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[p. 1]


MICS questionnaire for individual women


kenya

Woman's information panel: WM

This module is to be administered to all women age 15 through 49 (see column HL6 of HH listing). Fill in one form of each eligible woman. Fill in the cluster and household number, and the nae and line number of the woman in the space below. Fill in your name, number and the date.

WM1. Cluster number: _ _ _

WM2. Household number: _ _

WM3. Woman's name:
Name ____

WM4. Woman's line number: _ _

WM5. Interviewer name and number
Name ____ _ _

WM6. Day/month/year of interview _ _ / _ _ / _ _ _ _

Repeat greeting if not already read to this woman:
We are from [Kenya national bureau of statistics (KNBS)]. We are working on a project concerned with family health and education. I would like to talk to you about this. The interview usually takes around [30-35] minutes. All the information we obtain will remain strictly confidential and your answers will never be identified. Also, you are not obliged to answer any question you don?t want to, and you may withdraw from the interview at any time. May I start now?

If permission is given, begin the interview. If the woman does not agree to continue, thank her, complete WM7, and go to the next interview. Discuss this result with your supervisor for a future re-visit.

WM7. Result of woman's interview

[] 01 Completed
[] 02 Not at home
[] 03 Refused
[] 04 Partly completed
[] 05 Incapacitated
[] 06 Other (specify) ____

Interviewer/editor/supervisor notes: Use this space to record notes about the interview with this household, such as call-back times, incomplete individual interview forms, number of attempts to re-visit, etc.
WM71. Supervisor:

Name___________

WM72. Field edited by (name and number):

Name____________
English
The child is reading a book.
The rains came late this year.
Parents must care for their children.
Farming is hard work.

WM7A. Record the time.

Hour and minutes____:____

WM8. In what month and year were you born?

[] __ Month
[] 98 DK month
[] ____ Year
[] 9998 DK year

WM9. How old were you at your last birthday?

Age (in completed years)________

[p. 2]
WM10.Have you ever attended school, preschool or any non-formal education?

[] 1 Yes
[] 2 No (Go to WM14)

WM11. What is the highest level of school you attended?

[] 0 Preschool (Go to WM14)
[] 1 Primary
[] 2 Secondary
[] 3 Higher
[] 6 non-formal education (Go to WM14)

WM12. What is the highest grade (standard/form/class) you completed at that level? If less than 1 grade, enter 00.

Grade___ ___

WM13. Check WM11:

[] Secondary or higher. Go to next module
[] Preschool, primary or non-formal education. Continue with WM14.

WM14. Now I would like you to read this sentence to me.
Show sentences to respondent. If respondent cannot read whole sentence, probe: Can you read part of the sentence to me?
Example sentences for literacy test:

1.The child is reading a book.
2.The rains came late this year.
3.Parents must care for their children.
4.Farming is hard work.
[] 1 Cannot read at all
[] 2 Able to read only parts of sentence
[] 3 Able to read whole sentence
[] 4 No sentence in required language _______(specify language)
[] 5 Blind/mute, visually/speech impaired

Child mortality: CM

All questions refer only to live births.

CM1. Now I would like to ask about all the births you have had during your life. Have you ever given birth?
If ?no? probe by asking: I mean, to a child who ever breathed or cried or showed other signs of life even if he or she lived only a few minutes or hours?

[] 1 Yes
[] 2 No (Go to Marriage/Union Module)

CM3. Do you have any sons or daughters to whom you have given birth who are now living with you?

[] 1 Yes
[] 2 No (Go to CM5)

CM5. Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?

[] 1 Yes
[] 2 No (Go to CM7)

CM4. How many sons live with you? How many daughters live with you?

_ _ Sons at home
_ _ Daughters at home

CM6. How many sons are alive but do not live with you? How many daughters are alive but do not live with you?

[] Sons elsewhere
[] Daughters elsewhere

CM7. Have you ever given birth to a boy or girl who was born alive but later died?

[] 1 Yes
[] 2 No (Go to CM9)

CM8. How many boys have died? How many girls have dies?

