FORMATTING DATE: 03 Feb 2023

ENGLISH LANGUAGE: 03 Feb 2023

DEMOGRAPHIC AND HEALTH SURVEYS
MODEL MAN'S QUESTIONNAIRE
[NAME OF COUNTRY]
[NAME OF ORGANIZATION]

IDENTIFICATION (1)

PLACE NAME

NAME OF HOUSEHOLD HEAD

CLUSTER NUMBER ......................................................................

HOUSEHOLD NUMBER ...................................................................

NAME AND LINE NUMBER OF MAN

INTERVIEWER VISITS

1 2 3 FINAL VISIT

DATE DAY

MONTH

YEAR
INTERVIEWER'S
NAME INT. NO.

RESULT* RESULT*

NEXT VISIT: DATE

TOTAL NUMBER
TIME OF VISITS

*RESULT CODES: 1 COMPLETED 4 REFUSED

2 NOT AT HOME 5 PARTLY COMPLETED 7 OTHER
3 POSTPONED 6 INCAPACITATED SPECIFY

LANGUAGE OF
QUESTIONNAIRE** 0 1 LANGUAGE OF
INTERVIEW**
NATIVE LANGUAGE
OF RESPONDENT**
TRANSLATOR USED
(YES = 1, NO = 2)

LANGUAGE OF
QUESTIONNAIRE** ENGLISH **LANGUAGE CODES:
01 ENGLISH 03 LANGUAGE 3 05 LANGUAGE 5
02 LANGUAGE 2 04 LANGUAGE 4 06 LANGUAGE 6

TEAM TEAM SUPERVISOR CAPI SUPERVISOR (2)

NUMBER NAME NUMBER NAME NUMBER

(1) This section should be adapted for country-specific survey design.

(2) Remove the section for recording the name and ID number of the CAPI supervisor if the survey does not have CAPI supervisors who are
separate from the team supervisors.
Note: Questions with highlighting in the question number column may be deleted in some circumstances (see footnotes). Brackets [ ] indicate
items that should be adapted on a country-specific basis.

M-1
 INTRODUCTION AND CONSENT
(1)

Err:502

SIGNATURE OF INTERVIEWER DATE

RESPONDENT AGREES RESPONDENT DOES NOT AGREE

TO BE INTERVIEWED . . 1 TO BE INTERVIEWED . . 2 END

SECTION 1. RESPONDENT'S BACKGROUND

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

101 RECORD THE TIME.

HOURS .........................

MINUTES . . . . . . . . . . . . . . . . . . . . . . . . .

102 Err:502 [PROVINCE/REGION/STATE] . . . . . . . . . . . . . . . . 01

[PROVINCE/REGION/STATE] . . . . . . . . . . . . . . . . 02 104
[PROVINCE/REGION/STATE] . . . . . . . . . . . . . . . . 03
OUTSIDE OF [COUNTRY] . . . . . . . . . . . . . . . . . . . 96

103 Err:502
COUNTRY

104 Err:502
YEARS .........................

ALWAYS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
110
VISITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

105 CHECK 104:

00 - 04 YEARS 05 YEARS 107

OR MORE

106 Err:502
MONTH .........................

DON'T KNOW MONTH . . . . . . . . . . . . . . . . . . . . . . 98

YEAR . . . . . . . . . . . . . . . .

DON'T KNOW YEAR . . . . . . . . . . . . . . . . . . . . . . 998

107 Err:502 [PROVINCE/REGION/STATE] . . . . . . . . . . . . . . . . 01

[PROVINCE/REGION/STATE] . . . . . . . . . . . . . . . . 02
[PROVINCE/REGION/STATE] . . . . . . . . . . . . . . . . 03
OUTSIDE OF [COUNTRY] . . . . . . . . . . . . . . . . . . . 96

108 Err:502 CITY ................................. 1

TOWN ................................. 2
RURAL AREA . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

M-2
 SECTION 1. RESPONDENT'S BACKGROUND

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

109 Err:502 EMPLOYMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 01

(2) EDUCATION/TRAINING ................... 02
MARRIAGE FORMATION . . . . . . . . . . . . . . . . . . . 03
FAMILY REUNIFICATION/OTHER
FAMILY RELATED REASON . . . . . . . . . . . . . 04
FORCED DISPLACEMENT . . . . . . . . . . . . . . . . . . . 05
OTHER 96
(SPECIFY)

110 Err:502
MONTH .........................

DON'T KNOW MONTH . . . . . . . . . . . . . . . . . . . . . . 98

YEAR . . . . . . . . . . . . . . . .

DON'T KNOW YEAR ................... 9998

111 Err:502
AGE IN COMPLETED YEARS . . . . . . . .

112 Err:502 VERY GOOD ............................ 1

GOOD ................................. 2
MODERATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
BAD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
VERY BAD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

113 Err:502 YES .................................... 1

NO .................................... 2 117

114 Err:502 PRIMARY ............................... 1

(3) SECONDARY ............................ 2
HIGHER ............................... 3

115 Err:502
(3)
[GRADE/FORM/YEAR] . . . . . . . . . . . . .

116 CHECK 114:

PRIMARY OR HIGHER
119
SECONDARY

117 Err:502 CANNOT READ AT ALL ................... 1

(4) ABLE TO READ ONLY PART OF
THE SENTENCE . . . . . . . . . . . . . . . . . . . . . . . . . 2
ABLE TO READ WHOLE SENTENCE . . . . . . . . . . . 3
NO CARD WITH REQUIRED
LANGUAGE 4
(SPECIFY LANGUAGE)
BLIND/VISUALLY IMPAIRED . . . . . . . . . . . . . . . . 5

118 CHECK 117:

CODE '2', '3' CODE '1' OR '5'

OR '4' CIRCLED 120
CIRCLED

119 Err:502 AT LEAST ONCE A WEEK . . . . . . . . . . . . . . . . . . . 1

LESS THAN ONCE A WEEK . . . . . . . . . . . . . . . . 2
NOT AT ALL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

120 Err:502 AT LEAST ONCE A WEEK . . . . . . . . . . . . . . . . . . . 1

LESS THAN ONCE A WEEK . . . . . . . . . . . . . . . . 2
NOT AT ALL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

M-3
 SECTION 1. RESPONDENT'S BACKGROUND

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

121 Err:502 AT LEAST ONCE A WEEK . . . . . . . . . . . . . . . . . . . 1

LESS THAN ONCE A WEEK . . . . . . . . . . . . . . . . 2
NOT AT ALL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

122 Err:502 YES .................................... 1

NO .................................... 2 127

123 Err:502 YES .................................... 1

NO .................................... 2

127 Err:502 YES .................................... 1

NO .................................... 2 130

128 Err:502
YES .................................... 1
NO .................................... 2 130

129 Err:502 ALMOST EVERY DAY . . . . . . . . . . . . . . . . . . . . . . 1

AT LEAST ONCE A WEEK . . . . . . . . . . . . . . . . . . . 2
LESS THAN ONCE A WEEK . . . . . . . . . . . . . . . . 3
NOT AT ALL ............................ 4

130 Err:502 [RELIGION] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 01

[RELIGION] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 02
[RELIGION] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 03
OTHER 96
(SPECIFY)

131 Err:502 [ETHINIC GROUP] . . . . . . . . . . . . . . . . . . . . . . . . . 01

[ETHINIC GROUP] . . . . . . . . . . . . . . . . . . . . . . . . . 02
[ETHINIC GROUP] . . . . . . . . . . . . . . . . . . . . . . . . . 03
OTHER 96
(SPECIFY)

(1) Increase the time reported to the respondent if modules are added to the questionnaire.
(2) Adapt the list of codes to include other common country-specific reasons for migration; e.g., repatriation, post-conflict return to prior place of
residence, environmental crisis, natural disaster, or nomadic/pastoralist.
(3) Revise according to the local education system.
(4) Each card should have four simple sentences appropriate to the country (e.g., "Parents love their children.", "Farming is hard work.", "The
child is reading a book.", "Children work hard at school."). Cards should be prepared for every language in which respondents are likely to be
literate.

M-4
 SECTION 2. REPRODUCTION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

201 Err:502

YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
NO .................................... 2
206
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

202 Err:502 YES .................................... 1

NO .................................... 2 204

203 a) Err:502
a) SONS AT HOME . . . . . . . . . . . . . . . .

b) Err:502
b) DAUGHTERS AT HOME ........

204 Err:502 YES .................................... 1

NO .................................... 2 206

205 a) Err:502
a) SONS ELSEWHERE ..........

b) Err:502
b) DAUGHTERS ELSEWHERE .....

206 Err:502

YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
NO .................................... 2
208
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

207 a) Err:502
a) BOYS DEAD ................

b) Err:502
b) GIRLS DEAD ................

208 SUM ANSWERS TO 203, 205, AND 207, AND ENTER

TOTAL. IF NONE, RECORD '00'. TOTAL CHILDREN . . . . . . . . . . . . . . . .

209 CHECK 208:

HAS HAD
HAS HAD ONLY 211
MORE THAN ONE CHILD
ONE CHILD HAS NOT HAD
ANY CHILDREN 301

210 Err:502 YES .................................... 1

NO .................................... 2

211 CHECK 208:

HAS HAD HAS HAD

MORE THAN ONLY
ONE CHILD ONE CHILD

a) Err:502 b) Err:502
AGE IN YEARS . . . . . . . . . . . . . . . . . . .

M-5
 SECTION 2. REPRODUCTION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

212 CHECK 203 AND 205:

AT LEAST ONE NO LIVING
301
LIVING CHILD CHILDREN

213 CHECK 203 AND 205:

MORE THAN ONE ONLY ONE

LIVING CHILD LIVING CHILD

a) Err:502 b) Err:502
AGE IN YEARS . . . . . . . . . . . . . . . . . . .

214 CHECK 213:

(YOUNGEST) CHILD IS (YOUNGEST) CHILD IS

301
AGE 0-2 YEARS AGE 3 YEARS OR OLDER

215 CHECK 203 AND 205:

MORE THAN ONE ONLY ONE

LIVING CHILD LIVING CHILD

a) Err:502 b) Err:502
(NAME OF (YOUNGEST) CHILD)

216 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO .................................... 2
218
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

217 Err:502 PRESENT .............................. 1

NOT PRESENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

218 Err:502 HOSPITAL/HEALTH FACILITY . . . . . . . . . . . . . . . . 1

OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 301

219 Err:502 YES .................................... 1

NO .................................... 2

M-6
 SECTION 3. CONTRACEPTION

301 Err:502

01 Err:502 YES ................................. 1

NO ................................. 2

02 Err:502 YES ................................. 1

NO ................................. 2

03 Err:502 YES ................................. 1

NO ................................. 2

04 Err:502 YES ................................. 1

NO ................................. 2

05 Err:502 YES ................................. 1

NO ................................. 2

06 Err:502 YES ................................. 1

NO ................................. 2

07 Err:502 YES ................................. 1

NO ................................. 2

08 Err:502 YES ................................. 1

NO ................................. 2

09 Err:502 YES ................................. 1

(1) NO ................................. 2

10 Err:502 YES ................................. 1

(2) NO ................................. 2

11 Err:502
(3) YES ................................. 1
NO ................................. 2

12 Err:502 YES ................................. 1

NO ................................. 2

13 Err:502 YES ................................. 1

NO ................................. 2

14 Err:502 YES, MODERN METHOD

A
(SPECIFY)
YES, TRADITIONAL METHOD

B
(SPECIFY)
NO ................................. Y

M-7
 SECTION 3. CONTRACEPTION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

