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Man's information panel: MWM

Man's Information panel: This questionnaire is to be administered to all men age 15 through 49 (see list of household members, column HL7A) A separate questionnaire should be used for each eligible man.

MWM1. Cluster number _ _ _

MWM2. Household Number _ _

MWM3. Man's Name: ____

MWM4. Man's line number: _ _

MWM5. Interviewer's name and number: ____ _ _

MWM6. Day/Month/Year of interview _ _ /_ _ /201_

Repeat greeting if not already read to this man: We are from [insert country-specific affiliation]. We are conducting a survey about the situation of children, families and households. I would like to talk to you about these subjects. The interview will take about [insert number] minutes. All the information we obtain will remain strictly confidential and anonymous.
If greeting at the beginning of the household questionnaire has already been read to this man, then read the following:
Now I would like to talk to you more about your health and other topics. This interview will take about [insert number] minutes. Again, all the information we obtain will remain strictly confidential and anonymous.

May I start now?

MWM7. Result of man's interview

MWM8. Field editor's name and number:
Name ____ _ _

MWM9. Main data entry clerk's name and number:
Name ____ _ _

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MWM10. Record the time

Man's background: MWB

MWB1. In what month and year were you born?

MWB2. How old are you?
Probe: How old were you at your last birthday? Compare and correct MWB1 and/or MWB2 if inconsistent.
MWB3. Have you ever attended school or preschool?

MWB4. What is the highest level of school you attended?

MWB5. What is the highest grade you completed at that level? If the first grade at this level is not completed, enter "00".

MWB6. Check MWB4:
MWB7. Now I would like you to read this sentence to me. Show sentence on the card to the respondent. If respondent cannot read whole sentence, probe: Can you read part of the sentence to me?

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Access to mass media use of information/communication technology: MMT

MMT1. Check MWB7:
MMT2. How often do you read a newspaper or magazine: Almost every day, at least once a week, less than once a week or not at all?

MMT3. Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?

MMT4. How often do you watch television: Would you say that you watch almost every day, at least once a week, less than once a week or not at all?

MMT5. Check MWB2: Age of respondent
MMT6. Have you ever used a computer?

MMT7. Have you used a computer from any location in the last 12 months?

MMT8. During the last one month, how often did you use a computer: almost every day, at least once a week, less than once a week or not at all?

MMT9. Have you ever used the internet?

MMT10. In the last 12 months, have you used the internet?
If necessary, probe for use from any location, with any device.

MMT11. 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?

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Fertility: MCM

MCM1. Now I would like to ask about all the children you have had in 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?

MCM3. How old were you when your first child was born?

MCM4. Do you have any sons or daughters that you have fathered who are now living with you?

MCM5. How many sons live with you? How many daughters live with you?
If none, record "00".
MCM6. Do you have any sons or daughters that you have fathered who are alive but do not live with you?

MCM7. How many sons are alive but do not live with you? How many daughters are alive but do not live with you?
If none, record "00".
MCM8. Have you ever fathered a son or daughter who was born alive but later died?
If "No" probe by asking: I mean, 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?
MCM9. How many boys have died? How many girls have died?
If none, record "00".
MCM10. Sum answers to MCM5, MCM7, and MCM9.
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MCM11. Just to make sure that I have this right, you have fathered in total (total number in MCM10) live births during your life. Is this correct?

MCM11A. Did all the children you have fathered have the same biological mother?

MCM11B. In all, how many women have you fathered children with?

MCM12. Of these (total number in MCM10) births you have fathered, when was the last one born (even if he or she has died)? Month and year must be recorded.

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: Attitudes toward Domestic Violence: MDV

MDV1. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

MDV1A. If she goes out without telling him?

MDV1B. If she neglects the children?

MDV1C. If she argues with him?

MDV1D. If she refuses to have sex with him?

MDV1E. If she burns the food?

MDV1F. [Country Specific Situation (Add as necessary)]

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Marriage/Union: MMA

MMA1. Are you currently married or living together with a woman as if married?

MMA3. Do you have other wives or do you live with other women as if married?

MMA4. How many other wives or live-in partners do you have?

MMA5. Have you ever been married or lived together with a woman as if married?

MMA6. What is your marital status now: are you widowed, divorced or separated?

MMA7. Have you been married or lived with a woman only once or more than once?

MMA8A. In what month and year did you marry or start living with a woman as if married?
MMA8B. In what month and year did you first marry or start living with a woman as if married?

MMA9. How old were you when you first started living with your (first) wife/partner?

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Sexual behavior: MSB

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

MSB1. Now I would like to ask you some questions about sexual activity in order to gain a better understanding of some important life issues. The information you supply will remain strictly confidential. How old were you when you had sexual intercourse for the very first time?

MSB2. The first time you had sexual intercourse, was a condom used?

MSB3. When was the last time you had sexual intercourse?
Record answers in days, weeks or months if less than 12 months (one year). If more than 12 months (one year), answer must be recorded in years.
MSB4. The last time you had sexual intercourse, was a condom used?

MSB5. What was your relationship to this person with whom you last had sexual intercourse? Probe to ensure that the response refers to the relationship at the time of sexual intercourse. If 'girlfriend', then ask: Were you living together as if married? If "yes", circle "2". If "no", circle"3".
MSB8. Have you had sexual intercourse with any other person in the last 12 months?

MSB9. The last time you had sexual intercourse with this other person, was a condom used?

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MSB10. What was your relationship to this person?
Probe to ensure that the response refers to the relationship at the time of sexual intercourse If 'girlfriend' then ask: Were you living together as if married? If "yes", circle "2". If "no", circle "3".
MSB13. Other than these two persons, have you had sexual intercourse with any other person in the last 12 months?

MSB14. In total, with how many different people have you had sexual intercourse in the last 12 months?

MSB15. In total, with how many different people have you had sexual intercourse in your lifetime?
If a non-numeric answer is given, probe to get an estimate. If number of partners is 95 or more, write '95'.
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HIV/AIDS: MHA

MHA1. Now I would like to talk with you about something else. Have you ever heard of an illness called AIDS?

MHA2. Can people reduce their chance of getting the AIDS virus by having just one uninfected sex partner who has no other sex partners?

MHA3. Can people get the AIDS virus because of witchcraft or other supernatural means?

MHA4. Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?

MHA5. Can people get the AIDS virus from mosquito bites?

MHA6. Can people get the AIDS virus by sharing food with a person who has the AIDS virus?

MHA7. Is it possible for a healthy-looking person to have the AIDS virus?

MHA8. Can the virus that causes AIDS be transmitted from a mother to her baby:



C. By breastfeeding

MHA9. In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in school?

MHA10. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

MHA11. If a member of your family got infected with the AIDS virus, would you want it to remain a secret?

MHA12. If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?

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MHA24. I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?

MHA25. When was the most recent time you were tested?

MHA26. I don't want to know the results, but did you get the results of the test?

MHA27. Do you know of a place where people can go to get tested for the AIDS virus?

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Circumcision: MMC

MMC1. Some men are circumcised, that is, the foreskin is completely removed from the penis. Are you circumcised?

MMC2. How old were you when you got circumcised?

MMC3. Who did the circumcision?

MMC4. Where was it done?

Tobacco and Alcohol use: MTA

MTA1. Have you ever tried cigarette smoking, even one or two puffs?

MTA2. How old were you when you smoked a whole cigarette for the first time?

MTA3. Do you currently smoke cigarettes?

MTA4. In the last 24 hours, how many cigarettes did you smoke?

MTA5. During the last one month, on how many days did you smoke cigarettes?
If less than 10 days, record the number of days. If 10 days or more but less than a month, circle "10". If "every day" or "almost every day", circle "30".
MTA6. Have you ever tried any smoked tobacco products other than cigarettes, such as cigars, water pipe, cigarillos or pipe?

MTA7. During the last one month, did you use any smoked tobacco products?

MTA8. What type of smoked tobacco product did you use or smoke during the last one month? Circle all mentioned.
MTA9. During the last one month, on how many days did you use smoked tobacco products?
If less than 10 days, record the number of days. If 10 days or more but less than a month, circle "10". If "every day" or "almost every day", circle "30".
MTA10. Have you ever tried any form of smokeless tobacco products, such as chewing tobacco, snuff, or dip?

MTA11. During the last one month, did you use any smokeless tobacco products?

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MTA12: What type of smokeless tobacco product did you use during the last one month? Circle all mentioned.

MTA13. During the last one month, on how many days did you use smokeless tobacco products?
If less than 10 days, record the number of days. If 10 days or more but less than a month, circle "10". If "every day" or "almost every day", circle "30".
MTA14: Now I would like to ask you some questions about drinking alcohol. Have you ever drank alcohol?

MTA15. We count one drink of alcohol as one can or bottle of beer, one glass of wine, or one shot of cognac, vodka, whiskey or rum. How old were you when you had your first drink of alcohol, other than a few sips?

MTA16. During the last one month, on how many days did you have at least one drink of alcohol?
If respondent did not drink, circle ?00". If less than 10 days, record the number of days. If 10 days or more but less than a month, circle "10". If "every day" or "almost every day", circle "30".
MTA17. In the last one month, on the days that you drank alcohol, how many drinks did you usually have per day?

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Life satisfaction: MLS

MLS1. Check MWB2: Age of respondent is between 15 and 24?
MLS2. I would like to ask you some simple questions on happiness and satisfaction. First, taking all things together, would you say you are very happy, somewhat happy, neither happy nor unhappy, somewhat unhappy or very unhappy? You can also look at these pictures to help you with your response.
Show side 1 of response card and explain what each symbol represents. Circle the response code selected by the respondent.
MLS3. Now I will ask you questions about your level of satisfaction in different areas. In each case, we have five possible responses: Please tell me, for each question, whether you are very satisfied, somewhat satisfied, neither satisfied nor unsatisfied, somewhat unsatisfied or very unsatisfied. Again, you can look at these pictures to help you with your response.
Show side 2 of response card and explain what each symbol represents. Circle the response code selected by the respondent, for questions MLS3 to MLS13.
How satisfied are you with your family life?

MLS4. How satisfied are you with your friendships?

MLS5. During the current / 2013-2014 school year, did you attend school at any time?

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MLS6. How satisfied (are/were) you with your school?

MLS7. How satisfied are you with your current job?
If the respondent says that he does not have a job, circle "0" and continue with the next question. Do not probe to find out how he feels about not having a job, unless he tells you himself.
MLS8. How satisfied are you with your health?

MLS9. How satisfied are you with where you live?
If necessary, explain that the question refers to the living environment, including the neighbourhood and the dwelling.
MLS10. How satisfied are you with how people around you generally treat you?

MLS11. How satisfied are you with the way you look?

MLS12. How satisfied are you with your life, overall?

MLS13. How satisfied are you with your current income? If the respondent says that he does not have any income, circle "0" and continue with the next question. Do not probe to find out how he feels about not having any income, unless he tells you himself.

MLS14. Compared to this time last year, would you say that your life has improved, stayed more or less the same, or worsened, overall?

MLS15. And in one year from now, do you expect that your life will be better, will be more or less the same, or will be worse, overall?

MWM11: Record the time.
MWM12. Check List of Household Members, columns HL7B and HL15: Is the respondent the caretaker of any child age 0-4 living in this household?