[] Boys dead
[] Girls dead

CM19. Sum answers to CM4, CM6, and CM8.
Sum _ _

[p. 5]
CM10. Just to make sure that I have this right, you have had in total (total number in cm9)births during your life. Is this correct?

[] Yes. Go to BH1
[] No (Check responses and make corrections before proceeding to BH1

Birth History: BH

Now I would like to record the names of all of your births, whether still alive or not, starting with the first one you had.
Record names of all of the births in BH1. Record twins and triplets on separate line.

BH1. What name was given to your (first/next) baby? ____

BH2. Were any of these births twins?

[] 1 Single
[] 2 Multiple

BH3. Is (name) a boy or a girl?

[] 1 Boy
[] 2 Girl

BH4. In what month and year was (name) born?
Probe: what is his/her birthday?
_ _ Month
_ _ _ _ Year

BH5. Is (name) still alive?

[] 1 Yes
[] 2 No (Go to BH9)

BH6. How old was (name) at his/her last birthday?

Record age in completed years. _ _

BH7. Is (name) living with you?

[] 1 Yes
[] 2 No

BH8. Record household line number of child
Record "00" if child is not listed. _ _ (Go to BH10)

BH9. If dead: How old was (name) when he/she died? How many months old was (name)?
Record days if less than 1 month; months if less than 2 years; or years
Unit
[] 1 Days
[] 2 Months
[] 3 Years
Number _ _

BH10. Were there any other live births between (name of previous birth) and (name)?

[] 1 Yes (Add)
[] 2 No (next)

[p. 6]
BH11. Have you had any live births since the birth of (name of last birth)? If yes, record birth(s)

[] 1 Yes
[] 2 No

BH12. Compare CM9 with number of births in history above and mark:

[] Numbers are different, probe and reconcile
[] Numbers are same

Check:

For all births: Year of birth is recorded []
For each living child: Current age is recorded []
For each dead child: Age at death is recorded []
For age at death 12 months or 1 year: Probe to determine exact number of months []

BH13. Check BH4: Did the woman?s last birth occur within the last 2 years, that is, since (day and month of interview) in 2007? If child has died, take special care when referring to this child by name in the following modules.

[] No live birth in last 2 years. Go to marriage/union module.
[] Yes, live birth in last 2 years. Record name of last born child and continue with BH14
Name of child __________

BH14. At the time you became pregnant with (name), did you want to become pregnant then, did you want to wait later, or did you want no (more) children at all?

[] 1 Then
[] 2 Later
[] 3 No more

Tetanus Toxoid: TT
This module is to be administered to all women with a live birth in the 2 years preceding date of interview.
TT1. Do you have a card or other document with your own immunization listed?
If a card is presented, use it to assist with answers to the following questions.

[] 1 Yes (card seen)
[] 2 Yes (card not seen)
[] 3 No
[] 8 DK

TT2. When you were pregnant with (name), did you receive any injection to prevent him or her from getting tetanus, that is convulsions after birth? Probe: an anti-tetanus shot, an injection at the top of the arm or shoulder?

[] 1 Yes
[] 2 No (Go to TT5)
[] 8 DK (Go to TT5)

TT3. How many times did you receive this anti-tetanus injection during your pregnancy with (name)?

[] No. of times __ __
[] 98 DK (Go to TT5)

TT4. How many TT doses during last pregnancy were reported in TT3?

[] At least two TT injections during last pregnancy. (Go to Next Module)
[] Fewer than two TT injections during last pregnancy (Continue with TT5)

TT5. Did you receive any tetanus toxoid injection at any time before your pregnancy with (name)?

[] 1 Yes
[] 2 No (Go to next module)
[] 8 DK (Go to next module)

TT6. How many times did you receive it?

[] NO. of times ___ ___

TT7. In what month and year did you receive the last anti-tetanus injection before your pregnancy with (name)? Skip to next module only if year of injection is given. Otherwise, continue with TT8.

[] Month __ __
[] 98 DK Month
[] Year __ __ __ __ (Go to next module)
[] 9998 DK Year (Go to TT8)

TT8. How many years ago did you receive the last anti-tetanus injection before your pregnancy with (name)?