302 Err:502 YES NO

a) Err:502 a) RADIO ...................... 1 2

b) Err:502 b) TELEVISION . . . . . . . . . . . . . . . . . . . 1 2

c) Err:502 c) NEWSPAPER OR MAGAZINE . . . . . 1 2

d) Err:502 d) MOBILE PHONE . . . . . . . . . . . . . . . . 1 2

e) Err:502 e) FACEBOOK/TWITTER/
INSTAGRAM . . . . . . . . . . . . . . . . 1 2
f) Err:502 f) POSTER/LEAFLET/
BROCHURE ............. 1 2
g) Err:502 g) OUTDOOR SIGN/BILLBOARD . . . . . 1 2

h) Err:502 h) COMMUNITY MEETINGS/

EVENTS . . . . . . . . . . . . . . . . . . . 1 2

303 Err:502 YES .................................... 1

NO .................................... 2

304 Err:502
YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
NO .................................... 2
306
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

305 Err:502 JUST BEFORE HER PERIOD BEGINS . . . . . . . . 1

DURING HER PERIOD . . . . . . . . . . . . . . . . . . . . . . 2
RIGHT AFTER HER PERIOD HAS ENDED . . . . . 3
HALFWAY BETWEEN TWO PERIODS . . . . . . . . 4

OTHER 6
(SPECIFY)
DON'T KNOW ............................ 8

306 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO .................................... 2
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

307 Err:502
DIS-
AGREE AGREE DK

a) Err:502 a) CONTRACEPTION
WOMAN'S CONCERN 1 2 8
b) Err:502 b) WOMEN MAY BECOME
PROMISCUOUS 1 2 8

(1) Studies have indicated emergency contraception can be effective up to 5 days. Verify country program recommendations and modify
wording if appropriate.
(2) The Standard Days Method (SDM) should be deleted in countries that do not have an SDM program. In these countries, SDM should also
be deleted as a coding category in Q. 418.
(3) The LAM method should be deleted in countries that do not have a LAM program. In these countries, LAM should also be deleted as a
coding category in Q. 418.

M-8
 SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

401 Err:502 YES, CURRENTLY MARRIED . . . . . . . . . . . . . . . . 1

404
YES, LIVING WITH A WOMAN ............. 2
NO, NOT IN UNION . . . . . . . . . . . . . . . . . . . . . . . . . 3

402 Err:502 YES, FORMERLY MARRIED . . . . . . . . . . . . . . . . 1

YES, LIVED WITH A WOMAN . . . . . . . . . . . . . . . . 2
NO .................................... 3 413

403 Err:502 WIDOWED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

DIVORCED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 410
SEPARATED ............................ 3

404 Err:502 LIVING WITH HIM . . . . . . . . . . . . . . . . . . . . . . . . . 1

STAYING ELSEWHERE ................... 2

405 Err:502 YES (MORE THAN ONE WIFE) ............. 1

(1) NO (ONLY ONE WIFE) . . . . . . . . . . . . . . . . . . . . . . 2 407

406 Err:502 TOTAL NUMBER OF WIVES

(1) AND LIVE-IN PARTNERS . . . . . . . . . .

407 CHECK 405: 408 (1)

(1) ONE WIFE/ MORE THAN Err:502

PARTNER ONE WIFE/
PARTNER

a) Err:502 b) Err:502

LINE
NAME NUMBER AGE

RECORD THE NAME AND THE LINE NUMBER FROM

THE HOUSEHOLD QUESTIONNAIRE FOR THE
(FIRST/NEXT) WIFE OR LIVE-IN PARTNER.

IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD,

RECORD '00'.

408 Err:502
(1)

RETURN TO 407 FOR THE NEXT WIFE OR LIVE-IN

PARTNER.

409 CHECK 407:

(1) ONE WIFE/ MORE THAN

PARTNER ONE WIFE/ 411
PARTNER

410 Err:502 MORE THAN ONCE . . . . . . . . . . . . . . . . . . . . . . . . . 1

ONLY ONCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

M-9
 SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

411 CHECK 405 AND 410:

BOTH ARE OTHER MONTH .........................

CODE '2'

a) Err:502 b) Err:502 DON'T KNOW MONTH ................... 98

413
YEAR . . . . . . . . . . . . . . . .

DON'T KNOW YEAR ................... 9998

412 Err:502
AGE ............................

413 CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

414 Err:502

NEVER HAD SEXUAL

INTERCOURSE . . . . . . . . . . . . . . . . . . . . . . . . . 00 501

AGE IN YEARS . . . . . . . . . . . . . . . . . . .

415 Err:502
DAYS AGO ............. 1

WEEKS AGO ............. 2

IF LESS THAN 12 MONTHS, ANSWER MUST BE MONTHS AGO ............. 3

RECORDED IN DAYS, WEEKS OR MONTHS. IF 12
MONTHS (ONE YEAR) OR MORE, ANSWER MUST 429
YEARS AGO ............. 4
BE RECORDED IN YEARS.

416 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 418

NO .................................... 2
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

417 Err:502 YES .................................... 1

419
NO .................................... 2

418 Err:502 FEMALE STERILIZATION . . . . . . . . . . . . . . . . . . . A

(2) MALE STERILIZATION . . . . . . . . . . . . . . . . . . . . . . B
(3) IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C
(4) INJECTABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . D
IMPLANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E
IF CODES 'G' OR 'H' ARE CIRCLED, SKIP TO 420 PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F
EVEN IF ANOTHER METHOD WAS ALSO USED. CONDOM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G
420
FEMALE CONDOM . . . . . . . . . . . . . . . . . . . . . . . . . H
EMERGENCY CONTRACEPTION . . . . . . . . . . . . . I
STANDARD DAYS METHOD . . . . . . . . . . . . . . . . J
LACTATIONAL AMENORRHEA METHOD. . . . . . . . K
RHYTHM METHOD . . . . . . . . . . . . . . . . . . . . . . . . . L
WITHDRAWAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . M
OTHER MODERN METHOD . . . . . . . . . . . . . . . . X
OTHER TRADITIONAL METHOD . . . . . . . . . . . . . Y

419 Err:502 YES .................................... 1

(5) NO .................................... 2 422

M-10
 SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

420 Err:502 BRAND A .............................. 01

(5) BRAND B .............................. 02
BRAND C .............................. 03

OTHER 96
(SPECIFY)
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

421 Err:502 PUBLIC SECTOR

(5) GOVERNMENT HOSPITAL . . . . . . . . . . . . . . . . 11
(6) GOVERNMENT HEALTH CENTER . . . . . . . . 12
FAMILY PLANNING CLINIC ............. 13
MOBILE CLINIC . . . . . . . . . . . . . . . . . . . . . . . . . 14
COMMUNITY HEALTH WORKER/
FIELD WORKER . . . . . . . . . . . . . . . . . . . . . . 15
OTHER PUBLIC SECTOR

16
(SPECIFY)

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL ................... 21
PRIVATE CLINIC ...................... 22
PHARMACY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
PRIVATE DOCTOR . . . . . . . . . . . . . . . . . . . . . . 24
MOBILE CLINIC . . . . . . . . . . . . . . . . . . . . . . . . . 25
COMMUNITY HEALTH WORKER/
FIELD WORKER . . . . . . . . . . . . . . . . . . . . . . 26
OTHER PRIVATE MEDICAL SECTOR

27
(SPECIFY)

NGO MEDICAL SECTOR

NGO HOSPITAL . . . . . . . . . . . . . . . . . . . . . . . . . 31
NGO CLINIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
OTHER NGO MEDICAL SECTOR

36
(SPECIFY)

OTHER SOURCE
SHOP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
CHURCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
FRIEND/RELATIVE . . . . . . . . . . . . . . . . . . . . . . 43

OTHER 96
(SPECIFY)
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

422 Err:502 WIFE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

(7) LIVE-IN PARTNER . . . . . . . . . . . . . . . . . . . . . . . . . 2
GIRLFRIEND NOT LIVING WITH
RESPONDENT . . . . . . . . . . . . . . . . . . . . . . . . . 3
CASUAL ACQUAINTANCE ................ 4
CLIENT/SEX WORKER ................... 5

OTHER 6
(SPECIFY)

423 Err:502 YES .................................... 1

NO .................................... 2 429

424 Err:502 YES .................................... 1

(5) NO .................................... 2

M-11
 SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

425 Err:502 WIFE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

(7) LIVE-IN PARTNER . . . . . . . . . . . . . . . . . . . . . . . . . 2
GIRLFRIEND NOT LIVING WITH
RESPONDENT . . . . . . . . . . . . . . . . . . . . . . . . . 3
CASUAL ACQUAINTANCE ................ 4
CLIENT/SEX WORKER ................... 5

OTHER 6
(SPECIFY)

426 Err:502 YES .................................... 1

NO .................................... 2 429

427 Err:502 YES .................................... 1

(5) NO .................................... 2

428 Err:502 WIFE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

(7) LIVE-IN PARTNER . . . . . . . . . . . . . . . . . . . . . . . . . 2
GIRLFRIEND NOT LIVING WITH
RESPONDENT . . . . . . . . . . . . . . . . . . . . . . . . . 3
CASUAL ACQUAINTANCE ................ 4
CLIENT/SEX WORKER ................... 5

OTHER 6
(SPECIFY)

429 Err:502
NUMBER OF PARTNERS
IN LIFETIME . . . . . . . . . . . . . . . . . . .

DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

(1) Delete Qs. 405-409 in countries where polygyny is not practiced and replace with Q. 710 from the Woman's Questionnaire with the word
'HUSBAND'S' replaced with 'WIFE'S' and 'HE' replaced with 'SHE'.
(2) The Standard Days Method (SDM) should be deleted in countries that do not have an SDM program.
(3) The LAM method coding category should be deleted in countries that do not have a LAM program.
(4) Other commonly used methods may be added to the list, such as contraceptive patch, contraceptive vaginal ring, or sponge.
(5) In countries with an active female condom program, the wording of the question should be modified to include reference to both the male
and female condom.
(6) Coding categories to be developed locally; however, the broad categories must be maintained.
(7) High polygyny, high HIV prevalence countries may want to add line number of wife from Q. 407 here in the response category.

M-12
 SECTION 5. FERTILITY PREFERENCES

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

501 CHECK 401:

CURRENTLY MARRIED OR NOT CURRENTLY MARRIED
514
LIVING WITH A PARTNER AND NOT LIVING
WITH A PARTNER

502 CHECK 418:

MAN NOT STERILIZED MAN
514
OR QUESTION NOT ASKED STERILIZED

503 CHECK 407:

(1) ONE WIFE/ MORE THAN
509
PARTNER ONE WIFE/
PARTNER

504 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO .................................... 2
507
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

505 Err:502 HAVE ANOTHER CHILD . . . . . . . . . . . . . . . . . . . 1

NO MORE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
514
UNDECIDED/DON'T KNOW . . . . . . . . . . . . . . . . 8

506 Err:502
MONTHS . . . . . . . . . . . . . . . . . . . 1

YEARS ................... 2
514
SOON/NOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 993

OTHER 996
(SPECIFY)
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998

507 CHECK 208:

HAS NOT
HAS FATHERED FATHERED
CHILDREN CHILDREN HAVE (A/ANOTHER) CHILD ................ 1

a) Err:502 b) Err:502 NO MORE/NONE . . . . . . . . . . . . . . . . . . . . . . . . . 2

SAYS COUPLE CAN’T GET PREGNANT . . . . . . . . 3
WIFE/PARTNER STERILIZED . . . . . . . . . . . . . . . . 4 514
RESPONDENT STERILIZED . . . . . . . . . . . . . . . . 5
UNDECIDED/DON'T KNOW . . . . . . . . . . . . . . . . 8

508 CHECK 208:

HAS NOT MONTHS . . . . . . . . . . . . . . . . . . . 1
HAS FATHERED FATHERED
CHILDREN CHILDREN YEARS ................... 2

a) Err:502 b) Err:502 SOON/NOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 993

