1999 ZIMBABWE DEMOGRAPHIC AND HEALTH SURVEY
NAME OF HOUSEHOLD HEAD __________
WARD NAME __________
CLUSTER NUMBER ___
HOUSEHOLD NUMBER ___
PROVINCE ___
RURAL 2
LARGE CITY/SMALL CITY/TOWN/RURAL
SMALL CITY 2
TOWN 3
RURAL 4
VISIT 1
DATE _____
INTERVIEWER'S NAME __________
RESULT * __________
NEXT VISIT
DATE _____
TIME _____
VISIT 2
DATE _____
INTERVIEWER'S NAME __________
RESULT * __________
NEXT VISIT
DATE _____
TIME _____
VISIT 3
DATE _____
INTERVIEWER'S NAME __________
RESULT * __________
FINAL VISIT
DAY ___
MONTH __________
YEAR _____
NAME __________
RESULT * __________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) __________ 7
LANGUAGE OF QUESTIONNAIRE: ENGLISH 3
NDEBELE 2
ENGLISH 3
OTHER 4
SUPERVISOR
NAME __________
DATE _____
FIELD EDITOR
NAME __________
DATE _____
OFFICE EDITOR ___
KEYED BY ___
SECTION 1. RESPONDENT'S BACKGROUND
Hello. My name is __________ and I am working with the Central Statistical Office. We are conducting a national survey about the health of women, men, and children. We would very much appreciate your participation in this survey.
I would like to ask you about your health and that of your children. This information may help the country plan health services. Whatever answers you provide will be confidential and will not be shown to other persons.
We hope you will participate in this survey since your views are important. Shall we proceed with the interview?
RESPONDENT DOES NOT AGREE 2 (END)
I HAVE READ THE ABOVE STATEMENT TO THE RESPONDENT AND HE HAS AGREED TO BE INTERVIEWED.
SIGNATURE OF INTERVIEWER __________
MINUTES ___
102) First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a city, in a town, on a commercial farm or in another rural area?
TOWN 2
COMMERCIAL FARM 3
OTHER RURAL 4
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 (SKIP TO 105)
VISITOR 96 (SKIP TO 105)
104) Just before you moved here, did you live in a city, in a town, on a commercial farm or in another rural area?
TOWN 2
COMMERCIAL FARM 3
OTHER RURAL 4
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?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.
107) Have you ever attended school?
NO 2 (SKIP TO 114)
108) What is the highest level of school you attended: primary, secondary, or higher?
SECONDARY 2
HIGHER 3
109) What is the highest (grade/form/year) you completed at that level?
SECONDARY OR HIGHER ___ (SKIP TO 115)
114) Can you read and understand a letter or newspaper easily, with difficulty, or not at all?
WITH DIFFICULTY 2
NOT AT ALL 3 (SKIP TO 116)
115) 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
116) 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
117) 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
CHRISTIAN 2
MUSLIM 3
NONE 4
OTHER (SPECIFY) __________ 6
120) Have you ever drank an alcohol-containing beverage?
NO 2 (SKIP TO 123)
121) In the last 30 days, on how many days did you drink an alcohol-containing beverage?
NONE/NEVER 97 (SKIP TO 123)
122) In the last 30 days, on how many occasions did you get "drunk"?
NONE/NEVER 97
123) In the last 3 months, have you had any kind of injection?
NO 2 (SKIP TO 126)
124) In the last 3 months, how many times did you have an injection?
EVERY DAY 98
124A) What was the injection for?
RECORD ALL RESPONSES.
OTHER B
125) The last time you had an injection, who was the person who gave you the injection?
PHARMACIST 2
TRADITIONAL HEALER 3
FRIEND/RELATIVE 4
SELF 5
OTHER (SPECIFY) __________ 6
126) Are you currently working?
NO 2 (SKIP TO 201)
127) What is your occupation, that is, what kind of work do you mainly do?
201) Now I would like to ask about your children. I am interested only in the children that are biologically yours. Have you ever had children?
NO 2 (SKIP TO 206)
202) Do you have any sons or daughters who are now living with you?
NO 2 (SKIP 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 who are alive but do not live with you?
