILE CLINIC / HOSPITAL 14
COMMUNITY BASED AGENT / FIELDWORKER 15
OTHER PUBLIC SECTOR (SPECIFY)_______ 16
PRIVATE HOSPITAL / CLINIC 21
MISSION HOSPITAL / CLINIC 22
PHARMACY 23
PRIVATE DOCTOR 24
MOBILE HOSPITAL 25
COMMUNITY BASED AGENT / FIELDWORKER 26
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)_________ 27
SHOP 31
CHURCH 32
FRIEND / RELATIVE 33
OTHER (SPECIFY)_______ 96
DON'T KNOW 98
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?
NO 2 (SKIP TO 440)
DON'T KNOW (SKIP TO 440)
438. The last time you had sex did you or your partner use any method to avoid or prevent a pregnancy?
NO 2 (SKIP TO 440)
DON'T KNOW 8 (SKIP TO 440)
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
CONDOM G
FEMALE CONDOM H
EMERGENCY CONTRACEPTION I
STANDARD DAYS METHOD J
LACTATIONAL AMENORRHEA METHOD K
RHYTHM METHOD L
WITHDRAWAL M
OTHER MODERN METHOD X
OTHER TRADITIONAL METHOD Y
ALL SKIP TO 501.
440. Do you know of a place where you can obtain a method of family planning?
NO 2
SECTION 5: FERTILITY PREFERENCES
501. CHECK 401:
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (SKIP TO 514)
MAN STERILIZED (SKIP TO 514)
MORE THAN ONE WIFE / PARTNER (SKIP TO 509)
504. Is your (wife / partner) currently pregnant?
NO 2 (SKIP TO 507)
DON'T KNOW 8 (SKIP TO 507)
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?
NO MORE 2 (SKIP TO 514)
UNDECIDED / DON'T KNOW 8 (SKIP TO 514)
506. 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_______ (SKIP TO 514)
SOON / NOW 993 (SKIP TO 514)
OTHER (SPECIFY)________ 996
DON'T KNOW 998 (SKIP TO 514)
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?
NO MORE / NONE 2 (SKIP TO 514)
SAYS COUPLE CAN'T GET PREGNANT 3 (SKIP TO 514)
WIFE / PARTNER STERILIZED 4 (SKIP TO 514)
UNDECIDED / DON'T KNOW 8 (SKIP TO 514)
b) Now I have some questions about the future. Would you like to have a child, or would you prefer not to have any children?
NO MORE / NONE 2 (SKIP TO 514)
SAYS COUPLE CAN'T GET PREGNANT 3 (SKIP TO 514)
WIFE / PARTNER STERILIZED 4 (SKIP TO 514)
UNDECIDED / DON'T KNOW 8 (SKIP TO 514)
a) How long would you like to wait from now before the birth of another child?
YEARS 2 ________ (SKIP TO 514)
SOON / NOW 993 (SKIP TO 514)
SAYS COUPLE CAN'T GET PREGNANT 994 (SKIP TO 514)
OTHER (SPECIFY)________ 996 (SKIP TO 514)
DON'T KNOW 998 (SKIP TO 514)
b) How long would you like to wait from now before the birth of a child?
YEARS 2 ________ (SKIP TO 514)
SOON / NOW 993 (SKIP TO 514)
SAYS COUPLE CAN'T GET PREGNANT 994 (SKIP TO 514)
OTHER (SPECIFY)________ 996 (SKIP TO 514)
DON'T KNOW 998 (SKIP TO 514)
509. Are any of your (wives / partners) currently pregnant?
NO 2 (SKIP TO 512)
DON'T KNOW 8 (SKIP TO 512)
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?
NO MORE 2 (SKIP TO 514)
UNDECIDED/ DON'T KNOW 8 (SKIP TO 514)
511. 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______ (SKIP TO 514)
SOON / NOW 993 (SKIP TO 514)
OTHER (SPECIFY)______ 996 (SKIP TO 514)
DON'T KNOW 998 (SKIP TO 514)
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?
NO MORE / NONE 2 (SKIP TO 514)
SAYS COUPLE CAN'T GET PREGNANT 3 (SKIP TO 514)
(WIFE / WIVES / PARTNER(S)) STERILIZED 4 (SKIP TO 514)
UNDECIDED / DON'T KNOW 8 (SKIP TO 514)
b) Now I have some questions about the future. Would you like to have a child, or would you prefer not to have any children?
NO MORE / NONE 2 (SKIP TO 514)
SAYS COUPLE CAN'T GET PREGNANT 3 (SKIP TO 514)
(WIFE / WIVES / PARTNER(S)) STERILIZED 4 (SKIP TO 514)
UNDECIDED / DON'T KNOW 8 (SKIP TO 514)
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?
NUMBER_________
OTHER (SPECIFY)_______ 96 (SKIP TO 601)
b) If you could choose exactly the number of children to have in your whole life, how many would that be?
NUMBER_________
OTHER (SPECIFY)_________ 96 (SKIP TO 601)
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?
NUMBER_________
OTHER (SPECIFY)________ 96 (SKIP TO 601)
b) If you could choose exactly the number of children to have in your whole life, how many would that be?