SAYS COUPLE 514
CAN’T GET PREGNANT . . . . . . . . . . . . . . . . 994

OTHER 996
(SPECIFY)
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998

509 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

(1) NO .................................... 2
512
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

M-13
 SECTION 5. FERTILITY PREFERENCES

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

510 Err:502 HAVE ANOTHER CHILD . . . . . . . . . . . . . . . . . . . 1

(1) NO MORE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
514
UNDECIDED/DON'T KNOW . . . . . . . . . . . . . . . . 8

511 Err:502
(1) MONTHS . . . . . . . . . . . . . . . . . . . 1

YEARS ................... 2
514
SOON/NOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 993

OTHER 996
(SPECIFY)
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998

512 CHECK 208:

(1) HAS NOT

HAS FATHERED FATHERED
CHILDREN CHILDREN HAVE (A/ANOTHER) CHILD ................ 1

a) Err:502 b) Err:502 NO MORE/NONE . . . . . . . . . . . . . . . . . . . . . . . . . 2

SAYS COUPLE CAN’T GET PREGNANT . . . . . . . . 3
(WIFE/WIVES/PARTNER(S)) STERILIZED . . . . . 4 514
RESPONDENT STERILIZED . . . . . . . . . . . . . . . . 5
UNDECIDED/DON'T KNOW . . . . . . . . . . . . . . . . 8

513 CHECK 208:

(1) HAS NOT MONTHS . . . . . . . . . . . . . . . . . . . 1
HAS FATHERED FATHERED
CHILDREN CHILDREN YEARS ................... 2

a) Err:502 b) Err:502 SOON/NOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 993

SAYS COUPLE
CAN’T GET PREGNANT . . . . . . . . . . . . . . . . 994

OTHER 996
(SPECIFY)
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998

514 CHECK 203 AND 205:

HAS LIVING NO LIVING NONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 601

CHILDREN CHILDREN

a) Err:502 b) Err:502

NUMBER . . . . . . . . . . . . . . . . . . . . . . . . .

OTHER 96 601
(SPECIFY)

PROBE FOR A NUMERIC RESPONSE.

515 Err:502 BOYS GIRLS EITHER

NUMBER . .

OTHER 96
(SPECIFY)

(1) This question should be deleted in countries where polygyny is not practiced.

M-14
 SECTION 6. EMPLOYMENT AND GENDER ROLES

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

601 Err:502 YES .................................... 1 604

NO .................................... 2

602 Err:502
YES .................................... 1 604
NO .................................... 2

603 Err:502 YES .................................... 1

NO .................................... 2 607

604 Err:502

605 Err:502 THROUGHOUT THE YEAR ................ 1

SEASONALLY/PART OF THE YEAR . . . . . . . . . . 2
ONCE IN A WHILE . . . . . . . . . . . . . . . . . . . . . . . . . 3

606 Err:502 CASH ONLY ............................ 1

CASH AND KIND ......................... 2
IN KIND ONLY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
NOT PAID .............................. 4

607 CHECK 401:

CURRENTLY MARRIED OR NOT CURRENTLY MARRIED
LIVING WITH A PARTNER AND 612
NOT LIVING WITH A PARTNER

608 CHECK 606:

CODE '1' OR '2' OTHER
610
CIRCLED

609 Err:502 RESPONDENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

WIFE/PARTNER . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
RESPONDENT AND WIFE/PARTNER JOINTLY . . 3

OTHER 6
(SPECIFY)

610 Err:502 RESPONDENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

WIFE/PARTNER . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
RESPONDENT AND WIFE/PARTNER JOINTLY . . 3
SOMEONE ELSE . . . . . . . . . . . . . . . . . . . . . . . . . 4
OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

611 Err:502 RESPONDENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

WIFE/PARTNER . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
RESPONDENT AND WIFE/PARTNER JOINTLY . . 3
SOMEONE ELSE . . . . . . . . . . . . . . . . . . . . . . . . . 4
OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

M-15
 SECTION 6. EMPLOYMENT AND GENDER ROLES

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

612 Err:502 ALONE ONLY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 01

JOINTLY WITH WIFE/PARTNER ONLY ..... 02
JOINTLY WITH SOMEONE ELSE ONLY ..... 03
JOINTLY WITH WIFE/PARTNER
AND SOMEONE ELSE ................ 04
BOTH ALONE AND JOINTLY . . . . . . . . . . . . . . . . 05
DOES NOT OWN . . . . . . . . . . . . . . . . . . . . . . . . . 06 615

613 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO .................................... 2
615
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

614 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO .................................... 2
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

615 Err:502 ALONE ONLY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 01

JOINTLY WITH WIFE/PARTNER ONLY ..... 02
JOINTLY WITH SOMEONE ELSE ONLY ..... 03
JOINTLY WITH WIFE/PARTNER
AND SOMEONE ELSE ................ 04
BOTH ALONE AND JOINTLY . . . . . . . . . . . . . . . . 05
DOES NOT OWN . . . . . . . . . . . . . . . . . . . . . . . . . 06 617A

616 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO .................................... 2
617A
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

617 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO .................................... 2
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

617A Err:502 YES .................................... 1

NO .................................... 2 617C

617B Err:502 YES .................................... 1

NO .................................... 2

617C Err:502
YES .................................... 1
NO .................................... 2

618 Err:502
YES NO DK

a) Err:502 a) GOES OUT . . . . . . . . . . 1 2 8

b) Err:502 b) NEGLECTS CHILDREN . . 1 2 8
c) Err:502 c) ARGUES . . . . . . . . . . . . . 1 2 8
d) Err:502 d) REFUSES SEX . . . . . . . . 1 2 8
e) Err:502 e) BURNS FOOD . . . . . . . . 1 2 8

619 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO .................................... 2
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

M-16
 SECTION 7. HIV/AIDS

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

700 Err:502

701 Err:502 YES .................................... 1

(1) NO .................................... 2 729

702 CHECK 111: AGE

15-24 YEARS 25 YEARS
OR OLDER 708

703 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO .................................... 2
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

704 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO .................................... 2
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

705 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO .................................... 2
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

706 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO .................................... 2
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

707 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO .................................... 2
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

708 Err:502 YES .................................... 1

NO .................................... 2

709 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO .................................... 2
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

710 Err:502 YES .................................... 1

(2)(3) NO .................................... 2 712

711 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

(3) NO .................................... 2
DON'T KNOW/NOT SURE/DEPENDS . . . . . . . . . . 8

712
CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

713 Err:502 YES .................................... 1

NO .................................... 2 721

714 Err:502
MONTH .........................

DON'T KNOW MONTH ................... 98

YEAR .............

DON'T KNOW YEAR ................... 9998

M-17
 SECTION 7. HIV/AIDS

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

715 Err:502 PUBLIC SECTOR

(4) GOVERNMENT HOSPITAL . . . . . . . . . . . . . . . . 11
GOVERNMENT HEALTH CENTER . . . . . . . . 12
STAND-ALONE HTC CENTER . . . . . . . . . . . . . 13
FAMILY PLANNING CLINIC ............. 14
MOBILE HTC SERVICES . . . . . . . . . . . . . . . . 15
OTHER PUBLIC SECTOR

16
(SPECIFY)

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL ................... 21
PRIVATE CLINIC ...................... 22
PRIVATE DOCTOR . . . . . . . . . . . . . . . . . . . . . . 23
STAND-ALONE HTC CENTER . . . . . . . . . . . . . 24
PHARMACY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
MOBILE HTC SERVICES . . . . . . . . . . . . . . . . 26
OTHER PRIVATE MEDICAL SECTOR

27
(SPECIFY)

NGO MEDICAL SECTOR

NGO HOSPITAL . . . . . . . . . . . . . . . . . . . . . . . . . 31
NGO CLINIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
OTHER NGO MEDICAL SECTOR

36
(SPECIFY)

OTHER SOURCE
HOME . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
WORKPLACE . . . . . . . . . . . . . . . . . . . . . . . . . 42
CORRECTIONAL FACILITY . . . . . . . . . . . . . 43

OTHER 96
(SPECIFY)

716 Err:502 YES .................................... 1

NO .................................... 2 720

717 Err:502 POSITIVE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NEGATIVE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
INDETERMINATE . . . . . . . . . . . . . . . . . . . . . . . . . 3 720
DECLINED TO ANSWER . . . . . . . . . . . . . . . . . . . 4

718 Err:502
MONTH .........................

DON'T KNOW MONTH ................... 98

YEAR .............

DON'T KNOW YEAR ................... 9998

SAME DATE AS MOST RECENT HIV TEST . . . . . 95

719 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO .................................... 2
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

M-18
 SECTION 7. HIV/AIDS

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

720 Err:502
NUMBER OF HIV TESTS ..........

721 Err:502 YES .................................... 1

NO .................................... 2 723

722 Err:502 YES .................................... 1

NO .................................... 2

723 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO .................................... 2
DON'T KNOW/NOT SURE/DEPENDS . . . . . . . . . . 8

724 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO .................................... 2
DON'T KNOW/NOT SURE/DEPENDS . . . . . . . . . . 8

725 CHECK 717:

(5) CODE '1' OTHER
729
CIRCLED

726 Err:502 YES .................................... 1

(5) NO .................................... 2

727 Err:502 AGREE .............................. 1

(5) DISAGREE ............................ 2

728 Err:502
(5)
YES NO

a)
Err:502 a) PEOPLE TALK BADLY . . . . . . . . . . 1 2

b)
Err:502 b) DISCLOSED STATUS .......... 1 2

c)
Err:502 c) VERBALLY INSULTED . . . . . . . . . . 1 2

d) d) HEALTHCARE WORKERS
Err:502 TALKED BADLY . . . . . . . . . . . . . 1 2

e) Err:502 e) HEALTHCARE WORKERS

VERBALLY ABUSED . . . . . . . . 1 2

729 CHECK 701:

(1) HEARD ABOUT NOT HEARD ABOUT
HIV OR AIDS HIV OR AIDS

a) Err:502 b) Err:502
YES .................................... 1
NO .................................... 2

730 CHECK 414:

HAS HAD SEXUAL NEVER HAD SEXUAL
735
INTERCOURSE INTERCOURSE

M-19
 SECTION 7. HIV/AIDS

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

731 CHECK 729: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES NO
733

732 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO .................................... 2
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

733 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO .................................... 2
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

734 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO .................................... 2
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

735 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO .................................... 2
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

736 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

(6) NO .................................... 2
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

(1) Delete question 701 in countries where knowledge of HIV and AIDS is nearly universal. If 701 is deleted, revise 729 to remove the reference
to 701 and version b). Only the text from version a) will remain.
(2) PrEP refers to pre-exposure prophylaxis. Use the local term for PrEP, if applicable.
(3) Delete these questions if the country does not have a national PrEP program.
(4) Coding categories to be developed locally; however, the broad categories must be maintained.
(5) These questions are used to report on a UNAIDS Global AIDS Monitoring (GAM) indicator. They should be used in countries with or without
HIV testing. However, if the estimated HIV prevalence in a country is below 1%, it is advisable to remove these questions, as the number of
self-reported HIV positive respondents will be extremely low, even at the national level. For countries with estimated HIV prevalence below 2%,
anticipated sample size should be considered in deciding whether to retain or remove the questions.

(6) In polygynous societies, the phrase 'other women' should be replaced by the phrase 'women other than his wives.'