[] Years ago __ __

Maternal and newborn health: MN

This module is to be administered to all women with a live birth in the 2 years preceding date of interview.
Check birth history module BH13 and record name of last-born child here ____
Use this child's name in the following questions, where indicated.


MN1. Did you see anyone for antenatal care during your pregnancy with (name)?

[] 1 Yes
[] 2 No (Go to MN5)

MN2. Did you see anyone for antenatal care for this pregnancy?
If yes: Whom did you see? Anyone else? Probe for the type of person seen and circle all answers given.
Health professional
[] A Doctor
[] B Community nurse
[] C Clinical officer
[] D Nurse/Midwife
Other person
[] E Traditional birth attendant
[] F Community health worker
[] G Relative/friend
[] X Other (specify) ____
[] Y No one (Go to MN7)

MN2A. How many times did you receive antenatal care during this pregnancy?

_ _ Number of times
[] 98 DK

MN3. As part of your antenatal care, were any of the following done at least once:

[A] Were you weighted?
[] 1 Yes
[] 2 No
[B] Was your blood pressure measured?

[] 1 Yes
[] 2 No

[C] Did you give a urine sample?

[] 1 Yes
[] 2 No

[D] Did you give a blood sample?

[] 1 Yes
[] 2 No

MN4.During any of the antenatal visits for the pregnancy, were you given any information or counseled about aids or the aids virus?

[] 1 Yes
[] 2 No
[] 8 DK

MN5. I don?t want to know the results, but were you tested for hiv/aids as part of your antenatal care?

[] 1 Yes
[] 2 No (Go to MN6A)
[] 8 DK (Go to MN6A)

MN6. I don?t want to know the results, but did you get the results of the test?

[]1 Yes
[] 2 No
[] 8 DK

MN6A. During any of these antenatal visits for the pregnancy, did you take any medicine in order to prevent you from getting malaria?

[]1 Yes
[] 2 No (Go to MN7)
[] 8 DK (Go to MN7)

MN6B. Which medicines did you take to prevent malaria?

[] A SP/Fansidar
[] B Chloroquine
[] X Other (specify)
[] Z DK

MN6C. Check MN6B for medicine taken:

[] SP/Fansidar taken. Continue with MN6D
[] SP/Fansidar not taken. Go to MN7

MN6D. How many times did you take SP/Fansidar?

Number of times___ ___

MN7. Who assisted with the delivery of (name)? Probe: Anyone else? Probe for the type of person assisting and circle all answers given.

Health professional
[] A Doctor
[] B Community nurse
[] C Clinical officer
[] D Nurse/midwife
Other person
[] E Traditional birth attendant
[] F Community health worker
[] G Relative/friend
[] X Other (specify)
[] Y No one

MN8. Where did you give birth to (name)? If source is hospital, health center, or clinic, write the name of the place below. Probe to identify the type of source and circle the appropriate code.
___________(Name of place)
[] 11 Your home (Go to MN8C)
[] 12 Other home (Go to MN8C)
Public sector
[] 21 Government hospital
[] 22 Government health center
[] 23 Government dispensary
[] 26 Other public (specify)
Private medical sector
[] 31 Mission hospital/clinic
[] 32 Private hospital/clinic
[] 33 Nursing/maternity home
[] 36 Other private medical (specify)
[] 96 Other (specify) (Go to MN8C)

MN8A. How long after (name) was delivered did you stay there? If less than one day, record hours. If less than one week, record days.

[] 1 Hours
[] 2 Days
[] 3 Weeks
[] 998 Don?t know/remember.

MN8B. Was (name) delivered by caesarean section?

[] 1 Yes (Go to MN8D)
[] 2 No (Go to MN8D)

MN8C. Why didn?t you deliver (name) in a health facility? Probe: Any other reason? Record all mentioned.

[] A Cost too much
[] B Facility not open
[] C Too far
[] D Don?t trust facility
[] E No female provider at facility
[] F Husband/family did not allow
[] G Not necessary
[] H Not customary
[] I No transportation
[] J Poor quality service
[] X Other (specify)

MN8D. After (name) was born, did any health care provider or a traditional birth attendant check on your health?