NUMBER_________
OTHER (SPECIFY)________ 96 (SKIP TO 601)
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?
NUMBER GIRLS_______
NUMBER EITHER_______
OTHER (SPECIFY)_______ 96
SECTION 6: EMPLOYMENT AND GENDER ROLES
601. Have you done any work in the last seven days?
NO 2
602. Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, or any other such reason?
NO 2
603. Have you done any work in the last 12 months?
NO 2 (SKIP TO 607)
604. What is your occupation, that is, what kind of work do you mainly do?
605. Do you usually work throughout the year, or do you work seasonally, or only once in a while?
SEASONALLY / PART OF THE YEAR 2
ONCE IN A WHILE 3
606. Are you paid in cash or kind for this work or are you not paid at all?
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (SKIP TO 612)
OTHER (SKIP TO 610)
609. Who usually decides how the money you earn will be used: you, your (wife / partner), or you and your (wife / partner) jointly?
WIFE / PARTNER 2
RESPONDENT AND WIFE / PARTNER JOINTLY 3
OTHER (SPECIFY)________ 6
610. Who usually makes decisions about health care for yourself: you, your (wife / partner), you and your (wife / partner) jointly, or someone else?
WIFE / PARTNER 2
RESPONDENT AND WIFE / PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6
611. Who usually makes decisions about making major household purchases?
WIFE / PARTNER 2
RESPONDENT AND WIFE / PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6
611A. Who usually makes decisions about making purchases for daily household needs?
WIFE / PARTNER 2
RESPONDENT AND WIFE / PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 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 (SKIP TO 615)
613. Do you have a title deed for any house you own?
NO 2 (SKIP TO 615)
DON'T KNOW 8 (SKIP TO 615)
614. Is your name on the title deed?
NO 2
DON'T KNOW 8
615. Do you own any agricultural or non-agricultural land either alone or jointly with someone else?
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4 (SKIP TO 618)
616. Do you have a title deed for any land you own?
NO 2 (SKIP TO 618)
DON'T KNOW 8 (SKIP TO 618)
617. Is your name on the title deed?
NO 2
DON'T KNOW 8
618. 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
NO 2
DON'T KNOW 8
701. Now I would like to talk about something else. Have you ever heard of HIV or AIDS?
NO 2 (SKIP TO 727)
702. HIV is the virus that can lead to AIDS. Can people reduce their chance of getting HIV by having just one uninfected sex partner who has no other sex partners?
NO 2
DON'T KNOW 8
703. Can people get HIV from mosquito bites?
NO 2
DON'T KNOW 8
704. Can people reduce their chance of getting HIV by using a condom every time they have sex?
NO 2
DON'T KNOW 8
705. Can people get HIV by sharing food with a person who has HIV?
NO 2
DON'T KNOW 8
705A. Can people reduce their chance of getting HIV by not having sexual intercourse at all?
NO 2
DON'T KNOW 8
706. Can people get HIV because of witchcraft or other supernatural means?
NO 2
DON'T KNOW 8
707. Is it possible for a healthy-looking person to have HIV?
NO 2
DON'T KNOW 8
708. Can HIV 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 (SKIP TO 711)
710. Are there any special drugs that a doctor or a nurse can give to a woman infected with HIV 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 for HIV?
NO 2 (SKIP 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 (SKIP TO 715)
714A. Did you disclose your results to any of the following:
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
715. Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT HEALTH POST 13
STAND-ALONE HTC CENTER 14
FAMILY PLANNING CLINIC 15
MOBILE HTC SERVICES 16
OTHER PUBLIC SECTOR (SPECIFY)_________ 17
PRIVATE HOSPITAL / CLINIC / PRIVATE DOCTOR 21
MISSION HOSPITAL / CLINIC 22
STAND-ALONE HTC CENTER 23
PHARMACY 24
MOBILE HTC SERVICES 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)________ 26
HOME 31
WORKPLACE 32
CORRECTIONAL FACILITY 33
OTHER (SPECIFY)_________ 96
ALL SKIP TO 718.
716. Do you know of a place where people can go to get an HIV test?
NO 2 (SKIP TO 718)
717. Where is that? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
STAND-ALONE HTC CENTER D
FAMILY PLANNING CLINIC E
MOBILE HTC SERVICES F
OTHER PUBLIC SECTOR (SPECIFY)________ G
PRIVATE HOSPITAL / CLINIC / PRIVATE DOCTOR H
MISSION HOSPITAL / CLINIC I
STAND-ALONE HTC CENTER J
PHARMACY K
MOBILE HTC SERVICES L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)__________ M
OTHER (SPECIFY)_________ X
718. Have you heard of test kits people can use to test themselves for HIV?
NO 2 (SKIP TO 720)
719. Have you ever tested yourself for HIV using a self-test kit?
NO 2
720. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?
NO 2
DON'T KNOW / NOT SURE / DEPENDS 8
721. Do you think children living with HIV should be allowed to attend school with children who do not have HIV?
NO 2
DON'T KNOW / NOT SURE / DEPENDS 8
722. Do you think people hesitate to take an HIV test because they are afraid of how other people will react if the test result is positive for HIV?