M-20
 SECTION 8. OTHER HEALTH ISSUES

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

801 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO .................................... 2
806
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

802 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

(1) NO .................................... 2
804
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

803 Err:502
(1) AGE IN COMPLETED YEARS . . . . . . . .

DURING CHILDHOOD (<5 YEARS) . . . . . . . . . . 95

DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

804 Err:502 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

(1) NO .................................... 2
806
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

805 Err:502
(1) AGE IN COMPLETED YEARS . . . . . . . .

DURING CHILDHOOD (<5 YEARS) . . . . . . . . . . 95

DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

806 Err:502 EVERY DAY ............................ 1 809

SOME DAYS ............................ 2
NOT AT ALL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 808

807 Err:502 YES .................................... 1

810
NO .................................... 2

808 Err:502 EVERY DAY ............................ 1

SOME DAYS ............................ 2 811
NOT AT ALL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

809 Err:502
(2)

NUMBER DAILY

a) Err:502 a) MANUFACTURED
CIGARETTES ........

b) Err:502 b) HAND-ROLLED
CIGARETTES ........

c) Err:502
c) KRETEKS .............

d) Err:502 d) PIPES FULL OF

811
TOBACCO . . . . . . . . . .

e) Err:502 e) CIGARS, CHEROOTS,

OR CIGARILLOS .....

f) Err:502 f) NUMBER OF WATER

PIPE SESSIONS .....

g) Err:502
g) OTHERS . . . . . . . . . . . . . . . .
(SPECIFY)

M-21
 SECTION 8. OTHER HEALTH ISSUES

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

810 Err:502
(2)

NUMBER WEEKLY

a) Err:502 a) MANUFACTURED
CIGARETTES ........

b) Err:502 b) HAND-ROLLED
CIGARETTES ........

c) Err:502
c) KRETEKS .............

d) Err:502 d) PIPES FULL OF

TOBACCO . . . . . . . . . .

e) Err:502 e) CIGARS, CHEROOTS,

OR CIGARILLOS .....

f) Err:502 f) NUMBER OF WATER

PIPE SESSIONS .....

g) Err:502
g) OTHERS . . . . . . . . . . . . . . . .
(SPECIFY)

811 Err:502 EVERY DAY ............................ 1

SOME DAYS ............................ 2 813
NOT AT ALL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 814

812 Err:502
(2)

TIMES DAILY

a) Err:502
a) SNUFF, BY MOUTH . . . . . . . .

b) Err:502
b) SNUFF, BY NOSE ........

c) Err:502
814
c) CHEWING TOBACCO . . . . .

d) Err:502 d) BETEL QUID

WITH TOBACCO .....

e) Err:502
e) ANY OTHERS ..........
(SPECIFY)

M-22
 SECTION 8. OTHER HEALTH ISSUES

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

813 Err:502
(2)

TIMES WEEKLY

a) Err:502
a) SNUFF, BY MOUTH . . . . . . . .

b) Err:502
b) SNUFF, BY NOSE ........

c) Err:502
c) CHEWING TOBACCO . . . . .

d) Err:502 d) BETEL QUID

WITH TOBACCO .....

e) Err:502
e) ANY OTHERS ..........
(SPECIFY)

814 Err:502 YES .................................... 1

NO .................................... 2 817

815 Err:502 DID NOT HAVE EVEN ONE DRINK .......... 00 817

NUMBER OF DAYS . . . . . . . . . . . . . . . .

EVERY DAY/ALMOST EVERY DAY .......... 95

816 Err:502
NUMBER OF DRINKS . . . . . . . . . . . . .

817 Err:502 YES .................................... 1

(3) NO .................................... 2 819

818 Err:502 MUTUAL HEALTH ORGANIZATION/

(3) COMMUNITY-BASED HEALTH
INSURANCE ......................... A
HEALTH INSURANCE THROUGH
EMPLOYER . . . . . . . . . . . . . . . . . . . . . . . . . . . . B
SOCIAL SECURITY ...................... C
OTHER PRIVATELY PURCHASED
COMMERCIAL HEALTH INSURANCE ..... D

OTHER X
(SPECIFY)

819 RECORD THE TIME.

HOURS .........................

MINUTES . . . . . . . . . . . . . . . . . . . . . . . . .

(1) Question may be omitted depending on the practice of male circumcision in specific countries. Information on type of circumcision is most
relevant for interpreting HIV prevalence estimates. Questions on type of circumcision must be retained in surveys that include HIV serology
testing.
(2) Add local terms.
(3) All response categories are to be adapted to the country environment. If a health service prepayment plan or other types of plans are
available in the country, add those types of plans to the question in Qs. 817 and 818 and to the response codes in Q. 818.

M-23
 INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT INTERVIEW:

COMMENTS ON SPECIFIC QUESTIONS:

ANY OTHER COMMENTS:

SUPERVISOR'S OBSERVATIONS

M-24
CSPro Field CSPro Condition Question Num ENGLISH LANGUAGE 2
Translation Date 03 Feb 2023
Language Number 01 02
Language Code EN
Hello. My name is
_______________________________________. I am
working with [NAME OF ORGANIZATION]. We are
conducting a survey about health and other topics all
over [NAME OF COUNTRY]. The information we collect
will help the government to plan health services. Your
household was 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. You
don't have to be in the survey, but we hope you will
agree to answer the questions since your views are
INTRODUCTION important. If I ask you any question you don't want to
ACONSENT AQTYPE = 2
AND CONSENT answer, just let me know and I will go on to the next
question or you can stop the interview at any time.

In case you need more information about the survey, you

may contact the person listed on the card that has
already been given to your household.

Do you have any questions?

May I begin the interview now?

AM102 102 What [PROVINCE/REGION/STATE] were you born in?

AM103 103 What country were you born in?
How long have you been living continuously in (NAME
OF CURRENT CITY, TOWN OR VILLAGE OF
AM104 104 RESIDENCE)?

IF LESS THAN ONE YEAR, RECORD ‘00’ YEARS.

AM106_BLOCK 106 In what month and year did you move here?
Just before you moved here, which
AM107 107
[PROVINCE/REGION/STATE] did you live in?
Just before you moved here, did you live in a city, in a
AM108 108 town, or in a rural area?
AM109 109 Why did you move to this place?
AM110_BLOCK 110 In what month and year were you born?
How old were you at your last birthday?
AM111 111 COMPARE AND CORRECT 105 AND/OR 106 IF
INCONSISTENT.
CSPro Field CSPro Condition Question Num ENGLISH LANGUAGE 2
In general, would you say your health is very good, good,
AM112 112
moderate, bad, or very bad?
AM113 113 Have you ever attended school?
What is the highest level of school you attended: primary,
AM114 114
secondary, or higher?
What is the highest [GRADE/FORM/YEAR] you
completed at that level?
AM115 115
IF COMPLETED LESS THAN ONE YEAR AT THAT
LEVEL, RECORD '00'.
Now I would like you to read this sentence to me.

SHOW CARD TO RESPONDENT.

AM117 117
IF RESPONDENT CANNOT READ WHOLE
SENTENCE,
PROBE: Can you read any part of the sentence to me?

Do you read a newspaper or magazine at least once a

AM119 119
week, less than once a week or not at all?
Do you listen to the radio at least once a week, less than
AM120 120
once a week or not at all?
Do you watch television at least once a week, less than
AM121 121
once a week or not at all?
AM122 122 Do you own a mobile phone?
AM123 123 Is your mobile phone a smart phone?
Have you ever used the Internet from any location on any
AM127 127 device?
In the last 12 months, have you used the Internet?
AM128 128 IF NECESSARY, PROBE FOR USE FROM ANY
LOCATION, WITH ANY DEVICE.
During the last one month, how often did you use the
AM129 129 Internet: almost every day, at least once a week, less
than once a week, or not at all?
AM130 130 What is your religion?
AM131 131 What is your ethnic group?
Now I would like to ask about any children you have had
during your life. I am interested in all of the children that
AM201 201 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?
Do you have any sons or daughters that you have
AM202 202
fathered who are now living with you?
CSPro Field CSPro Condition Question Num ENGLISH LANGUAGE 2
How many sons live with you?
AM203A 203a)
IF NONE, RECORD '00'.
And how many daughters live with you?
AM203B 203b)
IF NONE, RECORD '00'.
Do you have any sons or daughters that you have
AM204 204 fathered who are alive but do not live with you?
How many sons are alive but do not live with you?
AM205A 205a)
IF NONE, RECORD '00'.
And how many daughters are alive but do not live with
you?
AM205B 205b)
IF NONE, RECORD '00'.
Have you ever fathered a son or a daughter who was
born alive but later died?

AM206 206 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?

How many boys have died?

AM207A 207a)
IF NONE, RECORD '00'.
And how many girls have died?
AM207B 207b)
IF NONE, RECORD '00'.
Did all of the children you have fathered have the same
AM210 210
biological mother?
AM211 AM208 > 1 211a) How old were you when your first child was born?
AM211 AM208 = 1 211b) How old were you when your child was born?
AM213 lchild > 1 213a) How old is your youngest child?
AM213 lchild = 1 213b) How old is your child?
AM215 lchild > 1 215a) What is the name of your youngest child?
AM215 lchild = 1 215b) What is the name of your child?
When (NAME IN 215)'s mother was pregnant with
AM216 216
(NAME IN 215), did she have any antenatal check-ups?
Were you ever present during any of those antenatal
AM217 217
check-ups?
AM218 218 Was (NAME IN 215) born in a hospital or health facility?
Did you go with (NAME IN 215)'s mother to the hospital
AM219 219
or health facility where she gave birth to (NAME IN 215)?
CSPro Field CSPro Condition Question Num ENGLISH LANGUAGE 2
Now I would like to talk about family planning - the
AM301_INTRO 301 various ways or methods that a couple can use to delay
or avoid a pregnancy.
Have you heard of Female Sterilization?
AM301 curocc() in 1 301.01 PROBE: Women can have an operation to avoid having
any more children.
Have you heard of Male Sterilization?
AM301 curocc() in 2 301.02 PROBE: Men can have an operation to avoid having any
more children.
Have you heard of IUD?
PROBE: Women can have a loop or coil placed inside
AM301 curocc() in 3 301.03 them by a doctor or a nurse which can prevent
pregnancy for one or more years.
Have you heard of Injectables?
PROBE: Women can have an injection by a health
AM301 curocc() in 4 301.04 provider that stops them from becoming pregnant for one
or more months.
Have you heard of Implants?
PROBE: Women can have one or more small rods
AM301 curocc() in 5 301.05 placed in their upper arm by a doctor or nurse which can
prevent pregnancy for one or more years.
Have you heard of Pill?
AM301 curocc() in 6 301.06 PROBE: Women can take a pill every day to avoid
becoming pregnant.
Have you heard of Condom?
AM301 curocc() in 7 301.07 PROBE: Men can put a rubber sheath on their penis
before sexual intercourse.
Have you heard of Female Condom?
AM301 curocc() in 8 301.08 PROBE: Women can place a sheath in their vagina
before sexual intercourse.
Have you heard of Emergency Contraception?
PROBE: As an emergency measure, within 3 days after
AM301 curocc() in 9 301.09 they have unprotected sexual intercourse, women can
take special pills to prevent pregnancy.
Have you heard of Standard Days Method?
PROBE: A woman uses a string of colored beads to
AM301 curocc() in 10 301.10 know the days she can get pregnant. On the days she
can get pregnant, she uses a condom or does not have
sexual intercourse.
Have you heard of Lactational Amenorrhea Method
(LAM)?
AM301 curocc() in 11 301.11 PROBE: Up to 6 months after childbirth, before the
menstrual period has returned, women use a method
requiring frequent breastfeeding day and night.
CSPro Field CSPro Condition Question Num ENGLISH LANGUAGE 2
Have you heard of Rhythm Method?
PROBE: To avoid pregnancy, women do not have sexual
AM301 curocc() in 12 301.12 intercourse on the days of the month they think they can
get pregnant.
Have you heard of Withdrawal?
AM301 curocc() in 13 301.13
PROBE: Men can be careful and pull out before climax.
Have you heard of any other ways or methods that
AM301 curocc() in 14:15 301.14
women or men can use to avoid pregnancy?
AM302_BLOCK 302 In the last 12 months have you:
AM302A 302a) Heard about family planning on the radio?
AM302B 302b) Seen anything about family planning on the television?
AM302C 302c) Read about family planning in a newspaper or
magazine?
Received a voice or text message about family planning
AM302D 302d)
on a mobile phone?
Seen anything about family planning on social media
AM302E 302e)
such as Facebook, Twitter, or Instagram?
Seen anything about family planning on a poster, leaflet
AM302F 302f)
or brochure?
Seen anything about family planning on an outdoor sign
AM302G 302g)
or billboard?
Heard anything about family planning at community
AM302H 302h)
meetings or events?
In the last few months, have you discussed family
AM303 303
planning with a health worker or health professional?
Now I would like to ask you about a woman's risk of
pregnancy. From one menstrual period to the next, are
AM304 304 there certain days when a woman is more likely to
become pregnant when she has sexual relations?
Is this time just before her period begins, during her
AM305 305 period, right after her period has ended, or halfway
between two periods?
After the birth of a child, can a woman become pregnant
AM306 306
before her menstrual period has returned?
I will now read you some statements about
AM307_BLOCK 307
contraception. Please tell me if you agree or disagree
with each one. is a woman’s concern and a man should
Contraception
AM307A 307a)
not have to worry about it.
Women who use contraception may become
AM307B 307b)
promiscuous.
Are you currently married or living together with a woman
AM401 401 as if married?
Have you ever been married or lived together with a
AM402 402 woman as if married?
What is your marital status now: are you widowed,
AM403 403
divorced, or separated?
CSPro Field CSPro Condition Question Num ENGLISH LANGUAGE 2
Is your (wife/partner) living with you now or is she staying
AM404 404
elsewhere?
Do you have other wives or do you live with other women
AM405 405
as if married?
Altogether, how many wives or live-in partners do you
AM406 406
have?
407a) Please tell me the name of your (wife/partner).
Please tell me the name of your (first/next) wife or
407b)
woman you are living with as if married.
Please tell me the name of your first wife or woman you
are living with as if married.