[] 1 Yes
[] 2 No (Go to MN8I)

MN8E. How long after the birth of (name) dud this first check take place? If less than one day, record hours. If less than one week, record days.

[] 1 Hours
[] 2 Days
[] 3 Weeks
[] 998 Don?t know/remember

MN8F. Who checked on your health at that time? Probe for most qualified person.

Health professional
[] 11 Doctor
[] 12 Community nurse
[] 13 Clinical officer
[] 14 Nurse/midwife
Other person
[] 21 Traditional birth attendant
[] 22 Community health worker
[] 96 Other (specify)

MN8G. Where did this first check place? Probe to identify the type of source and circle the appropriate code. If unable to determine if a hospital, health center, or clinic is public or private medical, write the name of the place.

Name of place__________
[] 11 Your home
[] 12 Other home
Public sector
[] 21 Government hospital
[] 22 Government health center
[] 23 Government dispensary
[] 26 Other public (specify)
Private medical sector
[] 31 Mission hospital/clinic
[] 32 Private hospital/clinic
[] 33 Nursing/maternity home
[] 34 Pharmacy
[] 36 Other private medical (specify)
[] 96 Other (specify)
[] 98 DK

MN8H. Was the health of (name)also checked at this time?

[] 1 Yes
[] 2 No (Go to MN8I)

MN8H2. Was this also the first time (name?s) health was checked?

[] 1 Yes (Go to MN9)
[] 2 No (Go to MN8J)

MN8I. After (name) was born, did any health care provider or a traditional birth attendant check on his/her health?

[] 1 Yes
[] 2 No (Go to MN9)
[] 8 DK (Go to MN9)

MN8J. How long after the birth of (name) did this first check take place? If less than one day, record hours. If less than one week, record days.

[] 1 Hours
[] 2 Days
[] 3 Weeks
[] 998 Don?t know/remember

MN8K. Who checked on (name?s) health at that time? Probe for most qualified person.

Health professional
[] 11 Doctor
[] 12 Community nurse
[] 13 Clinical officer
[] 14 Nurse/midwife
Other person

[] 21 Traditional birth attendant
[] 22 Community health worker
[] 96 Other (specify)

MN8L. Where did this first check take place? Probe to identify the type of source and circle the appropriate code. If unable to determine if a hospital, health center, or clinic is public or private medical, write the name of the place.

Name of place__________

[] 11 Your home
[] 12 Other home

Public sector
[] 21 Government hospital
[] 22 Government health center
[] 23 Government dispensary
[] 26 Other public (specify)
Private medical sector
[] 31 Mission hospital/clinic
[] 32 Private hospital/clinic
[] 33 Nursing/maternity home
[] 34 Pharmacy
[] 36 Other private medical (specify)
[] 96 Other (specify)
[] 98 DK

MN8M. Were you present when this first check took place?

[] 1 Yes
[] 2 No

MN9. When your last child (name) was born, was he/she very large, larger than average, average, smaller than average, or very small?

[] 1 Very large
[] 2 Larger than average
[] 3 Average
[] 4 Smaller than average
[] 5 Very small
[] 8 DK

MN10. Was (name) weighted at birth?

[] 1 Yes
[] 2 No (Go to MN12)

MN11. How much did (name) weigh? Record weight from health card, if available.

From card [] 1 Kilograms__.______
From recall [] 2 Kilograms__.______
[] 99998 DK

MN12. Did you ever breastfeed (name)?

[] 1 Yes
[] 2 No (Go to next module)

MN13. How long after birth did you first put (name) to the breast? If less than 1 hour, record ?00? hours. If less than 24 hours, record hours. Otherwise, record days.

[] 000 Immediately
[] 1 Hours
[] 2 Days
[] 998 Don?t know/remember

Marriage/union: MA

MA1. Are you currently married or living together with a man as if married?

[] 1 Yes, currently married
[] 2 Yes, living with a man
[] 3 No, not in union (Go to MA3)

MA2. How old was your husband/partner on his last birthday?

_ _ Age in years
[] 98 DK

MA2A. Does your husband/partner have any other wives?

[] 1 Yes
[] 2 No (Go to MA5)

MA2B. Besides yourself, how many other wives does he have?

