ZIMBABWE
PLACE NAME:
NAME OF HOUSEHOLD HEAD:
CLUSTER NUMBER:
HOUSEHOLD NUMBER:
NAME AND LINE NUMBER OF MAN:
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
FINAL VISIT
DAY ___
MONTH ___
YEAR ___
INTERVIEWER'S NUMBER
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
TOTAL NUMBER OF VISITS
NDEBELE 02
SHONA 03
LANGUAGE OF INTERVIEW
NDEBELE 02
SHONA 03
TRANSLATOR USED?
NO 2
OFFICE EDITOR
NAME
NUMBER
KEYED BY
NAME
NUMBER
Hello. My name is ___. I am working with the Central Statistical Office/ZIMSTAT, in collaboration with the Ministry of Health. We are conducting a survey about health and other topics all over Zimbabwe. The information we collect will help the government to plan health services. Your household was randomly 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. Participation in the survey is completely voluntary. It's up to you if you want 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?
SIGNATURE OF INTERVIEWER ___
DATE ___
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (GO TO END)
MINUTES ___
102. How long have you been living continuously in (NAME OF CURRENT CITY, TOWN OR VILLAGE OF RESIDENCE)?
IF LESS THAN ONE YEAR, RECORD '00'.
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)
103. Just before you moved here, did you live in an urban or rural area?
RURAL AREA 2
104. Before you moved here, which province did you live in?
HARARE 09
MANICALAND 01
MASHONALAND CENTRAL 02
MASHONALAND EAST 03
MASVINGO 08
MATABELELAND NORTH 05
MATABELELAND SOUTH 06
MIDLANDS 07
OUTSIDE OF ZIMBABWE 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?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.
107. Have you ever attended school?
NO 2 (GO 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/FORM/YEAR) you completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.
HIGHER (GO 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 (GO TO 114)
113. Do you read a newspaper or magazine at least once a week, less than once a week or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
114. Do you listen to the radio at least once a week, less than once a week, or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
115. Do you watch television at least once a week, less than once a week or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
116. Do you own a mobile telephone?
NO 2 (GO 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
120. In the last 12 months, have you used the internet?
IF NECESSARY, PROBE FOR USE FORM ANY LOCATION, WITH ANY DEVICE.
NO 2 (GO TO 122)
121. During the last once 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
ROMAN CATHOLIC 2
PROTESTANT 3
PENTECOSTAL 4
APOSTOLIC SECT 5
OTHER CHRISTIAN 6
MUSLIM 7
NONE 8
OTHER (SPECIFY) 96
124. In the last 12 months, how many times have you been away from home for one or more nights?
NONE 00 (GO TO 201)
125. 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 currently 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, 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 (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 211)
HAS NOT HAD ANY CHILDREN (GO TO 301)
210. Did all of the children you have fathered have the same biological mother?
NO 2
HAS HAD MORE THAN ONE CHILD: How old were you when your first child was born?
HAS HAD ONLY ONE CHILD: How old were you when your child was born?
NO LIVING CHILDREN (GO TO 301)
MORE THAN ONE LIVING CHILD: How old is your youngest child?
ONLY ONE LIVING CHILD: How old is your child?
(YOUNGEST) CHILD IS AGE 3 YEARS OR OLDER (GO TO 301)
MORE THAN ONE LIVING CHILD: What is the name of your youngest child?
ONLY ONE LIVING CHILD: 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 (GO TO 218)
DON'T KNOW 8 (GO 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. Have you ever heard of (METHOD)?
NO 2
NO 2
prevent pregnancy for one or more years.
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
YES, TRADITIONAL METHOD (SPECIFY) 2
NO 3
302. In the last few months have you:
NO 2
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. After the birth of a child, can a woman become pregnant before her menstrual period has returned?
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
307A. CHECK 301 (07): KNOWS MALE CONDOM
NO (GO TO 307E)
307B. Do you know of a place where a person can get condoms?
NO 2 (GO TO 307E)
307C. Where is that? Any other place?
PROBE TO IDENTIFY TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
RURAL HEALTH CENTER B
MUNICIPAL CLINIC C
ZNFPC CLINIC D
ZNFPC CBD/DEPOT HOLDER E
VILLAGE HEALTH WORKER F
MOHCC MOBILE CLINIC G
OTHER PUBLIC SECTOR (SPECIFY) H
PHARMACY K
PRIVATE DOCTOR L
CBD M
PRIVATE OUTREACH CLINIC N
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) O
SUPERMARKET/TUCK SHOP Q
SERVICE STATION R
BOTTLE STORE/BAR S
FRIEND/RELATIVE U
PUBLIC TOILET V
STREET VENDOR W
WORKPLACE X
307D. If you wanted to, could you yourself get a condom?