RECORD THE PARTNER'S LINE NUMBER FROM THE

HOUSEHOLD QUESTIONNAIRE FOR THE FIRST
AM407 AM405 = 1 & curocc() in 1 407 WIFE AND LIVE-IN PARTNER.

IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD,

RECORD '00'.

Please tell me the name of your next wife or woman you

are living with as if married.

RECORD THE PARTNER'S LINE NUMBER FROM THE

HOUSEHOLD QUESTIONNAIRE FOR THE NEXT
AM407 AM405 = 1 & curocc() in 2:5 WIFE AND LIVE-IN PARTNER.

IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD,

RECORD '00'.

Please tell me the name of your (wife/partner).

RECORD THE LINE NUMBER FROM THE

AM407 AM405 <> 1 HOUSEHOLD QUESTIONNAIRE.

IF SHE IS NOT LISTED IN THE HOUSEHOLD,

RECORD '00'.

AM408 408 How old was (NAME IN 407) on her last birthday?
Have you been married or lived with a woman only once
AM410 410
or more than once?
In what month and year did you start living with your
AM411_BLOCK marriages = 0 411a)
(wife/partner)?
Now I would like to ask about your first wife or partner. In
AM411_BLOCK marriages = 1 411b)
what month and year did you start living with her?
AM412 412 How old were you when you first started living with her?
CSPro Field CSPro Condition Question Num ENGLISH LANGUAGE 2
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.
AM414 414 If we should come to any question that you don't want to
answer, just let me know and we will go to the next
question. How old were you when you had sexual
intercourse for the very first time?

I would like to ask you about your recent sexual activity.

AM415_BLOCK 415 When was the last time you had sexual intercourse?
The last time you had sexual intercourse, did you or your
AM416 416 partner do something or use any method to delay or
avoid a pregnancy?
Do you know of a place where you can obtain a method
AM417 417 of family planning?
What method did you or your partner use?
AM418 418
RECORD ALL MENTIONED.
The last time you had sexual intercourse, was a condom
AM419 419
used?
What was the brand name of the condom used?
AM420 420
IF BRAND NOT KNOWN, ASK TO SEE THE
PACKAGE.
From where did you obtain the condom the last time?

PROBE TO IDENTIFY TYPE OF SOURCE.

AM421 421
IF UNABLE TO DETERMINE IF PUBLIC, PRIVATE, OR
NGO SECTOR, RECORD '96' AND WRITE THE NAME
OF THE PLACE.

What was your relationship to this person with whom you

had sexual intercourse?

AM422 422 IF GIRLFRIEND: Were you living together as if married?

IF YES, RECORD '2'.

IF NO, RECORD '3'.

Apart from this person, have you had sexual intercourse

AM423 423
with any other person in the last 12 months?
The last time you had sexual intercourse with this second
AM424 424 person, was a condom used?
CSPro Field CSPro Condition Question Num ENGLISH LANGUAGE 2
What was your relationship to this second person with
whom you had sexual intercourse?

AM425 425 IF GIRLFRIEND: Were you living together as if married?

IF YES, RECORD '2'.

IF NO, RECORD '3'.

Apart from these two people, have you had sexual

AM426 426 intercourse with any other person in the last 12 months?
The last time you had sexual intercourse with this third
AM427 427
person, was a condom used?
What was your relationship to this third person with
whom you had sexual intercourse?

AM428 428 IF GIRLFRIEND: Were you living together as if married?

IF YES, RECORD '2'.

IF NO, RECORD '3'.

In total, with how many different people have you had

sexual intercourse in your lifetime?

AM429 429 IF NON-NUMERIC ANSWER, PROBE TO GET AN

ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR
MORE, RECORD '95'.

AM504 504 Is your (wife/partner) currently pregnant?

Now I have some questions about the future. After the
child you and your (wife/partner) are expecting now,
AM505 505 would you like to have another child, or would you prefer
not to have any more children?
After the birth of the child you are expecting now, how
AM506_BLOCK 506 long would you like to wait before the birth of another
child?
Now I have some questions about the future. Would you
AM507 AM208 > 0 507a) like to have another child, or would you prefer not to have
any more children?
Now I have some questions about the future. Would you
AM507 AM208 = 0 507b) like to have a child, or would you prefer not to have any
children?
How long would you like to wait from now before the birth
AM508_BLOCK AM208 > 0 508a)
of another child?
How long would you like to wait from now before the birth
AM508_BLOCK AM208 = 0 508b)
of a child?
AM509 509 Are any of your wives or partners currently pregnant?
CSPro Field CSPro Condition Question Num ENGLISH LANGUAGE 2
Now I have some questions about the future. After the
child you and your wife or partner are expecting now,
AM510 510 would you like to have another child, or would you prefer
not to have any more children?
After the birth of the child you are expecting now, how
AM511_BLOCK 511 long would you like to wait before the birth of another
child?
Now I have some questions about the future. Would you
AM512 AM208 > 0 512a) like to have another child, or would you prefer not to have
any more children?
Now I have some questions about the future. Would you
AM512 AM208 = 0 512b) like to have a child, or would you prefer not to have any
children?
How long would you like to wait from now before the birth
AM513_BLOCK AM208 > 0 513a)
of another child?
How long would you like to wait from now before the birth
AM513_BLOCK AM208 = 0 513b)
of a child?
If you could go back to the time you did not have any
AM514 lchild > 0 514a) children and could choose exactly the number of children
to have in your whole life, how many would that be?
If you could choose exactly the number of children to
AM514 lchild = 0 514b) have in your whole life, how many would that be?
How many of these children would you like to be boys,
AM515_BLOCK 515 how many would you like to be girls and for how many
would it not matter if it’s a boy or a girl?
AM601 601 Have you done any work in the last 7 days?
Although you did not work in the last 7 days, do you have
AM602 602 any job or business from which you were absent for
leave, illness, vacation, or any other such reason?
AM603 603 Have you done any work in the last 12 months?
What is your occupation? That is, what kind of work do
AM604 604
you mainly do?
Do you usually work throughout the year, or do you work
AM605 605
seasonally, or only once in a while?
Are you paid in cash or kind for this work or are you not
AM606 606
paid at all?
Who usually decides how the money you earn will be
AM609 609 used: you, your (wife/partner), or you and your
(wife/partner) jointly?
Who usually makes decisions about health care for
AM610 610 yourself: you, your (wife/partner), you and your
(wife/partner) jointly, or someone else?
Who usually makes decisions about making major
AM611 611
household purchases?
CSPro Field CSPro Condition Question Num ENGLISH LANGUAGE 2
Do you own this or any other house either alone or jointly
AM612 612
with someone else?
Do you have a title deed or other government recognized
AM613 613
document for any house you own?
AM614 614 Is your name on this document?
Do you own any agricultural or non-agricultural land
AM615 615
either alone or jointly with someone else?
Do you have a title deed or other government recognized
AM616 616
document for any land you own?
AM617 617 Is your name on this document?
Do you have an account in a bank or other financial
AM617A 617A
institution that you yourself use?
Did you yourself put money in or take money out of this
AM617B 617B account in the last 12 months?
In the last 12 months, have you used a mobile phone to
make financial transactions such as sending or receiving
AM617C 617C money, paying bills, purchasing goods or services, or
receiving wages?
In your opinion, is a husband justified in hitting or beating
AM618_BLOCK 618
his wife in the following situations:
AM618A 618a) If she goes out without telling him?
AM618B 618b) If she neglects the children?
AM618C 618c) If she argues with him?
AM618D 618d) If she refuses to have sex with him?
AM618E 618e) If she burns the food?
AM619 619 As far as you know did your father ever beat your
mother?
Now I would like to talk about HIV and AIDS.
AM700 700
AM701 701 Have you ever heard of HIV or AIDS?
HIV is the virus that can lead to AIDS. Can people
AM703 703 reduce their chance of getting HIV by having just one
uninfected sex partner who has no other sex partners?
AM704 704 Can people get HIV from mosquito bites?
Can people reduce their chance of getting HIV by using a
AM705 705
condom every time they have sex?
Can people get HIV by sharing food with a person who
AM706 706
has HIV?
AM707 707 Is it possible for a healthy-looking person to have HIV?
Have you heard of ARVs, that is, antiretroviral medicines
AM708 708
that treat HIV?
Are there any special medicines that a doctor or a nurse
AM709 709 can give to a woman infected with HIV to reduce the risk
of transmission to the baby?
CSPro Field CSPro Condition Question Num ENGLISH LANGUAGE 2
Have you heard of PrEP, a medicine taken daily that can
AM710 710
prevent a person from getting HIV?
Do you approve of people who take a pill every day to
AM711 711
prevent getting HIV?
CHECK FOR PRESENCE OF OTHERS. BEFORE
AM712 712 CONTINUING, MAKE EVERY EFFORT TO ENSURE
PRIVACY.
AM713 713 Have you ever been tested for HIV?
AM714_BLOCK 714 In what month and year was your most recent HIV test?
Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

AM715 715 IF UNABLE TO DETERMINE IF PUBLIC, PRIVATE, OR
NGO SECTOR, RECORD '96' AND WRITE THE NAME
OF THE PLACE.

AM716 716 Did you get the results of the test?

AM717 717 What was the result of the test?
In what month and year did you receive your first HIV-
AM718_BLOCK 718 positive test result?
Are you currently taking ARVs, that is antiretroviral
medicines?
AM719 719 By currently, I mean that you may have missed some
doses but you are still taking ARVs.
How many times have you been tested for HIV in your
lifetime?

AM720 720 IF NON-NUMERIC ANSWER, PROBE TO GET AN

ESTIMATE, IF NUMBER OF TESTS IS 95 OR MORE,
RECORD '95'.