[] ___Number (Go to MA5)
[] 98 DK (Go to MA5)

MA3. Have you ever been married or lived together with a man?

[] 1 Yes Formerly married
[] 2 Yes, formerly live with a man
[] 3 NO

MA4. What is your martial status now: Are you widowed, divorced or separated?

[] 1 Widowed
[] 2 Divorced
[] 3 Separated

MA5. Have you ever been married or lived with a man only once or more than once?

[] 1 Only once
[] 2 More than once

MA6. In what month and year did you first marry or start living with a man as if married?

[] ____Month
[] 98 DK month
[] ____ Year
[] 9998 DK year

MA7. Check MA6:

[] Both month and year of marriage/union known? (Go to next module)
[] Either month or year of marriage/ union not known? (Continue with MA8)

MA8. How old were you when you started living with your first husband/partner?

[] Age in years

Contraception: CP

CP1. I would like to talk with you about another subject ? family planning. And your reproductive health.
Are you pregnant now?

[] 1 Yes, currently pregnant
[] 2 No (Go to CP2)
[] 8 Unsure or DK (Go to CP2)

CP1A. At the time you became pregnant did you want to become pregnant then, did you want to wait until later, or did you not want to have any more children?

[] 1 Then (Go to CP4B)
[] 2 Later (Go to CP4B)
[] 3 Not want more children (Go to CP4B)

CP2. Some people use various ways or methods to delay or avoid a pregnancy. Are you currently doing something or using any method to delay or avoid getting pregnant?

[] 1 Yes
[] 2 No (Go to CP4A)

CP3. Which method are you using?
Do not prompt. If more than one method is mentioned, circle each one.
[] A Female sterilization
[] B Male sterilization
[] C Pill
[] D IUD
[] E Injection
[] F Implants
[] G condom
[] H Female condom
[] I Diaphragm
[] J Foam/jelly
[] K Lactational amenorrhoea method (LAM)
[] L Periodic abstinence
[] M Withdrawal
[] X Other (specify) ____

CP3B. Check CP3:

[] Currently using ?Female sterilization?? (Go to next module)
[] Not currently using ?Female sterilization? (Continue with CP4A)

CP4A. Now I would like to ask some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

CP4B. If currently pregnant: Now I would like to ask some questions about the future. After the child you are now expecting, would you like to have another child, or would you prefer not to have any (more) children?

[] 1 Have (a/another) child
[] 2 No more/none (Go to CP4D)
[] 3 Says she cannot get pregnant (Go to CP4F)
[] 8 Undecided/don?t know (Go to CP4D)

CP4C. How long would you like to wait before the birth of (a/another) child?

[] 1 Months
[] 2 Years
[] 993 Soon/now
[] 994 Says she cannot get pregnant (Go to CP4F)
[] 995 After marriage
[] 996 Other
[] 998 Don?t know

CP4D. Check CP1.

[] Currently pregnant? (Go to Next module)
[] Not currently pregnant or unsure? (Continue with CP4D2)

CP4D2. Check CP3.

[] Currently using a method? (Go to next module)
[] Not using a method (CP3 blank)? (Continue with CP4E)

CP4E. Do you think you are physically able to get pregnant at this time?

[] 1 Yes (Go to next module)
[] 2 No
[] 8 DK (Go to next module)

CP4F. What is the reason you think you cannot get pregnant?

[] 01 Infrequent sex/No sex
[] 02 Menopausal
[] 03 Hysterectomy
[] 04 Sub fecund/ Infecund
[] 05 Postpartum amenorrheic
[] 06 Breastfeeding
[] 07 Too old
[] 08 Fatalistic
[] 96 Other (Specify)
[] 98 DK

[p. 17]
Female genital mutilation/cutting: FG

FG1. Have you ever heard of female circumcision?

[] 1 Yes (Go to FG3)
[] 2 No

FG2. In a number of countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard about this practice?

[] 1 Yes
[] 2 No (Go to next module)

FG3. Have you yourself ever been circumcised?