NO 2
DON'T KNOW / NOT SURE / DEPENDS 8
723. Do people talk badly about people living with HIV, or who are thought to be living with HIV?
NO 2
DON'T KNOW / NOT SURE / DEPENDS 8
724. Do people living with HIV, or thought to be living with HIV, lose the respect of other people?
NO 2
DON'T KNOW / NOT SURE / DEPENDS 8
725. Do you agree or disagree with the following statement: I would be ashamed if someone in my family had HIV.
DISAGREE 2
DON'T KNOW / NOT SURE / DEPENDS 8
726. Do you fear that you could get HIV if you come into contact with the saliva of a person living with HIV?
NO 2
DON'T KNOW / NOT SURE / DEPENDS 8
a) Apart from HIV, have you heard about other infections that can be transmitted through sexual contact?
NO 2
b) Have you heard about infections that can be transmitted through sexual contact?
NO 2
NEVER HAD SEXUAL INTERCOURSE (SKIP TO 736)
729. CHECK 727: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?
NO (SKIP TO 731)
730. 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
731. 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
732. Sometimes men have a sore or ulcer 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 OR DOES NOT KNOW (SKIP TO 736)
734. The last time you had (PROBLEM FROM 730 / 731 / 732), did you seek any kind of advice or treatment?
NO 2 (SKIP TO 736)
735. Where did you go? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
STAND-ALONE HTC CENTER D
FAMILY PLANNING CLINIC E
MOBILE HTC SERVICES F
OTHER PUBLIC SECTOR (SPECIFY)_________G
PRIVATE HOSPITAL / CLINIC / PRIVATE DOCTOR H
MISSION HOSPITAL / CLINIC I
STAND-ALONE HTC CENTER J
PHARMACY K
MOBILE HTC SERVICES L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)________ M
SHOP N
OTHER (SPECIFY)________ X
736. 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
737. Is a wife justified in refusing to have sex with her husband when she knows he has sex with other women?
NO 2
DON'T KNOW 8
SECTION 8: OTHER HEALTH ISSUES
801. Some men are circumcised, that is, the foreskin is completely removed from the penis. Are you circumcised?
NO 2 (SKIP TO 805)
DON'T KNOW 8 (SKIP TO 805)
802. How old were you when you got circumcised?
DURING CHILDHOOD (UNDER 5 YEARS) 95
DON'T KNOW 98
803. Who performed your 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
804A. Why were you circumcised?
RECORD ALL MENTIONED.
TREATMENT FOR DISEASE B
HYGIENE C
PREVENTION FROM A DISEASE D
INCREASE SEXUAL PLEASURE E
OTHER (SPECIFY)________ X
DON'T KNOW Z
805. Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (SKIP TO 808)
806. Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or 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.
NONE 00 (SKIP TO 808)
807. The last time you got an injection from a health worker, did he / she take the syringe and needle from a new, unopened package?
NO 2
DON'T KNOW 8
808. Do you currently smoke tobacco every day, some days, or not at all?
SOME DAYS 2
NOT AT ALL 3 (SKIP TO 810)
809. In the past, have you smoked tobacco every day?
NO 2 (SKIP TO 812)
810. In the past, have you ever smoked tobacco every day, some days, or not at all?
SOME DAYS 2 (SKIP TO 813)
NOT AT ALL 3 (SKIP TO 813)
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'.
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'.
813. Do you currently use smokeless tobacco every day, some days, or not at all?
SOME DAYS 2 (SKIP TO 815)
NOT AT ALL 3 (SKIP TO 816)
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'.
815. 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'.
816. Are you covered by any health insurance or health scheme?
NO 2 (SKIP TO 818)
817. What type of health insurance or health scheme are you covered by?
RECORD ALL MENTIONED.
HEALTH INSURANCE THROUGH EMPLOYER B
SOCIAL SECURITY C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
OTHER (SPECIFY)________ X
817A. Have you ever undergone a surgical operation in the past 5 years?
NO 2 (SKIP TO 817D)
817B. What type of operation was the most recent one?
HYDROCELE OPERATION 2
LAPAROTOMY (cutting open the abdomen) 3
LUMP REMOVAL 4
ABSCESS DRAINAGE 5
WOUND CLOSURE 6
OPEN FRACTURE REPAIR 7
OTHER_________(specify) 8
817C. In the last 5 years has a doctor or another health care worker told you that you might need (a/another) operation?
YES 1
NO 2 (SKIP TO 818)
817D. Did you undergo the surgey?
NO 2
817E. Why you did not access it?
I COULD NOT AFFORD THE OPERATION B
I COULD NOT AFFORD TO GET TO THE HOSPITAL C
I COULD NOT AFFORD THE TIME OFF WORK D
IT WAS TOO FAR TO GET TO THE HOSPITAL E
I DID NOT TRUST THE OPERATION WOULD MAKE ME BETTER F
FEAR OF CARE G
OUT OF SHAME H
MY SPOUSE / FAMILY WOULD NOT LET ME I
OTHER___________ (specify) X
MINUTES________
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