Have you heard of test kits people can use to test

AM721 721
themselves for HIV?
Have you ever tested yourself for HIV using a self-test
AM722 722
kit?
Would you buy fresh vegetables from a shopkeeper or
AM723 723 vendor if you knew that this person had HIV?
Do you think children living with HIV should be allowed to
AM724 724
attend school with children who do not have HIV?
Now I would like to ask you a few questions about your
experiences living with HIV.
AM726 726
Have you disclosed your HIV status to anyone other than
me?
Do you agree or disagree with the following statement: I
AM727 727 have felt ashamed because of my HIV status.
CSPro Field CSPro Condition Question Num ENGLISH LANGUAGE 2
Please tell me if the following things have happened to
AM728_BLOCK 728 you, or if you think they have happened to you, because
of your HIV status in the last 12 months:
People have talked badly about me because of my HIV
AM728A 728a)
status.
Someone else disclosed my HIV status without my
AM728B 728b)
permission.
I have been verbally insulted, harassed, or threatened
AM728C 728c)
because of my HIV status.
Healthcare workers talked badly about me because of
AM728D 728d)
my HIV status.
Healthcare workers yelled at me, scolded me, called me
AM728E 728e) names, or verbally abused me in another way because of
my HIV status.
Apart from HIV, have you heard about other infections
AM729 AM701 = 1 729a)
that can be transmitted through sexual contact?
Have you heard about infections that can be transmitted
AM729 AM701 <> 1 729b) through sexual contact?
Now I would like to ask you some questions about your
health in the last 12 months. During the last 12 months,
AM732 732 have you had a disease which you got through sexual
contact?
Sometimes men experience an abnormal discharge from
AM733 733 their penis. During the last 12 months, have you had an
abnormal discharge from your penis?
Sometimes men have a sore or ulcer on or near their
AM734 734 penis. During the last 12 months, have you had a sore or
ulcer on or near your penis?
If a wife knows her husband has a disease that she can
AM735 735 get during sexual intercourse, is she justified in asking
that they use a condom when they have sex?
Is a wife justified in refusing to have sex with her
AM736 736
husband when she knows he has sex with other women?
AM801 801 Some men are circumcised. Are you circumcised?
Some men are traditionally circumcised by a traditional
AM802 802 practitioner, family member or friend. Are you
traditionally circumcised?
AM803 803 How old were you when you got traditionally
circumcised?
Some men are medically circumcised, that is, the
AM804 804 foreskin is completely removed from the penis by a
healthcare worker. Are you medically circumcised?
AM805 805 How old were you when you got medically circumcised?
Do you currently smoke tobacco every day, some days,
AM806 806
or not at all?
AM807 807 In the past, have you smoked tobacco every day?
CSPro Field CSPro Condition Question Num ENGLISH LANGUAGE 2
In the past, have you ever smoked tobacco every day,
AM808 808
some days, or not at all?
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.
AM809_BLOCK 809
IF RESPONDENT REPORTS USING THE PRODUCT
BUT NOT EVERY DAY, RECORD '888'. IF THE
PRODUCT IS NOT USED AT ALL, RECORD '000'.

AM809A 809a) Manufactured cigarettes?

AM809B 809b) Hand-rolled cigarettes?
AM809C 809c) Kreteks?
AM809D 809d) Pipes full of tobacco?
AM809E 809e) Cigars, cheroots, or cigarillos?
AM809F 809f) Number of water pipe sessions?
AM809G 809g) Any others?
On average, how many of the following products do you
currently smoke each week? Also, let me know if you use
the product, but not every week.

AM810_BLOCK 810 IF THE RESPONDENT REPORTS USING THE

PRODUCT, BUT NOT EVERY WEEK, RECORD '888'.
IF THE PRODUCT IS NOT USED AT ALL, RECORD
'000'.

AM810A 810a) Manufactured cigarettes?

AM810B 810b) Hand-rolled cigarettes?
AM810C 810c) Kreteks?
AM810D 810d) Pipes full of tobacco?
AM810E 810e) Cigars, cheroots, or cigarillos?
AM810F 810f) Number of water pipe sessions?
AM810G 810g) Any others?
Do you currently use smokeless tobacco every day,
AM811 811
some days, or not at all?
On average, how many times a day do you use the
following products? Also, let me know if you use the
product, but not every day.
AM812_BLOCK 812
IF THE RESPONDENT REPORTS USING THE
PRODUCT, BUT NOT EVERY DAY, RECORD '888'. IF
THE PRODUCT IS NOT USED AT ALL, RECORD '000'.

AM812A 812a) Snuff, by mouth?

AM812B 812b) Snuff, by nose?
CSPro Field CSPro Condition Question Num ENGLISH LANGUAGE 2
AM812C 812c) Chewing tobacco?
AM812D 812d) Betel quid with tobacco?
AM812E 812e) Any others?
On average, how many times a week do you use the
following products? Also, let me know if you use the
product, but not every week.

AM813_BLOCK 813 IF THE RESPONDENT REPORTS USING THE

PRODUCT, BUT NOT EVERY WEEK, RECORD '888'.
IF THE PRODUCT IS NOT USED AT ALL, RECORD
'000'.

AM813A 813a) Snuff, by mouth?

AM813B 813b) Snuff, by nose?
AM813C 813c) Chewing tobacco?
AM813D 813d) Betel quid with tobacco?
AM813E 813e) Any others?
Now I would like to ask you some questions about
drinking alcohol. Have you ever consumed any alcohol,
AM814 814 such as beer, wine, spirits, or [ADD OTHER LOCAL
EXAMPLES]?
During the last one month, on how many days did you
have an alcoholic drink?

AM815 815 IF NON-NUMERIC ANSWER, PROBE TO GET AN

ESTIMATE. IF RESPONDENT ANSWERS 'EVERY
DAY' OR 'ALMOST EVERY DAY,' CODE '95'.

We count one drink of alcohol as one can or bottle of

beer, one glass of wine, one shot of spirits, or one cup of
[ADD OTHER LOCAL EXAMPLES]. In the last one
AM816 816 month, on the days that you drank alcohol, how many
drinks did you usually have per day?

SHOW PICTURES OF SIZES OF STANDARD DRINKS.

AM817 817 Are you covered by any health insurance?

What type of health insurance are you covered by?
AM818 818
RECORD ALL MENTIONED.
ENGLISH LANGUAGE 3 LANGUAGE 4
03 Feb 2023
01 03 04
EN
Hello. My name is
_______________________________________. I am
working with [NAME OF ORGANIZATION]. We are
conducting a survey about health and other topics all
over [NAME OF COUNTRY]. The information we collect
will help the government to plan health services. Your
household was 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. You
don't have to be in the survey, but we hope you will
agree to answer the questions since your views are
important. If I ask you any question you don't want to
answer, just let me know and I will go on to the next
question or you can stop the interview at any time.

In case you need more information about the survey, you

may contact the person listed on the card that has
already been given to your household.

Do you have any questions?

May I begin the interview now?

What [PROVINCE/REGION/STATE] were you born in?

What country were you born in?
How long have you been living continuously in (NAME
OF CURRENT CITY, TOWN OR VILLAGE OF
RESIDENCE)?

IF LESS THAN ONE YEAR, RECORD ‘00’ YEARS.

In what month and year did you move here?
Just before you moved here, which
[PROVINCE/REGION/STATE] did you live in?
Just before you moved here, did you live in a city, in a
town, or in a rural area?
Why did you move to this place?
In what month and year were you born?
How old were you at your last birthday?

COMPARE AND CORRECT 105 AND/OR 106 IF

INCONSISTENT.
ENGLISH LANGUAGE 5 LANGUAGE 6
03 Feb 2023
01 05 06
EN
Hello. My name is
_______________________________________. I am
working with [NAME OF ORGANIZATION]. We are
conducting a survey about health and other topics all
over [NAME OF COUNTRY]. The information we collect
will help the government to plan health services. Your
household was 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. You
don't have to be in the survey, but we hope you will
agree to answer the questions since your views are
important. If I ask you any question you don't want to
answer, just let me know and I will go on to the next
question or you can stop the interview at any time.

In case you need more information about the survey, you

may contact the person listed on the card that has
already been given to your household.

Do you have any questions?

May I begin the interview now?

What [PROVINCE/REGION/STATE] were you born in?

What country were you born in?
How long have you been living continuously in (NAME
OF CURRENT CITY, TOWN OR VILLAGE OF
RESIDENCE)?

IF LESS THAN ONE YEAR, RECORD ‘00’ YEARS.

In what month and year did you move here?
Just before you moved here, which
[PROVINCE/REGION/STATE] did you live in?
Just before you moved here, did you live in a city, in a
town, or in a rural area?
Why did you move to this place?
In what month and year were you born?
How old were you at your last birthday?