[] 1 Yes
[] 2 No (Go to FG8)

FG4. Now I would like to ask you what was done to you at that time. Was any flesh removed from the genital area?

[] 1 Yes (Go to FG6)
[] 2 No
[] 8 DK

FG5. Was the genital area just nicked without removing any flesh?

[] 1 Yes
[] 2 No
[] 8 DK

FG6. Was the genital area sewn closed? (or ?sealed?)

[] 1 Yes
[] 2 No
[] 8 DK

FG7. Who circumcised you?

Health professional
[] 21 Doctor
[] 22Nurse/midwife
[] 26Other health professional (specify) ____
Traditional persons
[] 11Traditional 'circumciser'
[] 2Traditional birth attendant
[] 16Other traditional (specify) ____
[] 98 DK

FG8. The following questions apply only to women who have at least one living daughter. Check CM4 and CM6, child mortality module: Woman has living daughter?

[] Yes (Continue with FG9)
[] No (Go to FG16)

FG9.Have (any of ) your daughter(s) been circumcised? If yes, how many?

[] Number of daughters circumcised:___ ___
[] 00 No daughters circumcised

FG10. To which of your daughters did this happen most recently? Record the daughter?s name.

Name of daughter:________

FG11. Now I would like to ask you what was done to (name) at that time. Was any flesh removed from the genital area?

[] 1 Yes (Go to FG13)
[] 2 No
[] 8 DK

FG12. Was the genital area just nicked without removing any flesh?

[] 1 Yes
[] 2 No
[] 8 DK

FG13. Was the genital area swen closed? If necessary, probe: Was it sealed?

[] 1 Yes
[] 2 No
[] 8 DK

FG14. How old was (name) when this occurred? If the respondent does not know the age, probe to get an estimate.
[] Daughter?s age at circumcision __ __
[] 98 DK

FG15. Who did the circumcision?

Traditional persons
[] 11 Traditional ?circumciser?
[] 12 Traditional birth attendant
[] 16 Other traditional (specify)
Health professional
[] 21 Doctor
[] 22 Nurse/midwife
[] 26 Other health professional (specify)
[] 98 DK

FG16. Do you think this practice should be continued or should it be discontinued?

[] 1 Continued
[] 2 Discontinued
[] 3 Depends
[] 8 DK

DV1. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beathing his wife in the following situations:

A.If she leaves the house without telling him?
B.If she neglects the children?
C.If she argues with him?
D.If she refuses sex with him?
E.If she burns the food?
[] 1 Yes
[] 2 No
[] DK

Sexual behavior: SB

Check for the presence of others. Before continuing, ensure privacy.

SB1. Now I would like to ask you some questions about sexual activity in order to gain a better understanding of some family life issues.
The information you supply will remain strictly confidential.
How old were you when you first had sexual intercourse (If ever)?

[] 00 Never had intercourse (Go to next module)
_ _ Age in years
[] 95 First time when started living with (first) husband/partner

SB3. The last time you had sexual intercourse, was a condom used?

[] 1 Yes
[] 2 No

SB2. When was the last time you had sexual intercourse?
Record ?year ago? only if last intercourse was one or more years ago. If 12 months or more, answer must be recorded in years.
[] 1 Days ago _ _
[] 2 Weeks ago _ _
[] 3 Months ago _ _
[] 4 Years ago _ _ (Go to Next Module)

SB4. What is your relationship to this man with whom you last had sexual intercourse?
If man is 'boyfriend' or ?fiancée? , ask: Was your boyfriend/fiancee living with you when you last had sex? If 'yes', circle '1'. If 'no', circle'2'.
[] 1 Spouse/cohabiting partner (Go to SB6)
[] 2 Man is boyfriend/fiancée
[] 3 Other friend
[] 4 Casual acquaintance
[] 6 Other (specify) ____

SB5. How old is this person?
If response is DK, probe: About how old is this person?
_ _ Age of sexual partner
[] 98 DK

SB6. Have you had sex with any other man in the last 12 months?

[] 1 Yes
[] 2 No (Go to Next Module)

SB7. The last time you had sexual intercourse with this other person, was a condom used?