NO 2
DON'T KNOW 8
307E. CHECK 301 (08): KNOWS FEMALE CONDOM
NO (GO TO 401)
307F. Do you know of a place where a person can get female condoms?
NO 2 (GO TO 401)
307G. Where is that? Any other place?
PROBE TO IDENTIFY TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
RURAL HEALTH CENTER B
MUNICIPAL CLINIC C
ZNFPC CLINIC D
ZNFPC CBD/DEPOT HOLDER E
VILLAGE HEALTH WORKER F
MOHCC MOBILE CLINIC G
OTHER PUBLIC SECTOR (SPECIFY) H
PHARMACY K
PRIVATE DOCTOR L
CBD M
PRIVATE OUTREACH CLINIC N
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) O
SUPERMARKET/TUCK SHOP Q
SERVICE STATION R
BOTTLE STORE/BAR S
FRIEND/RELATIVE U
PUBLIC TOILET V
STREET VENDOR W
WORKPLACE X
307H. If you wanted to, could you yourself get a female condom?
NO 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 2 (GO 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 (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 WIFE) 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 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 411)
410. Have you been married or lived with a woman only once or more than once?
ONLY ONCE 2
BOTH ARE CODE '2': In what month and year did you start living with you (wife/partner)?
OTHER: 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 PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVER 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 questions that you don't want to answer, just let me know and we will go to the next questions. How old were you when you had sexual intercourse for the very first time?
AGE IN YEARS ___
415. Now 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 RECORD IN YEARS.
WEEKS AGO 2 ___ (GO TO 418)
MONTHS AGO 3 ___ (GO TO 418)
YEARS AGO 4 ___ (GO TO 428)
416. When was the last time you had sexual intercourse with this person?
WEEKS AGO 2 ___
MONTHS AGO 3 ___
417. The last time you had sexual intercourse with this person, was a condom used?
NO 2 (GO 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'.
LIVE-IN PARTNER 2
GIRLFRIEND NOT LIVING WITH RESPONDENT 3
CASUAL ACQUAINTANCE 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 (GO TO 423)
DON'T KNOW 8 (GO 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 (GO 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 (GO TO 427)
426. CHECK 420 AND 418 (ALL COLUMNS):
OTHER (GO 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 (GO TO 431)
429. The last time you paid someone in exchange for having sexual intercourse, was a condom used?
NO 2 (GO 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 418: MOST RECENT PARTNER (FIRST COLUMN)
NO CONDOM USED (GO TO 438)
NOT ASKED (GO 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.
PANTHER (PUBLIC SECTOR) 02
CAREX CHOICE ASSORTED 03
DUREX 04
VIBE 05
ECSTASY 06
CASANOVA 07
MOODS 08
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 OF THE PLACE.
RURAL HEALTH CENTRE 12
MUNICIPAL CLINIC 13
ZNFPC CLINIC 14
ZNFPC CLINIC 15
VILLAGE HEALTH WORKER 16
MOHCC MOBILE CLINIC 17
OTHER PUBLIC SECTOR (SPECIFY) 18
PHARMACY 32
PRIVATE DOCTOR 33
CBD 34
PRIVATE OUTREACH CLINIC 35
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36
SUPERMARKET/TUCK SHOP 42
SERVICE STATION 43
BOTTLE STORE/BAR 44
FRIEND/RELATIVE 52
PUBLIC TOILET 53
STREET VENDOR 54
WORKPLACE 55
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 (GO TO 440)
DON'T KNOW 8 (GO TO 440)
438. The last time you had sex did you or your partner use any method other than a condom to avoid or prevent pregnancy?
NO 2 (GO TO 440)
DON'T KNOW 8 (GO 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 (GO TO 501)
IUD C (GO TO 501)
INJECTABLES D (GO TO 501)
IMPLANTS E (GO TO 501)
PILL F (GO TO 501)
CONDOM G (GO TO 501)
FEMALE CONDOM H (GO TO 501)
EMERGENCY CONTRACEPTION I (GO TO 501)
LACTATIONAL AMENORRHEA METHOD J (GO TO 501)
RHYTHM METHOD K (GO TO 501)
WITHDRAWAL L (GO TO 501)
OTHER MODERN METHOD X (GO TO 501)
OTHER TRADITIONAL METHOD Y (GO TO 501)