NO 2 (SKIP 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 had a boy or girl 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 (SKIP 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 TOAL.
IF NONE, RECORD '00'.
209) CHECK 208:
Just to make sure that I have this right: you have had in TOTAL ___ children during your life. Is that correct?
NO ___ (PROBE AND CORRECT 201-208 AS NECESSARY)
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 303.
301) Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?
01 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
NO 2 (SKIP TO NEXT METHOD)
02 MALE STERILIZATION Men can have an operation to avoid having any more children.
NO 2 (SKIP TO NEXT METHOD)
03 PILL Women can take a pill every day.
NO 2 (SKIP TO NEXT METHOD)
04 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
NO 2 (SKIP TO NEXT METHOD)
05 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
NO 2 (SKIP TO NEXT METHOD)
06 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
NO 2 (SKIP TO NEXT METHOD)
07 CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
NO 2 (SKIP TO NEXT METHOD)
08 FEMALE CONDOM Women can place a rubber sheath in their vagina before sexual intercourse.
NO 2 (SKIP TO NEXT METHOD)
09 DIAPHRAGM Women can place a diaphragm in their vagina before intercourse.
NO 2 (SKIP TO NEXT METHOD)
10 FOAM OR JELLY Women can place a suppository, jelly, or cream in their vagina before intercourse.
NO 2 (SKIP TO NEXT METHOD)
11 LACTATIONAL AMENORRHEA METHOD (LAM) Women can use a specially taught method of pregnancy avoidance to delay the return of the menstrual period by feeding their child nothing but breast milk for up to six months after a birth.
NO 2 (SKIP TO NEXT METHOD)
12 RHYTHM OR PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant.
NO 2 (SKIP TO NEXT METHOD)
13 WITHDRAWAL Men can be careful and pull out before climax.
NO 2 (SKIP TO NEXT METHOD)
14 EMERGENCY CONTRACEPTION Women can take pills the day after sexual intercourse to avoid becoming pregnant.
NO 2 (SKIP TO NEXT METHOD)
15 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
(SPECIFY) __________
303) Have you ever used (METHOD)?
01 FEMALE STERILIZATION Have you ever had a partner who had an operation to avoid having any more children?
NO 2
02 MALE STERILIZATION Have you ever had an operation to avoid having children?
NO 2
03 PILL Women can take a pill every day.
NO 2
04 IUD Women can have a loop or coil placed inside them by a doctor or nurse.
NO 2
05 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
NO 2
06 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
NO 2
07 CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
NO 2
08 FEMALE CONDOM Women can place a rubber sheath in their vagina before sexual intercourse.
NO 2
09 DIAPHRAGM Women can place a diaphragm in their vagina before intercourse.
NO 2
10 FOAM OR JELLY Women can place a suppository, jelly, or cream in their vagina before intercourse.
NO 2
11 LACTATIONAL AMENORRHEA METHOD (LAM) Women can use a specially taught method of pregnancy avoidance to delay the return of the menstrual period by feeding their child nothing but breast milk for up to six months after a birth.
NO 2
12 RHYTHM OR PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant.
NO 2
13 WITHDRAWAL Men can be careful and pull out before climax.
NO 2
14 EMERGENCY CONTRACEPTION Women can take pills the day after sexual intercourse to avoid becoming pregnant.
NO 2
15 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
(SPECIFY) __________
AT LEAST ONE "YES" (EVER USED) ___ (SKIP TO 313)
305) Have you or any of your partners ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2 (SKIP TO 334)
307) What have you used or done?
CORRECT 303 AND 304 (AND 301 IF NECESSARY).
313) Are you or any of your partners currently doing something or using any method to delay or avoid getting pregnant?
NO 2 (SKIP TO 334)
314) Which method are you using?
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD.
MALE STERILIZATION B
PILL C (SKIP TO 334)
IUD D (SKIP TO 334)
INJECTIONS E (SKIP TO 334)
IMPLANTS F (SKIP TO 334)
CONDOM G (SKIP TO 334)
FEMALE CONDOM H (SKIP TO 334)
DIAPHRAGM I (SKIP TO 334)
FOAM/JELLY J (SKIP TO 334)
LACTATIONAL AMENORRHEA METHOD K (SKIP TO 334)
PERIODIC ABSTINENCE L (SKIP TO 334)
WITHDRAWAL M (SKIP TO 334)
OTHER (SPECIFY) __________ X (SKIP TO 334)
318) Where did the sterilization take place?