[] 1 Yes
[] 2 No

[p. 25]
SB8. What is your relationship to this man?
Probe to ensure that the response refers to the relationship at the time of sexual intercourse
If 'boyfriend' or ?fiancée?, ask: was your boyfriend/fiancée living with you when you last had sex? If 'yes', circle '1'. If 'no', circle '2'.
[] 1 Spouse/ Cohabiting partner
[] 2 Man is boyfriend/fiancée
[] 3 Other friend
[] 4 Casual acquaintance
[] 6 Other (specify) ____

SB9. How old is this person?
If response is DK, probe: About how old is this person?
_ _ Age of sexual partner
[] 98 DK

SB10. Other than these two persons, have you had sex with any other man in the last 12 months?

[] 1 Yes
[] 2 No (Go to Next Module)

SB11. In total, with how many different men have you had sex in the last 12 months?

_ _ Number of partners

HIV/AIDS: HA

HA1. Now I would like to talk with you about something else.
Have you ever heard of the virus HIV or an illness called AIDS?

[] 1 Yes
[] 2 No (Go to next module)

HA2. Can people protect themselves from getting infected with the AIDS virus by having one sex partner who is not infected and also has no other partners?

[] 1 Yes
[] 2 No
[] 8 DK

HA3. Can people get infected with the AIDS virus because of witchcraft or other supernatural means?

[] 1 Yes
[] 2 No
[] 8 DK

HA4. Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?

[] 1 Yes
[] 2 No
[] 8 DK

HA5. Can people get the AIDS virus from mosquito bites?

[] 1 Yes
[] 2 No
[] 8 DK

HA6. Can people reduce their chance of getting infected with the aids virus by not having sex at all?

[] 1 Yes
[] 2 No
[] 8 DK

HA7. Can people get the aids virus by sharing food with a person who has aids?

[] 1 Yes
[] 2 No
[] 8 DK

HA8. Is it possible for a healthy-looking person to have the aids virus?

[] 1 Yes
[] 2 No
[] 8 DK


HA9. Can the virus that causes AIDS be transmitted from a mother to her baby:

[A] During pregnancy?

[] 1 Yes
[] 2 No
[] 8 DK

[B] During delivery?

[] 1 Yes
[] 2 No
[] 8 DK

[C] By breastfeeding?

[] 1 Yes
[] 2 No
[] 8 DK

HA10. If a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in school?

[] 1 Yes
[] 2 No
[] 8 DK/not sure/depends

HA11. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

[] 1 Yes
[] 2 No
[] 8 DK/not sure/depends

HA12. If a member of your family got infected with the AIDS virus, would you want it to remain a secret?

[] 1 Yes, keep secret
[] 2 No
[] 8 DK/not sure/depends

HA13. If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?

[] 1 Yes
[] 2 No
[] 8 DK/not sure/depends

[p. 27]
HA14. Check MN5: Tested for HIV during antenatal care?
[] Yes (Go to HA18A)
[] No(Continue with HA15)

HA15. I do not want to know the results, but have you ever been tested to see if you have HIV, the virus that causes AIDS?
[] 1 Yes
[] 2 No (Go to HA18)

HA16. I don't want you to tell me the results of the test, but have you been told the results?

[] 1 Yes
[] 2 No

HA17. Did you, yourself, ask for the test, was it offered to you and your accepted or was it required?

[] 1 Asked for the test (Go to next module)
[] 2 Offered and accepted (Go to HA22 Next Module)
[] 3Required (Go to HA22 Next module)

HA18. At this time, do you know of a place where you can go to get such a test to see if you have the AIDS virus?

HA18A. If tested for HIV during antenatal care: other than at the antenatal clinic, do you know of a place where you can go to get a test to see if you have the aids virus?

[] 1 Yes
[] 2 No

WT2. Record the time.
Hours and minutes ___:___

Interviewer's observations

Field editor's observations

Supervisor's observations

[p. 38]
Response card:

Side 1

Very happy
Somewhat happy
Neither happy, nor unhappy
Somewhat unhappy
Very unhappy

Side 2

Very satisfied
Somewhat satisfied
Neither satisfied, not unsatisfied
Somewhat unsatisfied
Very unsatisfied