COMPARE AND CORRECT 105 AND/OR 106 IF

INCONSISTENT.
CSPro Variable Human Text Used in Question
~~AM215~~ (NAME IN 215) 216, 218, 219
~~PARTNER~~ (NAME IN 407) 408
~~PARTNER~~ (wife/partner) 404, 407, 411a, 411b, 504, 505, 510, 609, 610
~~PARTNER~~ (wifes/partners) 509
Index CSPro Field CSPro Condition ENGLISH LANGUAGE 2
0 8 Apr 2022
1 01 02
2 EN
In case you need more information about the survey, you may contact the person listed on the card tha
3 ACONSENT AQTYPE = 2
4 AM102 102. What [PROVINCE/REGION/STATE] were you born in?
5 AM103 103.
104. What country
How long havewere
you you
beenborn in?continuously in (NAME OF CURRENT CITY, TOWN OR VILLAG
living
6 AM104
7 AM106_BLOCK IF LESS
106. THAN
In what ONEand
month YEAR,
yearRECORD ‘00’ YEARS.
did you move here?
8 AM107 107. Just before you moved here, which [PROVINCE/REGION/STATE] did you live in?
9 AM108 108. Just before you moved here, did you live in a city, in a town, or in a rural area?
10 AM109 109. Why did you move to this place?
11 AM110_BLOCK 110. How
111. In what
oldmonth andat
were you year were
your last you born?
birthday?
12 AM111
13 AM112 COMPARE ANDwould
112. In general, CORRECT
you say105 AND/OR
your health 106 IF INCONSISTENT.
is very good, good, moderate, bad, or very bad?
14 AM113 113. Have you ever attended school?
15 AM114 114. What is the highest [GRADE/FORM/YEAR]
115. level of school you attended: primary, secondary,
you completed or higher?
at that level?
16 AM115
SHOW CARD TOLESS
IF COMPLETED RESPONDENT.
THAN ONE YEAR AT THAT LEVEL, RECORD '00'.
17 AM117
18 AM119 119. Do you read a newspaper or magazine at least once a week, less than once a week or not at all?
19 AM120 120. Do you listen to the radio at least once a week, less than once a week or not at all?
20 AM121 121. Do you watch television at least once a week, less than once a week or not at all?
21 AM122 122. Do you own a mobile phone?
22 AM123 123. Is your mobile phone a smart phone?
23 AM127 127. In
128. Have
the you
last ever used the
12 months, Internet
have from the
you used anyInternet?
location on any device?
24 AM128
25 AM129 IF NECESSARY,
129. PROBE
During the last FOR USE
one month, how FROM
often didANY
youLOCATION, WITHalmost
use the Internet: ANY DEVICE.
every day, at least once a w
26 AM130 130. What is your religion?
27 AM131 131. What is your ethnic group?
28 AM201 201. Now I would like to ask about any children you have had during your life. I am interested in all of
29 AM202 202. DoHow
203a). youmany
have any
sonssons or daughters
live with you? that you have fathered who are now living with you?
30 AM203A 203b). And how many daughters live with you?
31 AM203B IF NONE, RECORD '00'.
32 AM204 IF NONE,
204. DoHow
205a). RECORD
you have any
many '00'.
sons sons or daughters
are alive but do notthat you
live have
with fathered who are alive but do not live with you
you?
33 AM205A 205b). And how many daughters are alive but do not live with you?
34 AM205B IF NONE,
206. HaveRECORD '00'.
you ever fathered a son or a daughter who was born alive but later died?
35 AM206 IF NONE,
207a). RECORD
How many boys'00'.have died?
36 AM207A IF NO, PROBE:
207b). And howAnymanybaby
girlswhohave cried, who made any movement, sound, or effort to breathe, or who sho
died?
37 AM207B IF NONE, RECORD '00'.
38 AM210 IF NONE,
210. RECORD
Did all '00'. you have fathered have the same biological mother?
of the children
39 AM211 AM208 > 1 211a). How old were you when your first child was born?
40 AM211 AM208 = 1 211b). How old were you when your child was born?
41 AM213 lchild > 1 213a). How old is your youngest child?
42 AM213 lchild = 1 213b). How old is your child?
43 AM215 lchild > 1 215a). What is the name of your youngest child?
44 AM215 lchild = 1 215b). What is the name of your child?
45 AM216 216. When ~~AM215~~'s mother was pregnant with ~~AM215~~, did she have any antenatal check-u
46 AM217 217. Were you ever present during any of those antenatal check-ups?
47 AM218 218. Was ~~AM215~~ born in a hospital or health facility?
48 AM219 219. Did you go with ~~AM215~~'s mother to the hospital or health facility where she gave birth to ~~A
49 AM301_INTRO 301. Now I would like to talk about family planning - the various ways or methods that a couple can us
301.01. Have you heard of Female Sterilization?
50 AM301 curocc() in 1
PROBE: Women
301.02. Have youcan have
heard of an
Maleoperation to avoid having any more children.
Sterilization?
51 AM301 curocc() in 2
PROBE: Have
301.03. Men can
you have
heardan ofoperation
IUD? to avoid having any more children.
52 AM301 curocc() in 3
PROBE: Women
301.04. Have youcan have
heard of aInjectables?
loop or coil placed inside them by a doctor or a nurse which can prevent p
53 AM301 curocc() in 4
PROBE: Have
301.05. Women youcan have
heard of an injection by a health provider that stops them from becoming pregnant fo
Implants?
54 AM301 curocc() in 5
PROBE: Have
301.06. Women youcan have
heard of one
Pill?or more small rods placed in their upper arm by a doctor or nurse whic
55 AM301 curocc() in 6
PROBE: Have
301.07. Women youcan takeofaCondom?
heard pill every day to avoid becoming pregnant.
56 AM301 curocc() in 7
PROBE: Have
301.08. Men can
you put a rubber
heard of Femalesheath on their penis before sexual intercourse.
Condom?
57 AM301 curocc() in 8
PROBE: Women
301.09. Have youcan place
heard a sheath in their
of Emergency vagina before sexual intercourse.
Contraception?
58 AM301 curocc() in 9
PROBE:Have
301.1. As anyouemergency measure,Days
heard of Standard withinMethod?
3 days after they have unprotected sexual intercourse, wom
59 AM301 curocc() in 10
PROBE: A woman
301.11. Have uses aofstring
you heard of colored
Lactational beads to Method
Amenorrhea know the(LAM)?
days she can get pregnant. On the days
60 AM301 curocc() in 11
PROBE: Have
301.12. Up to you
6 months
heard after childbirth,
of Rhythm before the menstrual period has returned, women use a meth
Method?
61 AM301 curocc() in 12
PROBE: Have
301.13. To avoid
you pregnancy, women do not have sexual intercourse on the days of the month they thi
heard of Withdrawal?
62 AM301 curocc() in 13
PROBE: Men can be careful and pull out before climax.
63 AM301 curocc() in 14:15 301.14. Have you heard of any other ways or methods that women or men can use to avoid pregnanc
64 AM302_BLOCK 302. In the last 12 months have you:
65 AM302A 302a). Heard about family planning on the radio?
66 AM302B 302b). Seen anything about family planning on the television?
67 AM302C 302c). Read about family planning in a newspaper or magazine?
68 AM302D 302d). Received a voice or text message about family planning on a mobile phone?
69 AM302E 302e). Seen anything about family planning on social media such as Facebook, Twitter, or Instagram?
70 AM302F 302f). Seen anything about family planning on a poster, leaflet or brochure?
71 AM302G 302g). Seen anything about family planning on an outdoor sign or billboard?
72 AM302H 302h). Heard anything about family planning at community meetings or events?
73 AM303 303. In the last few months, have you discussed family planning with a health worker or health profess
74 AM304 304. Now I would like to ask you about a woman's risk of pregnancy. From one menstrual period to the
75 AM305 305. Is this time just before her period begins, during her period, right after her period has ended, or h
76 AM306 306. After the birth of a child, can a woman become pregnant before her menstrual period has returne
77 AM307_BLOCK 307. I will now read you some statements about contraception. Please tell me if you agree or disagree
78 AM307A 307a). Contraception is a woman’s concern and a man should not have to worry about it.
79 AM307B 307b). Women who use contraception may become promiscuous.
80 AM401 401. Are you currently married or living together with a woman as if married?
81 AM402 402. Have you ever been married or lived together with a woman as if married?
82 AM403 403. What is your marital status now: are you widowed, divorced, or separated?
83 AM404 404. Is your ~~PARTNER~~ living with you now or is she staying elsewhere?
84 AM405 405. Do you have other wives or do you live with other women as if married?
85 AM406 406. Altogether, how many wives or live-in partners do you have?
86 407a). Please tell me the name of (your wife/the woman you are living with as if married).
87 407b). Please tell me the name of your (first/next) wife or woman you are living with as if married.
88 AM407 AM405 = 1 & curocc() in 1 RECORD THE PARTNER'S LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR THE
89 AM407 AM405 = 1 & curocc() in 2:5 RECORD THE PARTNER'S LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR THE
90 AM407 AM405 <> 1 RECORD THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE.
91 AM408 408. How old was ~~PARTNER~~ on her last birthday?
92 AM410 410. Have you been married or lived with a woman only once or more than once?
93 AM411_BLOCK marriages = 0 411a). In what month and year did you start living with your ~~PARTNER~~?
94 AM411_BLOCK marriages = 1 411b). Now I would like to ask about your first ~~PARTNER~~. In what month and year did you start l
95 AM412 412. How old were you when you first started living with her?
96 AM413 413. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO E
97 AM414 414. I would like to ask some questions about sexual activity in order to gain a better understanding of
98 AM415_BLOCK 415. I would like to ask you about your recent sexual activity. When was the last time you had sexual i
99 AM416 416. The last time you had sexual intercourse, did you or your partner do something or use any metho
100 AM417 417. What
418. Do you know of
method dida you
place
or where you can
your partner obtain a method of family planning?
use?
101 AM418
102 AM419 RECORD
419. What
420. ALL
The last
was MENTIONED.
time
theyou hadname
brand sexualof intercourse,
the condom was a condom used?
used?
103 AM420
104 AM421 IF BRAND
PROBE TONOT KNOWN,
IDENTIFY ASK
TYPE OFTO SEE THE PACKAGE.
SOURCE.
IF GIRLFRIEND: Were you living together as if married?
105 AM422
106 AM423 423. Apart from this person, have you had sexual intercourse with any other person in the last 12 mon
107 AM424 424. The last time you had sexual intercourse with this second person, was a condom used?
IF GIRLFRIEND: Were you living together as if married?
108 AM425
109 AM426 426. Apart from these two people, have you had sexual intercourse with any other person in the last 1
110 AM427 427. The last time you had sexual intercourse with this third person, was a condom used?
IF GIRLFRIEND: Were you living together as if married?
111 AM428 429. In total, with how many different people have you had sexual intercourse in your lifetime?
112 AM429
113 AM504 IF NON-NUMERIC
504. ANSWER,currently
Is your ~~PARTNER~~ PROBE pregnant?
TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 O
114 AM505 505. Now I have some questions about the future. After the child you and your ~~PARTNER~~ are ex
115 AM506_BLOCK 506. After the birth of the child you are expecting now, how long would you like to wait before the birth
116 AM507 AM208 > 0 507a). Now I have some questions about the future. Would you like to have another child, or would yo
117 AM507 AM208 = 0 507b). Now I have some questions about the future. Would you like to have a child, or would you prefe
118 AM508_BLOCK AM208 > 0 508a). How long would you like to wait from now before the birth of another child?
119 AM508_BLOCK AM208 = 0 508b). How long would you like to wait from now before the birth of a child?
120 AM509 509. Are any of your (wives/partners) currently pregnant?
121 AM510 510. Now I have some questions about the future. After the child you and your ~~PARTNER~~ are ex
122 AM511_BLOCK 511. After the birth of the child you are expecting now, how long would you like to wait before the birth
123 AM512 AM208 > 0 512a). Now I have some questions about the future. Would you like to have another child, or would yo
124 AM512 AM208 = 0 512b). Now I have some questions about the future. Would you like to have a child, or would you prefe
125 AM513_BLOCK AM208 > 0 513a). How long would you like to wait from now before the birth of another child?
126 AM513_BLOCK AM208 = 0 513b). How long would you like to wait from now before the birth of a child?
127 AM514 lchild > 0 514a). If you could go back to the time you did not have any children and could choose exactly the num
128 AM514 lchild = 0 514b). If you could choose exactly the number of children to have in your whole life, how many would
129 AM515_BLOCK 515. How many of these children would you like to be boys, how many would you like to be girls and f
130 AM601 601. Have you done any work in the last 7 days?
131 AM602 602. Although you did not work in the last 7 days, do you have any job or business from which you we
132 AM603 603. Have you done any work in the last 12 months?
133 AM604 604. What is your occupation? That is, what kind of work do you mainly do?
134 AM605 605. Do you usually work throughout the year, or do you work seasonally, or only once in a while?
135 AM606 606. Are you paid in cash or kind for this work or are you not paid at all?
136 AM609 609. Who usually decides how the money you earn will be used: you, your ~~PARTNER~~, or you an
137 AM610 610. Who usually makes decisions about health care for yourself: you, your ~~PARTNER~~, you and
138 AM611 611. Who usually makes decisions about making major household purchases?
139 AM612 612. Do you own this or any other house either alone or jointly with someone else?
140 AM613 613. Do you have a title deed or other government recognized document for any house you own?
141 AM614 614. Is your name on this document?
142 AM615 615. Do you own any agricultural or non-agricultural land either alone or jointly with someone else?
143 AM616 616. Do you have a title deed or other government recognized document for any land you own?
144 AM617 617. Is your name on this document?
145 AM617A 617A. Do you have an account in a bank or other financial institution that you yourself use?
146 AM617B 617B. Did you yourself put money in or take money out of this account in the last 12 months?
147 AM617C 617C. In the last 12 months, have you used a mobile phone to make financial transactions such as se
148 AM618_BLOCK 618. In your opinion, is a husband justified in hitting or beating his wife in the following situations:
149 AM618A 618a). If she goes out without telling him?
150 AM618B 618b). If she neglects the children?
151 AM618C 618c). If she argues with him?
152 AM618D 618d). If she refuses to have sex with him?
153 AM618E 618e). If she burns the food?
154 AM619 619. As far as you know did your father ever beat your mother?
155 AM700 700. Now I would like to talk about HIV and AIDS.
156 AM701 701. Have you ever heard of HIV or AIDS?
157 AM703 703. HIV is the virus that can lead to AIDS. Can people reduce their chance of getting HIV by having ju
158 AM704 704. Can people get HIV from mosquito bites?
159 AM705 705. Can people reduce their chance of getting HIV by using a condom every time they have sex?
160 AM706 706. Can people get HIV by sharing food with a person who has HIV?
161 AM707 707. Is it possible for a healthy-looking person to have HIV?
162 AM708 708. Have you heard of ARVs, that is, antiretroviral medicines that treat HIV?
163 AM709 709. Are there any special medicines that a doctor or a nurse can give to a woman infected with HIV to
164 AM710 710. Have you heard of PrEP, a medicine taken daily that can prevent a person from getting HIV?
165 AM711 711. Do you approve of people who take a pill every day to prevent getting HIV?
166 AM712 712. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO E
167 AM713 713. Have you ever been tested for HIV?
168 AM714_BLOCK 714. In what month and year was your most recent HIV test?
169 AM715
PROBE TO IDENTIFY THE TYPE OF SOURCE.
170 AM716 716. Did you get the results of the test?
171 AM717 717. What was the result of the test?
172 AM718_BLOCK 718. In what month and year did you receive your first HIV-positive test result?
719. Are you currently taking ARVs, that is antiretroviral medicines?
173 AM719 720. How many times have
By currently, I mean that youyou
maybeen
havetested forsome
missed HIV indoses
your lifetime?
but you are still taking ARVs.
174 AM720
175 AM721 IF NON-NUMERIC
721. Have you heard ANSWER, PROBE
of test kits peopleTO
canGET
use AN ESTIMATE,
to test themselvesIF NUMBER
for HIV? OF TESTS IS 95 OR MO
176 AM722 722. Have you ever tested yourself for HIV using a self-test kit?
177 AM723 723. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had H
178 AM724 724. Now
726. Do you think like
I would children
to askliving
you with
a fewHIV should be
questions allowed
about your to attend school
experiences with
living children
with HIV. who do not
179 AM726
180 AM727 Have youyou
727. Do disclosed
agree oryour HIV status
disagree with to
theanyone other
following than me?
statement: I have felt ashamed because of my HIV s
181 AM728_BLOCK 728. Please tell me if the following things have happened to you, or if you think they have happened to
182 AM728A 728a). People have talked badly about me because of my HIV status.
183 AM728B 728b). Someone else disclosed my HIV status without my permission.
184 AM728C 728c). I have been verbally insulted, harassed, or threatened because of my HIV status.
185 AM728D 728d). Healthcare workers talked badly about me because of my HIV status.
186 AM728E 728e). Healthcare workers yelled at me, scolded me, called me names, or verbally abused me in anot
187 AM729 AM701 = 1 729a). Apart from HIV, have you heard about other infections that can be transmitted through sexual c
188 AM729 AM701 <> 1 729b). Have you heard about infections that can be transmitted through sexual contact?
189 AM732 732. Now I would like to ask you some questions about your health in the last 12 months. During the la
190 AM733 733. Sometimes men experience an abnormal discharge from their penis. During the last 12 months, h
191 AM734 734. Sometimes men have a sore or ulcer on or near their penis. During the last 12 months, have you
192 AM735 735. If a wife knows her husband has a disease that she can get during sexual intercourse, is she just
193 AM736 736. Is a wife justified in refusing to have sex with her husband when she knows he has sex with other
194 AM801 801. Some men are circumcised. Are you circumcised?
195 AM802 802. Some men are traditionally circumcised by a traditional practitioner, family member or friend. Are
196 AM803 803. How old were you when you got traditionally circumcised?
197 AM804 804. Some men are medically circumcised, that is, the foreskin is completely removed from the penis
198 AM805 805. How old were you when you got medically circumcised?
199 AM806 806. Do you currently smoke tobacco every day, some days, or not at all?
200 AM807 807. In the past, have you smoked tobacco every day?
201 AM808 808.
809. In
Onthe past, have
average, how you
manyever smoked
of the tobacco
following everydo
products day,
yousome days,smoke
currently or not each
at all?day? Also, let me
202 AM809_BLOCK
203 AM809A IF RESPONDENT
809a). ManufacturedREPORTS USING THE PRODUCT BUT NOT EVERY DAY, RECORD '888'. IF TH
cigarettes?
204 AM809B 809b). Hand-rolled cigarettes?
205 AM809C 809c). Kreteks?
206 AM809D 809d). Pipes full of tobacco?
207 AM809E 809e). Cigars, cheroots, or cigarillos?
208 AM809F 809f). Number of water pipe sessions?
209 AM809G 809g).OnAny
810. others?how many of the following products do you currently smoke each week? Also, let m
average,
210 AM810_BLOCK
211 AM810A IF THE Manufactured
810a). RESPONDENT REPORTS USING THE PRODUCT, BUT NOT EVERY WEEK, RECORD '888
cigarettes?
212 AM810B 810b). Hand-rolled cigarettes?
213 AM810C 810c). Kreteks?
214 AM810D 810d). Pipes full of tobacco?
215 AM810E 810e). Cigars, cheroots, or cigarillos?
216 AM810F 810f). Number of water pipe sessions?
217 AM810G 810g). Any others?
218 AM811 811. On
812. Do you currently
average, howuse
manysmokeless tobacco
times a day every
do you use day, some days,
the following or not at
products? all? let me know if you u
Also,
219 AM812_BLOCK
220 AM812A IF THE Snuff,
812a). RESPONDENT
by mouth?REPORTS USING THE PRODUCT, BUT NOT EVERY DAY, RECORD '888'.
221 AM812B 812b). Snuff, by nose?
222 AM812C 812c). Chewing tobacco?
223 AM812D 812d). Betel quid with tobacco?
224 AM812E 812e).
813. OnAny others?how many times a week do you use the following products? Also, let me know if you
average,
225 AM813_BLOCK
226 AM813A IF THE Snuff,
813a). RESPONDENT
by mouth?REPORTS USING THE PRODUCT, BUT NOT EVERY WEEK, RECORD '888
227 AM813B 813b). Snuff, by nose?
228 AM813C 813c). Chewing tobacco?
229 AM813D 813d). Betel quid with tobacco?
230 AM813E 813e). Any others?
231 AM814 814.
815. Now I would
During like
the last to ask
one youon
month, some
howquestions about
many days drinking
did you havealcohol. Havedrink?
an alcoholic you ever consumed an
232 AM815 816. We count one drink of alcohol as one can or bottle of beer, one glass of wine, one shot of spirits,
233 AM816 IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF RESPONDENT ANSWERS 'EVER
234 AM817 SHOW
818. PICTURES
817. What
Are you covered
type OFbySIZES
of health OF STANDARD
any health
insurance insurance?
are DRINKS.
you covered by?
235 AM818
RECORD ALL MENTIONED.
 LANGUAGE 3 LANGUAGE 4 LANGUAGE 5 LANGUAGE 6

03 04 05 06

he person listed on the card that has already been given to your household.

ENT CITY, TOWN OR VILLAGE OF RESIDENCE)?

E] did you live in?

te, bad, or very bad?

ary, or higher?

than once a week or not at all?

week or not at all?
eek or not at all?

most every day, at least once a week, less than once a week, or not at all?

our 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
re now living with you?

re alive but do not live with you?

ut later died?

, or effort to breathe, or who showed any other signs of life even if for a very short time?

she have any antenatal check-ups?

cility where she gave birth to ~~AM215~~?

or methods that a couple can use to delay or avoid a pregnancy._x000D_(AFTER READING, CLICK ENTER OR THE ADVANCE BUTTON TO CONTINUE)

r or a nurse which can prevent pregnancy for one or more years.

hem from becoming pregnant for one or more months.
r arm by a doctor or nurse which can prevent pregnancy for one or more years.

rotected sexual intercourse, women can take special pills to prevent pregnancy.
e can get pregnant. On the days she can get pregnant, she uses a condom or does not have sexual intercourse.
as returned, women use a method requiring frequent breastfeeding day and night.
n the days of the month they think they can get pregnant.

men can use to avoid pregnancy?

 acebook, Twitter, or Instagram?

health worker or health professional?

rom one menstrual period to the next, are there certain days when a woman is more likely to become pregnant when she has sexual relations?
after her period has ended, or halfway between two periods?
er menstrual period has returned?
tell me if you agree or disagree with each one.
e to worry about it.

with as if married).
are living with as if married.
D QUESTIONNAIRE FOR THE FIRST WIFE AND LIVE-IN PARTNER.
D QUESTIONNAIRE FOR THE NEXT WIFE AND LIVE-IN PARTNER.

t month and year did you start living with her?

G, MAKE EVERY EFFORT TO ENSURE PRIVACY.

o 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 c
as the last time you had sexual intercourse?
do something or use any method to delay or avoid a pregnancy?

other person in the last 12 months?

was a condom used?

h any other person in the last 12 months?

as a condom used?
rcourse in your lifetime?

MBER OF PARTNERS IS 95 OR MORE, RECORD '95'.

nd your ~~PARTNER~~ are expecting now, would you like to have another child, or would you prefer not to have any more children?
you like to wait before the birth of another child?
have another child, or would you prefer not to have any more children?
have a child, or would you prefer not to have any children?

nd your ~~PARTNER~~ are expecting now, would you like to have another child, or would you prefer not to have any more children?
you like to wait before the birth of another child?
have another child, or would you prefer not to have any more children?
have a child, or would you prefer not to have any children?

nd could choose exactly the number of children to have in your whole life, how many would that be?
our whole life, how many would that be?
would you like to be girls and for how many would it not matter if it’s a boy or a girl?
 or business from which you were absent for leave, illness, vacation, or any other such reason?

ally, or only once in a while?

your ~~PARTNER~~, or you and your ~~PARTNER~~ jointly?

your ~~PARTNER~~, you and your ~~PARTNER~~ jointly, or someone else?

ent for any house you own?

or jointly with someone else?

ent for any land you own?

hat you yourself use?

in the last 12 months?
nancial transactions such as sending or receiving money, paying bills, purchasing goods or services, or receiving wages?
in the following situations:

hance of getting HIV by having just one uninfected sex partner who has no other sex partners?

m every time they have sex?

to a woman infected with HIV to reduce the risk of transmission to the baby?
a person from getting HIV?

G, MAKE EVERY EFFORT TO ENSURE PRIVACY.

e still taking ARVs.

MBER OF TESTS IS 95 OR MORE, RECORD '95'.

ou knew that this person had HIV?

school with
es living children
with HIV. who do not have HIV?

ashamed because of my HIV status.

you think they have happened to you, because of your HIV status in the last 12 months:

of my HIV status.

s, or verbally abused me in another way because of my HIV status.

be transmitted through sexual contact?
h sexual contact?
he last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?
nis. During the last 12 months, have you had an abnormal discharge from your penis?
ng the last 12 months, have you had a sore or ulcer on or near your penis?
g sexual intercourse, is she justified in asking that they use a condom when they have sex?
he knows he has sex with other women?

er, family member or friend. Are you traditionally circumcised?

pletely removed from the penis by a healthcare worker. Are you medically circumcised?

smoke each day? Also, let me know if you use the product, but not every day.

RY DAY, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.

smoke each week? Also, let me know if you use the product, but not every week.

T EVERY WEEK, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.

ducts? Also, let me know if you use the product, but not every day.

T EVERY DAY, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.

oducts? Also, let me know if you use the product, but not every week.

T EVERY WEEK, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.

ol. Havedrink?
coholic you ever consumed any alcohol, such as beer, wine, spirits, or [ADD OTHER LOCAL EXAMPLES]?
ass of wine, one shot of spirits, or one cup of [ADD OTHER LOCAL EXAMPLES]. In the last one month, on the days that you drank alcohol, how many drinks did you usually h
SPONDENT ANSWERS 'EVERY DAY' OR 'ALMOST EVERY DAY,' CODE '95'.
ve you ever fathered any children with any woman?

N TO CONTINUE)
ll not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question. How old were you when you had
ol, how many drinks did you usually have per day?
estion. How old were you when you had sexual intercourse for the very first time?