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 __________
PROVINCIAL HOSPITAL 12
DISTRICT/RURAL HOSPITAL 13
OTHER PUBLIC (SPECIFY) __________ 16
PRIVATE DOCTOR 32
OTHER PRIVATE MEDICAL (SPECIFY) __________ 36
DON'T KNOW 98
318A) Before the sterilization operation, were (you/your wife/your partner) told that you would not be able to have any (more) children?
NO 2
321) In what month and year was the sterilization performed?
YEAR _____
334) In the last 12 months, were you visited by a CBD who talked to you about family planning?
NO 2
335) In the last 12 months, have you attended a health facility for care for yourself (or your children)?
NO 2 (SKIP TO 401)
336) Did any staff member at the health facility speak to you about family planning methods?
NO 2
SECTION 4. MARRIAGE AND SEXUAL ACTIVITY
401) Are you currently married or living with a woman?
YES, LIVING WITH A WOMAN 2 (SKIP TO 403)
NO, NOT IN UNION 3 (SKIP TO 405)
402) How many wives do you have?
403) How many (other) women are you living with as if you were married?
RECORD '00' IF THE RESPONSE IS "NONE"
404) WRITE THE NAMES AND LINE NUMBERS FROM THE HOUSEHOLD QUESTIONNAIRE FOR HIS WIFE OR WIVES.
IF A WIFE DOES NOT LIVE IN THE HOUSEHOLD, WRITE '00' IN THE LINE NUMBER BOX.
THE NUMBER OF BOXES FILLED MUST BE EQUAL TO THE NUMBER OF WIVES.
IF THE SUM OF 402 AND 403 IS '01'
Please tell me the name of your wife/partner
IF THE SUM OF 402 AND 403 IS '02' OR MORE
Please tell me the names of all your wives and live-in partners
405) Do you currently have a regular sexual partner, an occasional sexual partner, or no sexual partner at all?
OCCASIONAL SEXUAL PARTNER 2
NO SEXUAL PARTNER 3
406) Have you ever been married or lived with a woman?
YES, LIVED WITH A WOMAN 2 (SKIP TO 408)
NO 3 (SKIP TO 411)
407) What is your marital status now: are you widowed, divorced or separated?
DIVORCED 2
SEPARATED 3
408) Have you been married or lived with a woman only once, or more than once?
MORE THAN ONCE 2
MARRIED/LIVED WITH A WOMAN ONLY ONCE ___
In what month and year did you start living with your wife/partner?
MARRIED/LIVED WITH A WOMAN MORE THAN ONCE ___
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
YEAR _____ (SKIP TO 411)
DON'T KNOW YEAR 9998
410) How old were you when you started living with her?
411) Now I need to ask you some questions about sexual history in order to gain a better understanding of some family life issues. How old were you when you first had sexual intercourse (if ever)?
AGE ___
FIRST TIME WHEN MARRIED 96
412) When was the last time you had sexual intercourse?
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___ (SKIP TO 434)
DO NOT REMEMBER 998
413) The last time you had sexual intercourse, did you use a condom?
NO 2 (SKIP TO 417)
414) What was the main reason you used a condom on that occasion?
OWN CONCERN TO PREVENT A PREGNANCY 2
OWN CONCERN TO PREVENT BOTH STD/HIV AND PREGNANCY 3
DID NOT TRUST PARTNER/FEELS SHE HAS OTHER PARTNERS 4
PARTNER INSISTED 5
OTHER (SPECIFY) __________ 6
DON'T KNOW 8
417) What is your relationship to the woman with whom you last had sex?
IF "BOYFRIEND OR FIANCE", ASK "the last time you had sex with this partner, were you living with her?"
IF "YES", RECORD '1'
IF "NO", RECORD '2'
BOYFRIEND/FIANCE 2
FRIEND/ACQUAINTANCE 3
RELATIVE 4
CUSTOMER (FOR SEX) 5
OTHER (SPECIFY) __________ 8
418) How long have you had a sexual relationship with the woman you last had sex with?