440. Do you know of a place where you can obtain method of family planning?
NO 2
SECTION 5. FERTILITY PREFERENCES
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (GO TO 514)
MAN STERILIZED (GO TO 514)
MORE THAN ONE WIFE/PARTNER (GO TO 509)
504. Is your (wife/partner) currently pregnant?
NO 2 (GO TO 507)
DON'T KNOW 8 (GO 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 (GO TO 514)
UNDECIDED/DON'T KNOW 8 (GO 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 ___ (GO TO 514)
SOON/NOW 993 (GO TO 514)
OTHER (SPECIFY) 996 (GO TO 514)
DON'T KNOW 998 (GO TO 514)
HAS FATHERED CHILDREN: Now I have some questions about the future. Would you like to have another child, or would you prefer not to have any more children?
HAS NOT FATHERED CHILDREN: 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 (GO TO 514)
SAYS COUPLE CAN'T GET PREGNANT 3 (GO TO 514)
WIFE/PARTNER STERILIZED 4 (GO TO 514)
UNDECIDED/DON'T KNOW 8 (GO TO 514)
HAS FATHERED CHILDREN: How long would you like to wait from now before the birth of another child?
HAS NOT FATHERED CHILDREN: How long would you like to wait from now before the birth of a child?
YEARS 2 ___ (GO TO 514)
SOON/NOW 993 (GO TO 514)
SAYS COUPLE CAN'T GET PREGNANT 994 (GO TO 514)
OTHER (SPECIFY) 996 (GO TO 514)
DON'T KNOW 998 (GO TO 514)
509. Are any of your (wives/partners) currently pregnant?
NO 2 (GO TO 512)
DON'T KNOW 8 (GO 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 have any more children?
NO MORE 2 (GO TO 514)
UNDECIDED/DON'T KNOW 8 (GO 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 ___ (GO TO 514)
SOON/NOW 993 (GO TO 514)
OTHER (SPECIFY) 996 (GO TO 514)
DON'T KNOW 998 (GO TO 514)
HAS FATHERED CHILDREN: Now I have some questions about the future. Would you like to have another child, or would you prefer not to have any more children?
HAS NOT FATHERED CHILDREN: 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 (GO TO 514)
SAYS COUPLE CAN'T GET PREGNANT 3 (GO TO 514)
(WIFE/WIVES/PARTNER(S)) STERILIZED 4 (GO TO 514)
UNDECIDED/DON'T KNOW 8 (GO TO 514)
HAS FATHERED CHILDREN: How long would you like to wait from now before the birth of another child?
HAS NOT FATHERED CHILDREN: How long would you like to wait from now before the birth of a child?
YEARS 2 ___
SOON/NOW 993
SAYS COUPLE CAN'T GET PREGNANT 994
OTHER (SPECIFY) 996
DON'T KNOW 998
HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?
NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be?
PROBE FOR A NUMERIC RESPONSE.
NUMBER ___
OTHER (SPECIFY) 96 (GO 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 girls?
NUMBER OF GIRLS___
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 (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 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 3
SOMEONE ELSE 4
OTHER (SPECIFY) 6
611. Who usually makes decisions about making major household purchases?
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER 3
SOMEONE LESE 4
OTHER (SPECIFY) 6
612. Do you own this or any other house either alone or jointly with someone else?
JOINTLY ONLY 2
BOTH ALONG AND JOINTLY 3
DOES NOT OWN 4 (GO TO 615)
613. Do you have a title deed for any house you own?
NO 2 (GO TO 615)
DON'T KNOW 8 (GO 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 (GO TO 618)
616. Do you have a title deed for any land you own?
NO 2 (GO TO 618)
DON'T KNOW 8 (GO 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 (GO 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
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
707A. Can men reduce their chance of getting HIV by getting circumcised?
NO 2
DON'T KNOW 8
707B. Can circumcised men who have sex without a condom get HIV during sex?
NO 2
DON'T KNOW 8
707C. Can an HIV-negative woman get HIV if she has sex without a condom with a circumcised HIV-positive man?
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 (GO TO 711)
710. Are there any special medicines 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 (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.