WEEKS 2 ___
MONTHS 3 ___
YEARS 4 ___
419) Have you had sex with anyone else in the last 12 months?
NO 2 (SKIP TO 434)
420) The last time you had sexual intercourse with another woman, did you use a condom?
NO 2 (SKIP TO 424)
421) What was the main reason you used a condom on that occasion?
OWN CONCERN TO PREVENT A PREGNANCY 2
OWN CONCERN TO PREVENT BOTH STD/HIV AND PREGNANCY 3
DID NOT TRUST PARTNER/FEELS SHE HAS OTHER PARTNERS 4
PARTNER INSISTED 5
OTHER (SPECIFY) __________ 6
DON'T KNOW 8
424) What is your relationship to this woman?
IF "BOYFRIEND OR FIANCE", ASK "the last time you had sex with this partner, were you living with her?"
IF "YES", RECORD '1'
IF "NO", RECORD '2'
BOYFRIEND/FIANCE 2
FRIEND/ACQUAINTANCE 3
RELATIVE 4
CUSTOMER (FOR SEX) 5
OTHER (SPECIFY) __________ 8
425) How long have you maintained a sexual relationship with this woman?
WEEKS 2 ___
MONTHS 3 ___
YEARS 4 ___
426) Other than these two women, have you had sex with anyone else in the last 12 months?
NO 2 (SKIP TO 434)
427) The last time you had sexual intercourse with this other woman, did you use a condom?
NO 2 (SKIP TO 431)
DOES NOT KNOW CONDOMS 3 (SKIP TO 431)
428) What was the main reason you used a condom on that occasion?
OWN CONCERN TO PREVENT A PREGNANCY 2
OWN CONCERN TO PREVENT BOTH STD/HIV AND PREGNANCY 3
DID NOT TRUST PARTNER/FEELS SHE HAS OTHER PARTNERS 4
PARTNER INSISTED 5
OTHER (SPECIFY) __________ 6
DON'T KNOW 8
431) What is your relationship to this woman?
IF "BOYFRIEND OR FIANCE", ASK "the last time you had sex with this partner, were you living with her?"
IF "YES", RECORD '1'
IF "NO", RECORD '2'
BOYFRIEND/FIANCE 2
FRIEND/ACQUAINTANCE 3
RELATIVE 4
CUSTOMER (FOR SEX) 5
OTHER (SPECIFY) __________ 8
432) How long have you maintained a sexual relationship with this woman?
WEEKS 2 ___
MONTHS 3 ___
YEARS 4 ___
DOES NOT REMEMBER 998
433) Altogether, with how many different women have you had sex in the last 12 months?
434) Have you ever paid for sex?
NO 2 (SKIP TO 437)
435) How long ago was the last time you paid for sex?
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___
DOES NOT REMEMBER 998
436) The last time that you paid for sex, did you use a condom?
NO 2
437) Do you know of a place where one can get condoms?
NO 2 (SKIP TO 440)
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 __________
RURAL/MUNICIPAL CLINIC 12
RURAL HEALTH CENTER 13
ZNFPC FIXED CLINIC 14
ZNFPC MOBILE CLINIC 15
MOH MOBLIE CLINIC 16
ZNFPC CBD 17
MOH CBD 18
OTHER PUBLIC (SPECIFY) __________ 19
PHARMACY 32
PRIVATE DOCTOR 33
CBD 34
OTHER PRIVATE MEDICAL (SPECIFY) __________ 36
CHURCH 42
FRIENDS/RELATIVES 43
439) If you wanted to, could you yourself easily get a condom?
NO 2
DON'T KNOW/UNSURE 8
440) Do you know of a place where one can get female condoms?
NO 2 (SKIP TO 501)
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 __________
RURAL/MUNICIPAL CLINIC 12
RURAL HEALTH CENTER 13
ZNFPC FIXED CLINIC 14
ZNFPC MOBILE CLINIC 15
MOH MOBLIE CLINIC 16
ZNFPC CBD 17
MOH CBD 18
OTHER PUBLIC (SPECIFY) __________ 19
PHARMACY 32
PRIVATE DOCTOR 33
CBD 34
OTHER PRIVATE MEDICAL (SPECIFY) __________ 36
CHURCH 42
FRIENDS/RELATIVES 43
442) If you wanted to, could you yourself easily get a female condom?
NO 2
DON'T KNOW/UNSURE 8
SECTION 5. FERTILITY PREFERENCES
CURRENTLY MARRIED OR LIVING WITH A WOMAN ___ (SKIP TO 503A)
HAS ONLY AN OCCASIONAL SEXUAL PARTNER OR NO SEXUAL PARTNER ___ (SKIP TO 505A)
A. HAS A WIFE OR LIVING WITH WOMAN ___
Are any of your wives/any of the women you are living with currently pregnant? ___
B. HAS A REGULAR SEXUAL PARTNER ___
Is one of your regular partners currently pregnant? ___
NO 2 (SKIP TO 505A)
DO NOT KNOW/UNSURE 8 (SKIP TO 505A)
504) When she became pregnant, did you want her to become pregnant then, did you want her to have a child but wanted to wait or did you not want her to have a child at all?
WANTED TO WAIT 2 (SKIP TO 505B)
NOT AT ALL 3 (SKIP TO 505B)
A. WIFE/PARTNER NOT PREGNANT OR UNSURE, OR HAS NO WIFE/PARTNER ___
B. WIFE/PARTNER PREGNANT ___
NO MORE/NONE 2 (SKIP TO 505B)
SAYS WIFE CAN'T GET PREGNANT 3 (SKIP TO 505B)
SAYS HE CAN'T HAVE ANY MORE 4 (SKIP TO 505B)
UNDECIDED/DON'T KNOW 8 (SKIP TO 505B)
WIFE/PARTNER NOT PREGNANT OR UNSURE, OR HAS NO WIFE/PARTNER ___
How long would you like to wait to have another child?
YEARS 2 ___
SOON/NOW 993
SAYS WIFE CAN'T GET PREGNANT 994
AFTER MARRIAGE 995
OTHER (SPECIFY) __________ 996
DON'T KNOW 998
WIFE/PARTNER PREGNANT ___
YEARS 2 __ __
SOON/NOW 993
SAYS WIFE CAN'T GET PREGNANT 994
AFTER MARRIAGE 995
OTHER(SPECIFY) ________ 996
DON'T KNOW 998
507) CHECK 314: USING A METHOD
NOT USING CURRENTLY ___
CURRENTLY USING ___ (SKIP TO 512)
508) Do you think you will use a method to avoid pregnancies within the next 12 months?
NO 2
DON'T KNOW 8
509) Do you think you will use a method to avoid pregnancies at any time in the future?
NO 2 (SKIP TO 511)
DON'T KNOW 8 (SKIP TO 511)
510) Which method would you prefer to use?
MALE STERILIZATION 02 (SKIP TO 512)
PILL 03 (SKIP TO 512)
IUD 04 (SKIP TO 512)
INJECTIONS 05 (SKIP TO 512)
IMPLANTS 06 (SKIP TO 512)
CONDOM 07 (SKIP TO 512)
FEMALE CONDOM 08 (SKIP TO 512)
DIAPHRAGM/FOAM/JELLY 09 (SKIP TO 512)
LACTATIONAL AMENORRHEA 10 (SKIP TO 512)
RHYTHM/PERIODIC ABSTINENCE 11 (SKIP TO 512)
WITHDRAWAL 12 (SKIP TO 512)
OTHER (SPECIFY) __________ 96 (SKIP TO 512)
UNDECIDED 98 (SKIP TO 512)
511) What is the main reason that you think you will never use a method?
WIFE MENOPAUSAL/HYSTERECTOMY 23
WIFE SUBFECUND/INFECUND 24
DESIRE MORE CHILDREN 26
WIFE OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
KNOWS NO SOURCE 42
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 ___
NO LIVING CHILDREN ___
PROBE FOR A NUMERIC RESPONSE.
OTHER (SPECIFY) __________ 96
513) Would you say that you approve or disapprove of couples using a method to avoid getting pregnant?
DISAPPROVE 2
NO OPINION 3
514) Is it acceptable or not acceptable to you for information on family planning to be provided on the radio?
NOT ACCEPTABLE 2
NO OPINION 8
515) Is it acceptable or not acceptable to you for information on family planning to be provided on the television?
NOT ACCEPTABLE 2
NO OPINION 8
516) In the last few months have you heard about family planning:
On the radio?
NO 2
On the television?
NO 2
In a newspaper or magazine?
NO 2
??) In the last few months have you discussed the practice of family planning with your friends, neighbors, or relatives?
NO 2 (SKIP TO 520)
ERR) With whom?
Anyone else?
RECORD ALL MENTIONED.
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
SON G
MOTHER/FATHER-IN-LAW H
FRIENDS/NEIGHBOURS I
OTHER (SPECIFY) __________ X
LIVING WITH A WOMAN ___
NOT IN UNION ___ (SKIP TO 601)
ERR) Husbands and wives do not always agree on everything. Now I want to ask you about your wife's/partner's views on family planning.
Do you think that your wife/partner approves or disapproves of couples using a method to avoid pregnancy?
DISAPPROVES 2
DON'T KNOW 8
ERR) How often have you talked to your wife/partner about family planning in the past year?
ONCE OR TWICE 2
MORE OFTEN 3
ERR) Do you think your wife/partner wants the same number of children that you want, or does she want more or fewer than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8
524) 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 when:
She is tired or not in the mood?
NO 2
DON'T KNOW 8
She has recently given birth?
NO 2
DON'T KNOW 8
She knows he has sex with women other than his wife (wives)?
NO 2
DON'T KNOW 8
She knows he has the AIDS virus?
NO 2
DON'T KNOW 8
SECTION 6: AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES
601) Now I would like to talk about something else.
Have you ever heard of an illness called AIDS?
NO 2 (SKIP TO 616)
602) Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?
NO 2 (SKIP TO 610)
DON'T KNOW 8 (SKIP TO 610)
603) What can a person do?
Anything else?
RECORD ALL 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 DURGS INTRAVEN. H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID KISSING K
AVOID MOSQUITO BITES L
SEEK PROTECTION FROM TRADITIONAL HEALER M
AVOID SHARING RAZOR BLADES N
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
DON'T KNOW Z
CODE 'C' AND/OR CODE 'D' CIRCLED ___ (SKIP TO 607)
605) In your view, is a person's chance of getting AIDS influenced by the number of partners he or she has?
NO 2 (SKIP TO 607)
DON'T KNOW 8 (SKIP TO 607)
606) If a person has sex with only one partner, does this person have a greater or a lesser chance of getting AIDS than a person who has sex with many partners?
LESSER CHANCE OF AIDS 2
MENTIONED USE OF A CONDOM DURING SEX (CODE 'B' CIRCLED) ___ (GO TO 610)
608) In your view, is a person's chance of getting AIDS affected by using a condom every time he or she has sexual intercourse?
NO 2 (SKIP TO 610)
UNSURE/DON'T KNOW 8 (SKIP TO 610)
609) If a person uses a condom every time he or she is engaged in sexual intercourse, does this person have a greater or a lesser chance of getting the AIDS virus than someone who doesn't use a condom?
LESSER CHANCE OF AIDS 2
610) Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DON'T KNOW 8
611) Do you know someone personally who has the virus that causes AIDS or someone who died from AIDS?
NO 2
612) Can the virus that causes AIDS be transmitted from a mother to a child?
NO 2 (SKIP TO 613)
DON'T KNOW 8 (SKIP TO 613)
612A) When can the virus that causes AIDS be transmitted from a mother to a child?
Any other times?
RECORD ALL RESPONSES
AT DELIVERY B
DURING BREASTFEEDING C
OTHER TIMES D
DON'T KNOW Z
NOT CURRENTLY MARRIED/NOT LIVING WITH A WOMAN ___ (SKIP TO 614A)
614) Have you ever talked about ways to prevent getting the virus that causes AIDS with (your wife/the woman you are living with)?
NO 2
614A) In your opinion, is it acceptable or unacceptable for AIDS to be discussed:
On the radio?
UNACCEPTABLE 2
On the TV?
UNACCEPTABLE 2
In newspapers?
UNACCEPTABLE 2
615A) 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/NOT SURE 8
615B) If a relative of yours 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/NOT SURE/DEPENDS 8
615C) Should persons with the AIDS virus who work with other persons such as in a shop, office, or farm be allowed to continue their work or not?
SHOULD NOT CONTINUE WORK 2
DON'T KNOW/NOT SURE/DEPENDS 8
615D) Should children aged 12-14 be taught about using a condom to avoid AIDS?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
615E) Have you ever been tested to see if you have the AIDS virus?
NO 2
615F) Would you want to be tested for the AIDS virus?
NO 2
DON'T KNOW/UNSURE 3
615G) Do you know a place where you could go to get an AIDS test?
NO 2 (SKIP TO 616)
615H) Where can you go for the test?
615HX) Where did you go for the test?
Any other places?
RECORD ALL MENTIONED.
PROVINCIAL HOSPITAL B
DISTRICT HOSPITAL C
RURAL HEALTH CENTRE D
RURAL/MUNICIPAL CLINIC E
OTHER PUBLIC (SPECIFY) __________ G
PRIVATE DOCTOR J
OTHER PRIVATE MEDICAL (SPECIFY) __________ K
616) (Apart from AIDS), have you heard about (other) infections that can be transmitted through sexual contact?
NO 2 (SKIP TO 630)
617) In a man, what signs and symptoms would lead you to think that he has such an infection?
Any others?
RECORD ALL MENTIONED.
GENITAL DISCHARGE/DRIPPING 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
BLOOD IN URINE I
LOSS OF WEIGHT J
IMPOTENCE/STERILITY K
NO SIGNS/SYMPTOMS L
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
DON'T KNOW Z
618) In a woman, what signs and symptoms would lead you to think that she has such an infection?
Any others?
RECORD ALL MENTIONED.
GENITAL DISCHARGE/DRIPPING 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
BLOOD IN URINE I
LOSS OF WEIGHT J
INFERTILITY/STERILITY K
NO SIGNS/SYMPTOMS L
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
DON'T KNOW Z
HAS NOT HAD SEXUAL INTERCOURSE ___ (SKIP TO 630)
620) Now, I would like to ask some questions about your health in the last 12 months.
During the last 12 months, have you had a sexually-transmitted infection?
NO 2
DON'T KNOW 8
620A) 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
620B) Sometimes men experience 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
DID NOT HAVE STI ___ (SKIP TO 630)
625) The last time you had (INFECTION FROM 620/620A/620B), did you seek advice or treatment?
NO 2 (SKIP TO 627)
626) Where did you seek advice or treatment?
Any other places?
RECORD ALL RESPONSES.
PROVINCIAL HOSPITAL B
DISTRICT HOSPITAL C
RURAL HEALTH CENTRE D
RURAL/MUNICIPAL CLINIC E
VILLAGE COMMUNITY WORKER F
OTHER PUBLIC (SPECIFY) __________ G
PHARMACY J
PRIVATE DOCTOR K
VILLAGE COMMUNITY WORKER L
OTHER PRIVATE MEDICAL (SPECIFY) __________ M
RELATIVE/FRIENDS O
TRADITIONAL HEALER P
627) When you had (INFECTION FROM 620/620A/620B), did you inform the persons with whom you have been having sex?
NO 2
SOME/NOT ALL 3
628) When you had (INFECTION FROM 620/620A/620B) did you do something to avoid infecting your sexual partner(s)?
NO 2 (SKIP TO 630)
PARTNER ALREADY INFECTED 3 (SKIP TO 630)
629) What did you do?
Anything else?
RECORD ALL RESPONSES.
USED CONDOMS B
TOOK MEDICINES C
OTHER (SPECIFY) __________ X
MINUTES ___
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT RESPONDENT:
COMMENTS ON SPECIFIC QUESTIONS:
ANY OTHER COMMENTS:
NAME OF THE SUPERVISOR: __________
DATE: _____
NAME OF EDITOR: __________
DATE: _____