PROVINCIAL HOSPITAL 12 (GO TO 718)
DISTRICT HOSPITAL 13 (GO TO 718)
RURAL HOSPITAL 14 (GO TO 718)
RURAL HEALTH CENTER/COUNCIL CLINIC 15 (GO TO 718)
URBAN MUNICIPAL CLINIC 16 (GO TO 718)
FAMILY PLANNING CLINIC 17 (GO TO 718)
SCHOOL BASED CLINIC 18 (GO TO 718)
OTHER PUBLIC SECTOR (SPECIFY) 19 (GO TO 718)
NEW START CENTER 32 (GO TO 718)
SCHOOL BASED CLINIC 33 (GO TO 718)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36 (GO TO 718)
WORKPLACE 42 (GO TO 718)
MOBILE VAN 43 (GO TO 718)
UNIFORMED FORCES FACILITY 44 (GO TO 718)
716. Do you know of a place where people can go to get an HIV test?
NO 2 (GO 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.
PROVINCIAL HOSPITAL B
DISTRICT HOSPITAL C
RURAL HOSPITAL D
RURAL HEALTH CENTER/COUNCIL CLINIC E
URBAN MUNICIPAL CLINIC F
FAMILY PLANNING CLINIC G
SCHOOL BASED CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) I
NEW START CENTER L
SCHOOL BASED CLINIC M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) N
WORKPLACE P
MOBILE VAN Q
UNIFORMED FORCES FACILITY R
718. Have you heard of test kits people can use to test themselves for HIV?
NO 2 (GO TO 719A)
719. Have you ever tested yourself for HIV using a self-test kit?
NO 2
719A. If a self-test kit was available, would you be willing to test yourself for HIV?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
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
SAYS HE HAS HIV 3
DON'T KNOW/NOT SURE/DEPENDS 8
HEARD ABOUT HIVE OR AIDS: Apart from HIV, have you heard about other infection that can be transmitted through sexual contact?
NOT HEARD ABOUT HIV OR AIDS: Have you heard about infections that can be transmitted through sexual contact?
NO 2
NEVER HAD SEXUAL INTERCOURSE (GO TO 736)
729. CHECK 727: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?
NO (GO 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 (GO TO 736)
734. The last time you had (PROBLEM FROM 730/731/732) did you seek any kind of advice or treatment?
NO 2 (GO 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.
PROVINCIAL HOSPITAL B
DISTRICT HOSPITAL C
RURAL HOSPITAL D
RURAL HEALTH CENTER/COUNCIL CLINIC E
URBAN MUNICIPAL CLINIC F
FAMILY PLANNING CLINIC G
OTHER PUBLIC SECTOR (SPECIFY) H
PHARMACY J
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) K
MOBIL VAN M
WORKPLACE N
TRADITIONAL HERBALIST O
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 (GO TO 805)
DON'T KNOW 8 (GO TO 805)
802. How old were you when you got circumcised?
DURING CHILDHOOD (LESS THAN 5 YEARS) 95
DON'T KNOW 8
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 00 (GO 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 (GO 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 (GO TO 810)
809. In the past, have you smoked tobacco every day?
NO 2 (GO TO 812)
810. In the past, have you ever smoked tobacco every day, some days, or not at all?
SOME DAYS 2 (GO TO 813)
NOT AT ALL 3 (GO 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 EVER 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 ever week.
IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVER 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 (GO TO 815)
NOT AT ALL 3 (GO TO 816)
814. On average, how many times a day do you use the following products? Also, let me know if you use the products, 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 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 medical aid?
NO 2 (GO TO 819)
817. What type of medical aid are you covered by?
RECORD ALL MENTIONED.
HEALTH INSURANCE THROUGH EMPLOYMENT B
SOCIAL SECURITY C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
OTHER (SPECIFY) X
817A. Have you ever drank alcohol?
NO 2 (GO TO 819)
817B. In the last 30 days, on how many days did you have at least one drink of alcohol?
IF NONE, RECORD '00'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
DON'T KNOW 998
817C. In the last 30 days, how many alcoholic drinks did you have on a typical day when you drank alcohol?
IF NONE, RECORD '00'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
DON'T KNOW 998
817D. In the last 30 days, on how many days did you get drunk?
IF NONE, RECORD '00'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
DON'T KNOW 998
THANK THE RESPONDENT FOR HIS COOPERATION AND REASSURE HIM ABOUT THE CONFIDENTIALITY OF HIS ANSWERS.
MINUTES ___
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT INTERVIEW:
COMMENTS ON SPECIFIC QUESTIONS:
ANY OTHER COMMENTS:
SUPERVISOR'S OBSERVATIONS:
EDITOR'S OBSERVATIONS: