Dhs VN 2005 Questionnaire

Department of population and labour statistics
General statistical office (GSO)
National institute of hygiene and epidemiology (NIHE)

Ministry of health
Vietnam population and aids indicator survey (vpais)
Household questionnaire
confidential
identification
Province: _______________________________________________________
district: ________________________________________________________
commune:_______________________________________________________
cluster number:................................................................................................
name of household head: _____________________________________
household number: .........................................................................................
urban/rural (Urban = 1; Rural = 2):..................................................................
large city/small city/town/rural (*) ...................................................
(Large City = 1; Small City = 2; Town = 3; Rural = 4):
Interviewer visits
Final visit
day
date
month
Interviewers
name
year
result (**)
result
2 0
int. number
Next visit
- date
total number of
visits
- time
(**) result codes:
total persons
in household
1 = completed
2 = no household member at home
or no competent respondent
at home at time of visit
6 = dwelling vacant or
address not a dwelling
3 = entire household absent for

extended period of time
8 = dwelling not found
7 = dwelling destroyed
total eligible
men
9 = other_______________________
4 = postponed
(specify)
5 = refused
Supervisor
total eligible
women
Field editor
Office editor
line no. of
respondent
to hh questionnaire
Keyed by
name
name
name
name
date
date
date
date
(*) The following guideliness should be used to categorize urban sample points: Large cities are national capitals and
places with over 1 million population; small cities are places between 50,000 and 1 million population; remaining
urban sample points are towns.
Appendix D |
129
A. household schedule
* codes for q.3 (relationship to head of hh)
Now we would like

some information
about the people who
usually live in your
household or who are
staying with you now?
01 = head
02 = wife/husband
03 = son/daughter
04 = son-in-law or
daughter-in-law
05 = grandchild
06 = parent
07 = parent-in-law
08 = brother/sister
Usual residents
and visitors
Line no
Please give me the

names of the
persons who
usually live in your
household and
guests of the
household who
stayed here last
night, starting with
the head of
household
(1)
(2)
Relation
ship to
head of
hh
What is
the relationship
of
[NAME]
to the
head of
the HH?*
sex
residence
Is
[NAME]
male or
female?
(3)
09 = niece/nephew
by blood
10 = niece/nephew
by marriage
11 = other relative
12 = adopted/foster/
step child
13 = not related
98 = dont know
age
Does
Did
How old is
[NAME] [NAME] [NAME]?
usually stay here
live here? last night? IF age 95
years
and
over,
record
95
(4)
(5)
(6)
marital
status
Eligible
for
indiv.
survey
Circle
line
numbe
What is
r of
[name]
all
current
men
marital
and
status
wome
n age
15-49
(7A)
1 = married/living together
2 = divorced/separated
3 = widowed
4 = never married/never lived with
a partner
If age 5 years or older
If age 5-17 years

Basic material needs
education
If age 5-
if age 15
and over
(7)
** codes for q.7a
Has
[NAME]
ever
attended
school?
(8)
In yrs
01
01
02
02
03
03
04
04
05
05
06
06
07
07
08
08
09
09
10
10
11
11
12
12
13
13
14
14
(9)
(10)
q13
1
q13
1
q13
1
q13
1
q13
1
q13
1
q13
1
q13
1
q13
1
q13
1
q13
1
q13
1
q13
1
What
is
the 24 years
highest level of
Did
school [NAME]
has attended? ** [NAME]
attend
What
is
the school at
highest
grade any time
during the
[NAME]
completed at that current
school
level? **
year?
q13
lvl grade
(11)
Does
Does
Does
[NAME] [NAME] [NAME]
have
have a pair have at
anything of shoes? least two
sets of
to cover
clothing?
him/her at
night
when
sleeping?
(13)
(14)
(15)
y n dk
y n dk
y n dk
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
1 2 8
tick here if continuation sheet used
Just to make sure that I have a complete listing:

1) Are there any other persons such as small children or infants that we have not listed?
2) In addition, are there any other people who may not be members of your family, such
as domestic servants, lodgers or friends who usually live here?
3) Are there any guests or temporary visitors staying here, or anyone else who stayed
here last night, who have not been listed?
130
| Appendix D
yes
(enter each in table)
NO
yes
NO
yes
NO
** codes for q.10

education
level:
1 = primary
2 = lower second.
3 = upper second.
4 = higher
8 = dont know
education grade:
Grades
= 0, 1, 2,., 12 (Level 1-3)
Years
= 0, 1, 2, 3, 4, 5+ (level 4)
dont know = 98
*** codes for q.16 through q.20

**** codes for q.27
these questions refer to biological
parents of the child.
In q.17 and q.20, record 00 if parent
not listed in the household
schedule.
If age 0-17 years

Parents
Survivorship and residence of biological parents***
alive
Is
Is
Check q.16
If mother alive
If father alive
[NAME]s
[NAME]s
Does [NAME]s natural
Does [NAME]s natural and q.19: if
natural
natural
yes to q.16
mother live in this
father live in this
and q.19
mother
father
household?
household?
(both
alive?
alive?
IF YES: What is her
IF YES: What is his
parents
name?
name?
alive),
record mothers
record fathers
circle 1,
line number.
line number.
otherwise
If no, record 00
If no, record 00
circle 2
(16)
y
(17)
dk
(19)
y
(20)
dk
Brothers 0-17 years

Does [NAME]
have any natural
brothers under
the age of 18?
By natural
brothers, I mean
of the same
mother and same
father.
(22)
(23)
n
dk
2
q27
1
1
1
1
1
1
q25
q27
1
8
1
2
q27
q25
1
8
1
q25
q27
8
q25
q27
8
q25
q27
8
q25
q27
1
q25
q27
1
q27
q25
DK
q27
1
1
q27
q25
q27
1
1
1
q27
q27
1
q25
q27
1
1
1
q27
1
q25
q27
1
(27)
q27
q27
1
q27
1
q25
q27
1
dk
1
1
Does [NAME] have

a birth certificate?
IF NO, PROBE:
Has [NAME]s
birth ever been
registered with the
civil authority?
(26)
q27
1
(25)
y
q25
q27
1
If age 0-4 years

Birth
registration
q27
1
q27
1
Does [NAME] Do all of

[NAME]
have any
natural
natural sisters
sisters
under the age
live in
of 18?
this HH?
By natural
sisters, I mean
of the same
mother and
same father.
q25
q27
1
q27
Sisters 0-17 years
(24)
Do all of
[NAME]
natural
brother
live in
this HH?
certificate
registration
neither
dont know
1=
2=
3=
8=
2
q27
Appendix D |
131
no
41
Questions and filters
Coding categories
skip
What is the main source of Piped water

drinking water for members of
Piped into residence/plot..................... 11
your household?
Piped to public tap ................................... 12
well
well into residence/plot..................... 31
public well.................................................. 32
surface water
Spring.............................................................. 41
River/stream............................................... 42
Pond/lake ..................................................... 43
dam .................................................................. 44
rain water .......................................................... 51
tanker truck .................................................... 61
bottled water.................................................. 71
other...................................................................... 96
(specify)
42
What kind of toilet facility do Flush toilet........................................................ 11

members of your household Pit latrine ventilated
usually use?
Improved pit toilet/latrine....................... 21
Traditional pit toilet/latrine ................ 22
no facility/bush/field .................................. 31
other...................................................................... 96
(specify)
43
Do you share this toilet facility yes ............................................................................. 1

no ............................................................................... 2
with other households?
44
Does your household have:

Electricity?
A radio/radio cassette?
A television?
A telephone (any kind)?
A refrigerator?
A washing machine?
A water pump?
A cupboard?
A table and chairs?
45
yes
no
electricity ......................................
radio ...................................................
television.........................................
telephone (any kind) ..................
refrigerator ..................................
washing machine..........................
water pump ......................................
cupboard ..........................................
table and chairs ..........................
What type of fuel does your electricity ......................................................... 01

household mainly use for cooking? gas ........................................................................... 02
ranger both eletric and gas ................... 03
kerosene .............................................................. 04
coal ........................................................................ 05
wood....................................................................... 06
straw ..................................................................... 07
other...................................................................... 96
(specify)
132
| Appendix D
44
no
46
Main material of the floor
Coding categories
skip
Natural floor
Earth/sand...................................................11
Record observation
rudimentary floor
wood planks ...............................................21
palm/bamboo ..............................................22
finished floor
parquet or polished wood..................31
vinyl or asphalt strip...........................32
ceramic tiles ..............................................33
cement............................................................34
carpet.............................................................35
other......................................................................96
(specify)
47
Main material of the roof
Natural roofing
Thatch/palm leaf.....................................11
Record observation
sod....................................................................12
ruidimentary roofing
rustic mat ....................................................21
palm/bamboo ..............................................22
wood planks ...............................................23
finished roofing
metal ..............................................................31
wood ...............................................................32
calamine/cement fiber .........................33
ceramic tiles ..............................................34
cement............................................................35
roofing shingles ......................................36
other......................................................................96
(specify)
Appendix D |
133
no
48
Main material of the walls
Coding categories
skip
Natural walls
No walls....................................................... 11
Record observation
50
Cane/palm/trunks ................................... 12
dirt .................................................................. 13
rudimentary walls
bamboo with mud .................................... 21
stone with mud ......................................... 22
uncovered adobe .................................... 23
plywood ....................................................... 24
carton ........................................................... 25
refused wood ............................................ 26
finished walls
cement ........................................................... 31
stone with lime/cement ....................... 32
bricks............................................................. 33
cement blocks .......................................... 34
covered adobe .......................................... 35
wood planks/shingles .......................... 36
other ..................................................................... 96
(specify)
49
How many rooms in this rooms .........................................................

household are used for sleeping?
50
Does any member of your

household own:
A bicycle?
A motorcycle or motor scooter?
An animal-drawn cart?
A car or truck?
A boat with a motor?
A boat without a motor?
51
51A
bicycle ..............................................
yes
no
motorcycle/scooter .................
animal-drawn cart....................
car/truck.........................................
boat with motor ..........................
boat without motor ..................
Does your household have any yes..............................................................................1

mosquito nets that can be used
no................................................................................2
while sleeping?
Do you do anything to protect yes, use mosquito spray ..........................a
your household from mosquitos?
yes, window screens .................................b
other ..................................................................x
Anything else?
_______________________________________
(specify)
nothing ............................................................y
52
How many mosquito nets does

Number of nets..............................................
your household have?
if 7 or more nets, record "7"
134
| Appendix D
52
end
53
54
Net # 1
Net # 2
Net # 3
Net # 4
observed............ 1
observed ............1
observed............1
observed ........... 1
not
observed....... 2
not
observed .......2
not
observed .......2
not
observed ...... 2
months
ago ............
months
ago............
months
ago ............
more than
3 years ago .. 95
more than
3 years ago.. 95
more than
3 years ago .. 95
When you got the net, Yes ......................... 1

was it already treated no........................... 2
with an insecticide to
kill
or
repel not sure ............. 8
mosquitoes?
yes..........................1
yes .........................1
yes......................... 1
no ...........................2
no ...........................2
no .......................... 2
not sure..............8
not sure..............8
not sure............. 8
Since you got the Yes .......................1

mosquito net, was it no.........................2
ever soaked or dipped
in a liquid to repel not sure ...........8
Q59
mosquitoes or bugs?
yes....................... 1
yes ...................... 1
yes....................... 1
no ........................ 2
no ........................ 2
no ........................ 2
not sure........... 8
not sure........... 8
not sure........... 8
How long ago was the months

ago ............
net soaked or dipped?
months
ago ............
months
ago............
months
ago ............
more than 2
years ago......95
more than 2
years ago ..... 95
more than 2
years ago..... 95
more than 2
years ago ..... 95
not sure ...........98
not sure........... 98
not sure........... 98
not sure........... 98
yes....................... 1
yes ...................... 1
yes....................... 1
no ........................ 2
no ........................ 2
no ........................ 2
not sure........... 8
not sure........... 8
not sure........... 8
Ask respondent to
show you the net(s)
in the household. If
more than 4 nets, use
additional
questionnaire(s).
How long ago did your months

household obtain the ago ............
mosquito net?
more than
3 years ago...95
56
57
58
If less than 1 month,

record 00
59
Did anyone sleep under Yes .......................1

this mosquito net last no.........................2
night?
not sure ...........8
Q59
Q61
Q61
60
Who slept under this

mosquito net last night?
Record name and

line number from
the household
schedule
61
Q59
Q61
Q59
Q61
name______________
name______________
name______________
name______________
line number
line number
line number
line number
name______________
name______________
name______________
name______________
line number
line number
line number
line number
name______________
name______________
name______________
name______________
line number
line number
line number
line number
name______________
name______________
name______________
name______________
line number
line number
line number
line number
Go back to q.53 for next net. If no more net, go to the individual

questionnaire.
Appendix D |
135
Department of population and labour statistics

General statistical office (GSO)
National institute of hygiene and epidemiology (NIHE)

Ministry of health
Vietnam population and aids indicator survey (vpais)
Individual questionnaire
confidential
identification
province: _______________________________________________________
district: ________________________________________________________
commune:_______________________________________________________
cluster number:................................................................................................
name of household head: _____________________________________
household number: .........................................................................................
urban/rural (Urban = 1; Rural = 2):..................................................................
large city/small city/town/rural (*) ...................................................
(Large city = 1; Small city = 2; Town = 3; Rural = 4):
name and line number of respondent: ________________________
sex of respondent (Male = 1; Female = 2): ....................................................
Interviewer visits
Final visit
date
date
month
year
interviewers
name
2 0 0
int. number
result (**)
result
Next visit
- date
total number
of visits
- time
(**) result codes:
1 = completed
2 = not at home
3 = postponed
4 = refused
5 = partly completed
6 = incapacitated
7 = other
(specify)
supervisor
Field editor
Keyed by
Office editor
name
name
name
name
date
date
date
date
(*) The following guideliness should be used to categorize urban sample points: Large cities are national capitals and
places with over 1 million population; small cities are places between 50,000 and 1 million population; remaining
urban sample points are towns.
Appendix D |
137
Section 1. respondents background

Introduction and consent
Informed consent
Hello. My name is _______________________________ and I am working with the Department of

Population and Labour Statistics and the National Institute of Hygiene and Epidemiology. We are
conducting a national health survey. We would very much appreciate your participation in this survey.
I would like to ask you about some important health issues. This information will help the government
to plan health services. The survey usually takes around 20 minutes to complete.
Whatever information you provide will be kept strictly confidential and will not be shown to other
persons.
Participation in this survey is voluntary and you can choose not to answer any individual question or
all of the questions. However, we hope that you will participate in this survey since your views are
important.
At this time, do you want to ask me anything about the survey?
May I begin the interview now?
Signature of interviewer: _________________________________ Date: ____________________
respondent agrees to be
no
101
espondent does not agree to be interviewed

end interviewed
Record the time
Coding categories
skip
hour..............................................................
minutes .......................................................
102
In what month and year were you month ..........................................................

born?
dont know month.......................................... 98
year .................................................. 1
dont know year......................................... 9998
103
How old were you at your last

Age in completed years .....................
birthday?
Compare and correct 102 and/or
103 if inconsistent
104
105
Have you ever attended school?
yes ............................................................................. 1
no ............................................................................... 2
What is the highest level of school primary................................................................... 1

you attended: primary, lower lower secondary.............................................. 2
secondary, upper secondary or upper secondary ............................................... 3
higher?
higher ...................................................................... 4
106
What is the highest

(grade/form/year) you completed?
Grade..
grades = 0,1,2,...,12 (Level 1-3)

years = 0,1,2,3,4,5+ ( Level 4)
don't know = 98
1
138
| Appendix D
107
no
107
Coding categories
skip
Do you read a newspaper or Almost everyday...............................................1

magazine almost everyday, at least At least once a week .......................................2
once a week, less than once a week Less than once a week ....................................3
or not at all?
Not at all ..............................................................4
Cannot read .........................................................5
108
Do you listen to the radio almost Almost everyday...............................................1

everyday, at least once a week, less At least once a week .......................................2
than once a week or not at all?
Less than once a week ....................................3
Not at all ..............................................................4
109
Do you watch television almost Almost everyday...............................................1

everyday, at least once a week, less At least once a week .......................................2
than once a week or not at all?
Less than once a week ....................................3
Not at all ..............................................................4
110
female
male
111
Aside from your own housework, yes ..............................................................................1

have you done any work in the last no................................................................................2
seven days?
112
As you know, some women take up

jobs for which they are paid in cash yes ..............................................................................1
or kind. Other sell things, have a
small business or work on the family no................................................................................2
farm or in the family business. In the
last seven days, have you done any
of these things or any other work?
113
Have you done any work in the last yes ..............................................................................1

no................................................................................2
seven days?
114
Although you did not work in the

last seven days, do you have any job yes ..............................................................................1
or business from which you were
absent for leave, illness, vacation or no................................................................................2
any other such reason?
115
116
Have you done any work in the last yes ..............................................................................1

no................................................................................2
12 months?
113
116
116
114
116
116
117
What is your occupation, that is,

what kind of work do you mainly
do?
Interviewer: probe to obtain
detailed information on the
kind of work respondent does
118
2
Appendix D |
139
no
117
Coding categories
skip
What have you been doing for most Going to school/studying ......................... 01
of the time over the last 12 months? Looking for work........................................... 02
retired.................................................................. 03
too ill to work ................................................ 04
handicapped, cannot work ....................... 05
housework/child care................................. 06
other ..................................................................... 96
(specify)
118
How long have you been living

continuously in [name of current years.............................................................
place of residence]?
always.................................................................. 95
If less than one year, record
00 years
119
visitor ................................................................... 96
In the last 12 months, on how many

separate occasions have you traveled
away from your home community number of trips.......................................
and slept away?
none........................................................................ 00
If more than 95, record 95
120
In the last 12 months, have you been yes ..............................................................................1

away from your home community no................................................................................2
for more than one month at a time?
121
What is your religion?
No religion ......................................................... 01
buddhist............................................................... 02
catholic............................................................... 03
protestant ......................................................... 04
caodai ................................................................... 05
hoa hao ................................................................ 06
islam ...................................................................... 07
other ..................................................................... 96
(specify)
122
What ethnic group do you belong vietnamese ......................................................... 01

to?
tay .......................................................................... 02
thai ......................................................................... 03
chinese.................................................................. 04
Khmer .................................................................... 05
muong.................................................................... 06
nung ....................................................................... 07
hre........................................................................... 08
phu la .................................................................... 09
e de.......................................................................... 10
Dao .......................................................................... 11
Co tu....................................................................... 12
Cham....................................................................... 13
other ..................................................................... 96
(specify)
3
140
| Appendix D
121
Section2. reproduction
no
201
202
203
Coding categories

male
female
Now I would like to

ask about all of the
children you have had
during your lifetime. I
am interested only in
the children that are
biologically yours.
Have you ever
fathered any children
with any woman?
Now I would like to

ask about all the
births you have had
during your lifetime.
Have you ever given
birth?
Do you have any sons

or daughters whom
you have fathered
who are now living
with you?

or daughters to whom
you have given birth
who are now living
with you?
yes ................................................................. 1
no ................................................................... 2
How many sons live with you?

And how many daughters live with you?
male
yes ................................................................. 1
no ................................................................... 2
204
Daughters at home .....................
female

or daughters whom
you have fathered
who are alive but do
not live with you?
205
206
Sons at home ...................................
If none, record '00'
204
skip

or daughters to whom
you have given birth
who are alive but do
not live with you?
yes ................................................................. 1
no ................................................................... 2
206
How many sons are alive but do not live with

you?
Sons elsewhere .............................
And how many daughters are alive but do not
Daughters elsewhere................
live with you?
206
male
female
Have you ever

fathered a boy or girl
who was born alive
but later died? And
baby who cried or
showed signs of life
but did not survive?
207
Have you ever given

birth to a boy or girl
who was born alive
but later died? And
baby who cried or
showed signs of life
but did not survive?
yes ................................................................. 1
no ................................................................... 2
How many boys have died?
208
boys dead .........................................
And how many girls have died?
girls dead.........................................
208
Sum answers to 203, 205 and 207, and enter

total. If none, record '00'
total ...................................................
4
Appendix D |
141
no
209
male
Just to make sure that

I have this right: you
have
fathered
in
TOTAL ______children
during your life.
Just to make sure that

I have this right: you
have had in TOTAL
_______births during
your life.
Is that correct?
Is that correct?
210
no
probe and correct 201-208 as necessary
female
male
215
no births
214
check 208:
one or more births
212
skip
female
yes
211
Coding categories
Now I would like to ask you about your last month ..............................................
birth, whether the child is still alive or not.
dont know month.............................. 98
In what month and year did you have your last year ......................................
birth?
214
dont know year...............................9998
213
About how many years ago was your last Years ago ......................................
birth?
214
Are you pregnant now?
yes ................................................................. 1
no ................................................................... 2
unsure ......................................................... 8
215
216
217
Are you the primary caregiver for any children yes ................................................................. 1
whether or not these children are yours?
no ................................................................... 2
301
Are any of these children for whom you are yes ................................................................. 1
the primary caregiver under the age of 18?
no ................................................................... 2
301
Now I would like to ask you about the children

who are under the age of 18 and for whom you
are the primary caregiver.
yes ................................................................. 1
Have you made arrangements for someone to no ................................................................... 2
care for these children in the event that you unsure ......................................................... 8
fall sick or are unable to care for them?
5
142
| Appendix D
Section 3. marriage and sexual activity

no
301
302
303
304
307
Coding categories

male
skip
female
Are you currently

married or living
together
with
a
woman as if married?
Are you currently yes, currently married..................... 1

married or living yes, living with a man/woman........ 2
together with a man no, not in union ..................................... 3
as if married?
Have you ever been

married
or
lived
together
with
a
woman as if married?
Have you ever been Yes, formerly married....................... 1

married
or
lived
together with a man Yes, lived with a man/woman ......... 2
no ................................................................... 3
as if married?
What is your marital

status now: are you
widowed, divorced, or
separated?
What is your marital widowed ..................................................... 1

status now: are you divorced .................................................... 2
widowed, divorced, or separated .................................................. 3
separated?
Is your wife/partner
living with you now
or is she staying
elsewhere?
Is your
husband/partner
living with you now
or is he staying
elsewhere?
Please tell me the

name of your wife
(the woman you are
living with as if
married)
Please tell me the

name of your husband name
(the man you are
living together with as
if married)
304
320
310
Living together ..................................... 1

Staying elsewhere ............................... 2
line number
Record the name and the line number

from the household questionnaire for
spouse and live-in partner. If the person
is not listed in the household, record
00
308
How old was your How old was your

wife/partner on her husband/partner
on age........................................................
last birthday?
his last birthday ?
95 age and over, record 95
310
Have
you
been
married or lived with
a woman only once or
more than once?
Have
you
been Only once .................................................. 1
married or lived with more than once...................................... 2
a man only once or
more than once?
312
6
Appendix D |
143
no
311
Coding categories

male
skip
female
In what month and In what month and

year did you start year did you start month ..............................................
living
with
your living
with
your
dont know month .............................. 98
wife/partner?
husband/partner?
312
Now I would like to

ask about when you
started living with a
woman as if married
for the very first time.
year ......................................
Now I would like to

ask about when you dont know year.............................. 9998
started living with
your
first
husband/partner.
314
In what month and In what month and

year was that?
year was that?
313
How old were you

when
you
(first)
started living with
her?
314
315
How old were you

when
you
(first) age........................................................
started living with
him?
female
Check 303:
is respondent currently widowed?
check 310:
married
only once
married more
than once
317
318
widowed
not asked or
not widowed
316
320
male
How did your previous marriage or union end?
320
Death/widowhood................................. 1
divorce ....................................................... 2
separation ................................................ 3
318
Who did most of your late husbands property respondent ............................................... 1

go to?
other wife ................................................. 2
spouses children.................................. 3
spouses family....................................... 4
other............................................................ 5
(specify)
no property .............................................. 6
319
Did you receive any of your late husbands yes ................................................................. 1

assets or valuables?
no ................................................................... 2
320
Check for the presence of others.

Before continuing, make every effort to ensure privacy.
7
144
| Appendix D
320
320
no
321
Coding categories
skip
Now I need to ask you some questions about Never had sexual
intercourse ....................................00
sexual activity in order to gain a better
understanding of some family life issues.
age in years.....................................
How old were you when you had sexual

first time when started
intercourse for the very first time?
323
Do you intend to wait until you get married to yes ................................................................. 1

have sexual intercourse for the first time?
no ................................................................... 2
352
living with (first)

husband/wife/partner...............95
322
dont know/unsure .............................. 3
323
check 103:
25-49 years old
15-24 years old
324
328
The first time you had sexual intercourse, was yes ................................................................. 1
a condom used?
no ................................................................... 2
dont know/dont remember........... 8
325
How old was the person you first had sexual age of partner...............................
intercourse with?
dont know .............................................98
326
Was this person older than you, younger than older............................................................ 1

you, or about the same age as you?
younger...................................................... 2
about the same age.............................. 3
328
328
dont know/dont remember........... 8
327
Would you say this person was ten or more Ten or more years older .................. 1
years older than you or less than ten years Less than ten years older ............... 2
older than you?
Older, unsure how much................... 3
328
When was the last time you had sexual

intercourse?
days ago....................................... 1
Record years ago only if last
intercourse was one or more years ago.
weeks ago.................................... 2
If 12 months or more, answer must be

recorded in years.
years ago .................................... 4
months ago................................. 3
330
347
8
Appendix D |
145
Last sexual partner
329
330
331
332
When was the last time

you
had
sexual
intercourse with this
person?
days............ 1
weeks......... 2
weeks......... 2
months...... 3
months...... 3
yes.................................1
no...................................2
yes .................................1
no...................................2
q332
q332
yes.................................1
yes .................................1
no...................................2
no...................................2
husband/wife...........01
q338
husband/wife...........01
q338
live-in
partner ....................02
live-in
partner ....................02
boyfriend/girlfriend
not living with
respondent ............03
not living with
not living with
casual
acquaintance ......04
casual
acquaintance.......04
casual
acquaintance.......04
commercial
sex worker ............05
commercial
sex worker ............05
commercial
sex worker ............05
other ...........................96
other ...........................96
other ...........................96
(specify)
(specify)
(specify)
Did you use a condom

every time you had yes.................................1
sexual intercourse with
this person in the last 12 no...................................2
months?
What
was
your husband/wife ..........01
q338
relationship
to
this
person with whom you live-in
had sexual intercourse?
partner....................02
Were you living together

as if married?
If yes, circle 02
If no, circle 03
332A
man
women
man
Q332c
332B
332C
other
codes
code 2
circled
Q338
333
For how long (have you

had/did you have) a
sexual relationship with days .................1
this person?
months............2
If only had sexual
relations with this
person once, record
01 days
years ...............3
9
146
| Appendix D
women
man
Q332c
Is this person female or Female ........................ 1

Male .............................2
male?
check 332:
third-to-last sexual
partner
days............ 1
The last time you had

sexual intercourse with yes.................................1
this
(second/third) no...................................2
person, was a condom
q332
used?
If
boyfriend/girlfriend:
Second-to-last sexual
partner
women
Q332c
Female......................... 1
Female......................... 1
Male .............................2
Male .............................2
other
codes
other
codes
code 2
circled
code 2
circled
Q338
Q338
days..................1
days..................1
months............2
months............2
years ...............3
years ...............3
Last sexual partner
334
man 15-49/
woman
25-49
check 103:
woman
15-24
Second-to-last
sexual partner
man 15-49/
woman
25-49
woman
15-24
Q338
335
How old is this person?
age of
partner...........
Q338
Dont know ............98
336
338
339
man 15-49/
woman
25-49
woman
15-24
Q338
age of
partner ..........
Q338
Q338
age of
partner...........
Q338
Dont know............ 98
Dont know ............98
Is this person older than you, older ..................... 01

younger than you, or about the younger ............... 02
same age?
older ......................01
older ..................... 01
younger ................02
younger ............... 02
same age .............. 03
same age ...............03
same age .............. 03
dont know ......... 04
dont know..........04
dont know ......... 04
Q338
337
third-to-last sexual
partner
Q338
Q338
Would you say this person is ten Ten or more

Years older ......... 1
or more years older than you or
less than ten years older than Less than ten
you?
Ten or more
Years older......... 1
Ten or more
Less than ten

Years older......... 2
Less than ten

older,
unsure
how much.............. 3
older,
unsure
how much.............. 3
older,
unsure
how much.............. 3
yes ................................ 1
yes................................ 1
yes ................................ 1
no.................................. 2
no.................................. 2
no.................................. 2
Q340
Q340
Q341
The last time you had sexual

intercourse with this
(second/third) person, did you or
this person drink alcohol?
Were you or your partner drunk Respondent

only............................. 1
at that time?
Respondent
only ............................ 1
Respondent
only...........................1
Partner only.......... 2
Partner only ......... 2
Partner only........2
Respondent and
Partner both.......... 3
Respondent and
Partner both.......... 3
Respondent and
Partner both........3
neither....................... 4
neither ...................... 4
neither.....................4
If yes:
Who was drunk?
Q341
340
341
Apart from [this person/these

two people], have you had
sexual intercourse with any
other person in the last 12
months?
yes ................................ 1
go back to 329
in next column
yes................................ 1
go back to 329
in next column
no.................................. 2
no.................................. 2
Q341A
In total, with how many

different people have you had
sexual intercourse in the last 12
months?
Q341A
Number of
partners
last 12
months....
If non-numeric answer,
probe to get an estimate.
If number of partners is
greater than 95, write 95
dont know ..........98
10
Appendix D |
147
no
341A
Coding categories
skip
Some people inject drugs for use other than yes ................................................................. 1
medicine. In the last 12 months, have any of no ................................................................... 2
your partners injected drugs for use other than
dont know ............................................... 8
medicine?
342
male
347
female
343
check 332:
no partners are
commercial sex workers
344
In the last 12 months, did you pay anyone in yes ................................................................. 1

exchange for sex?
no ................................................................... 2
347
The last time you paid someone in exchange yes ................................................................. 1

for sex, was a condom used?
no ................................................................... 2
347
345
at least one partner

a commercial
sex worker
346
Did you use a condom during every sexual yes ................................................................. 1

intercourse every time you paid someone in no ................................................................... 2
exchange for sex in the last 12 months?
dk ................................................................... 8
347
In total, with how many different people have

you had sexual intercourse in your lifetime?
Number of partners
If non-numeric answer, probe to get an
estimate.
347
in lifetime.........................................
dont know .............................................98
If number of partners is greater than 95,

write '95'.
352
353
Do you know of a place where a person can yes ................................................................. 1

get condoms?
no ................................................................... 2
Where is that?
If source is hospital, health center, or

clinic, write the name of place.
Probe to identify the type of source and
circle the appropriate code
Public sector
Government hospital .................... A
Delivery house .................................. b
Commune health center .............. c
Vct center............................................ d
Family planning center ............... e
Mobile clinic....................................... f
Community health worker ........ g
Other public........................................ h
(specify)
private medical sector
private hospital/ clinic ................ i
vct center............................................ j
pharmacy.............................................. k
private doctor .................................. l
other private medical .................. m
(name of place)
Any other place?
Record all sources mentioned

(specify)
other source
shop .......................................................... n
market ................................................... o
bar/hotel.............................................. p
friends/relatives ............................. q
other....................................................... x
(specify)
11
148
| Appendix D
401
Section 4. hiv/aids
no
401
Coding categories
skip
Now I would like to talk about yes ............................................................................. 1

something else.
Have you ever heard of an illness
called AIDS?
no ............................................................................... 2
402
Can people reduce their chances of yes ............................................................................. 1

getting the AIDS virus by having no ............................................................................... 2
just one sex partner who is not
infected and who has no other dont know ........................................................... 8
partners?
403
Can people get the AIDS virus from yes ............................................................................. 1

mosquito bites?
no ............................................................................... 2
445
dont know ........................................................... 8
404
Can people reduce their chances of yes ............................................................................. 1

getting the AIDS virus by using a no ............................................................................... 2
condom every time they have sex?
dont know ........................................................... 8
405
Can people get the AIDS virus by yes ............................................................................. 1

sharing food with a person who has no ............................................................................... 2
AIDS?
dont know ........................................................... 8
406
Can people reduce their chance of yes ............................................................................. 1

getting the AIDS virus by abstaining no ............................................................................... 2
from sexual intercourse?
dont know ........................................................... 8
407A
Can people get the AIDS virus yes ............................................................................. 1

because of injections with needles no ............................................................................... 2
already used by someone else?
dont know ........................................................... 8
408
Is there anything else a person can yes ............................................................................. 1

do to avoid or reduce the chances of no ............................................................................... 2
getting the AIDS virus?
dont know ........................................................... 3
410
12
Appendix D |
149
no
409
Coding categories
What can a person do?
skip
Abstain from sex ............................................... a

Use condoms......................................................... b
Limit sex to one partner/stay
Faithful to one partner......................... c
Anything else?
Limit number of sexual partners ............ d

Avoid sex with prostitutes......................... e
Avoid sex with persons who
Have many partners................................. f
Record all ways mentioned
Avoid sex with homosexuals...................... g

Avoid sex with persons who
Inject drugs .................................................. h
Avoid blood transfusions ........................... i
Avoid injections................................................. j
Avoid sharing rajors/blades...................... k
Avoid kissing........................................................ l
Avoid mosquito bites ...................................... m
Seek protection from
Traditional practitioner...................... n
other........................................................................ w
(specify)
other........................................................................ x
(specify)
dont know ........................................................... z
410
Is it possible for a healthy-looking yes.............................................................................. 1

person to have the AIDS virus?
no ............................................................................... 2
dont know ........................................................... 8
411
412
Can the virus that causes AIDS be

yes
transmitted from a mother to her
baby:
During pregnancy......... 1
during delivery............. 1
During pregnancy?
During delivery?
breastfeeding ................. 1
By breastfeeding?
| Appendix D
other
Is there any special medication that a yes.............................................................................. 1

doctor or a nurse can give to a no ............................................................................... 2
woman infected with the AIDS virus
to reduce the risk of transmission to dont know ........................................................... 8
the baby?
13
150
dk
check 411:
at least
one yes
413
no
414
no
414
415
416
418
skip
Is there any special medication that yes.............................................................................. 1

people infected with the AIDS virus no ............................................................................... 2
can get from a doctor or a nurse to
make them feel better and help them dont know ........................................................... 8
to live longer?
female
425
male
Check 212 and 213:

last birth since
January 2003
417
Coding categories
no births/
last birth before
january 2003
425
Now I would like to ask some yes.............................................................................. 1

questions about your last birth. Did
you see anyone for antenatal care no ............................................................................... 2
during that pregnancy?
During any of the antenatal visits for
that pregnancy, did anyone talk to
you about:
yes
Babies getting the AIDS virus from aids from mother.......... 1

their mother?
Things that you can do to prevent things to do...................... 1
getting the AIDS virus?
Getting tested for the AIDS virus?
tested for aids ............... 1
no
425
dk
419
Were you offered a test for the AIDS yes.............................................................................. 1

virus as part of your antenatal care?
no ............................................................................... 2
420
I dont want to know the results, but yes.............................................................................. 1

were you tested for the AIDS virus
no ............................................................................... 2
as part of your antenatal care?
425
I dont want to know the results, but yes.............................................................................. 1

did you get the results of the test?
no ............................................................................... 2
422
421
421A
After you have received your results,

did the doctor or the counselor give yes.............................................................................. 1
you any advice and answer any no ............................................................................... 2
question you have?
14
Appendix D |
151
no
422
Coding categories
Where was the test done?
skip
Public sector
Government hospital .............................. 11
Vct center...................................................... 12
If source is hospital, health

center, or clinic, write the
name of the source.
Probe to identify the type of
source
and
circle
the
appropriate code.
Family planning center ......................... 13

Other public.................................................. 16
(specify)
private hospital/clinic ........................... 21
vct center...................................................... 22
(name of place)
private laboratory ................................. 23

other private medical ............................ 26
(specify)
other...................................................................... 96
(specify)
423
Have you been tested for the AIDS yes ............................................................................. 1

virus since that time you were tested no ............................................................................... 2
during your pregnancy?
424
When was the last time you were less than 12 months ago................................ 1
tested for the AIDS virus?
12-23 months ago ................................................ 2
426
432
2 or more years ago ........................................ 3
425
426
I dont want to know the results, but yes ............................................................................. 1

have you ever been tested to see if no ............................................................................... 2
you have the AIDS virus?
430
When was the last time you were Less than 12 months ago................................ 1
tested?
12-23 months ago ................................................ 2
2 or more years ago ........................................ 3
427
The last time you had the test, did Asked for the test............................................ 1
you yourself ask for the test, was it Offered and accepted .................................... 2
offered to you and you accepted, or Required................................................................. 3
was it required?
428
I dont want to know the results, but yes ............................................................................. 1

did you get the results of the test?
no ............................................................................... 2
428A
After you have received your

results, did the doctor or the yes ............................................................................. 1
counselor give you any advice and no ............................................................................... 2
answer any question you have?
15
152
| Appendix D
429
no
429
Coding categories
Where was the test done?
skip
Public sector
government hospital .............................. 11
vct center...................................................... 12

name of the place.
source
and
circle
the
appropriate code.
family planning center ......................... 13

other public.................................................. 16
(specify)
private hospital/clinic ........................... 21
432
vct center...................................................... 22
(name of place)
private laboratory ................................. 23

other private medical ............................ 26
(specify)
other...................................................................... 96
(specify)
430
431
Do you know of a place where yes ............................................................................. 1

people can go to get tested for the
no ............................................................................... 2
AIDS virus?
Where is that?
432
Public sector
government hospital .............................. A
vct center...................................................... B

name of the place.
source
and
circle
the
appropriate code.
family planning center ......................... C

other public.................................................. D
(specify)
private hospital/clinic ........................... E
vct center...................................................... F
(name of place)
private laboratory ................................. G

other private medical ............................ H
Any other place?
(specify)
other...................................................................... X
Record all sources mentioned.

(specify)
432
Would you buy fresh vegetables yes ............................................................................. 1

from a shopkeeper or vendor if you no ............................................................................... 2
knew that this person had the AIDS
dont know ........................................................... 8
virus?
16
Appendix D |
153
no
Coding categories
433
If a member of your family got Yes, remain a secret ........................................ 1

infected with the AIDS virus, would
no ............................................................................... 2
you want it to remain a secret or
dk/not sure/depends ........................................ 8
not?
434
If a member of your family became yes ............................................................................. 1

sick with the virus that causes AIDS,
would you be willing to care for her no ............................................................................... 2
or him in your own household?
435
In your opinion, if a female teacher Should be allowed .......................................... 1

has the AIDS virus but is not sick,
Should not be allowed ................................. 2
should she be allowed to continue
Dk/not sure/depends ....................................... 8
teaching in the school?
440
Do you personally know someone yes ............................................................................. 1

who is suspected to have the AIDS
no ............................................................................... 2
virus or who has the AIDS virus?
441
Do you agree or disagree with the agree........................................................................ 1

following statement:
disagree ................................................................. 2
People with the AIDS virus should
dont know/no opinion ................................... 8
be ashamed of themselves?
442
Do you agree or disagree with the

agree........................................................................ 1
following statement:
People with the AIDS virus should disagree ................................................................. 2
be blamed for bringing the disease
dont know/no opinion ................................... 8
into the community.
443
Should children age 12-14 be taught yes ............................................................................. 1

about using a condom to avoid no ............................................................................... 2
AIDS?
444
Should children age 12-14 be taught yes ............................................................................. 1

to wait until they get married to
no ............................................................................... 2
have sexual intercourse in order to
avoid AIDS?
445
Do you believe that young men yes ............................................................................. 1

should wait until they are married to no ............................................................................... 2
have sexual intercourse?
447
Do you believe that men who are yes ............................................................................. 1

not married and are having sex
no ............................................................................... 2
should only have sex with one
partner?
449
Do you believe that married man yes ............................................................................. 1

should only have sex with their no ............................................................................... 2
wife?
17
154
| Appendix D
skip
no
Coding categories
451
Do you believe that young women yes ............................................................................. 1

should wait until they are married to no ............................................................................... 2
have sexual intercourse?
453
Do you believe that women who are yes ............................................................................. 1

not married and are having sex
no ............................................................................... 2
should only have sex with one
partner?
455
Do you believe that married women yes ............................................................................. 1

should only have sex with their no ............................................................................... 2
husbands?
skip
18
Appendix D |
155
Section 5. other reproductive health issues

no
502
Coding categories
skip
check 401:
heard about AIdS
Apart from AIDS, have you heard about

other infections that can be transmitted yes ................................................................. 1
through sexual contact?
no ................................................................... 2
Not heard about AIDS
Have you heard about infections that can

be transmitted through sexual contact?
503
check 321:
has not had
sexual intercourse
has had sexual

intercourse
504
Check 502: heard about other sexually transmitted infections ?

heard about infection
transmitted through
sexual contact
505
506
male
Female
Sometimes
women yes ................................................................. 1
experience a bad no ................................................................... 2
smelling
abnormal
genital
discharge. dont know ............................................... 8
During the last 12
months, have you had
a
bad
smelling
abnormal
genital
discharge?
During the last 12 dont know ............................................... 8

months, have you
had a genital sore or
ulcer
Check 505, 506 and 507:

has not had an
infection or
does not know
has had an infection

(any yes)
19
156
| Appendix D
506
Sometimes men have Sometimes

women
a sore or ulcer on or have a genital sore or yes ................................................................. 1
their penis.
ulcer.
no ................................................................... 2
During the last 12
an ulcer or sore on or
near your penis?
508
no
Now I would like to ask you some questions yes ................................................................. 1

about your health in the last 12 months. no ................................................................... 2
During the last 12 months, have you had a
disease which you got through sexual contact? dont know ............................................... 8
Sometimes
men
experience
an
abnormal discharge
from their penis.
During the last 12
an
abnormal
discharge from your
penis?
507
511
511
no
509
510
Coding categories
The last time you had (PROBLEM FROM yes ................................................................. 1

505/506/507), did you seek any kind of advice or no ................................................................... 2
treatment?
Where did you go?
skip
511
Public sector
Government hospital .................... A
Delivery house .................................. b
Any other place?
Commune health center .............. c

Vct center............................................ d
Family planning center ............... e
Mobile clinic....................................... f
Record all sources mentioned
Community health worker ........ g

Other public........................................ h
(specify)
private hospital/clinic ................. i
vct center............................................ j
pharmacy.............................................. k
private doctor .................................. l
other private medical .................. m
(specify)
other source
shop .......................................................... n
traditional practitioner............ o
other ....................................................... x
(specify)
511
Now I would like to ask you some questions

about any injections you have had in the last number of injections..................
twelve months. Have you had an injection for
any reason in the last twelve months?
none ............................................................00
IF YES:
515
How many injections did you have?
If number of injections is greater than

90 or daily for 3 months or more, record
90.
If non-numeric answer probe to get an
estimate.
20
Appendix D |
157
Coding categories
512
Among these injections, how many were

administered by a doctor, a nurse, a dentist, or number of injections..................
any other health workers?
If number of injections is greater than
90 or daily for 3 months or more, record
90.
none............................................................ 00
If non-numeric answer, probe to get an

estimate.
513
The last time you had an injection given to you Public sector
Government hospital .................. 11
by a health worker, where did you go to get the
Delivery house ................................ 12
injection?
Commune health center ............ 13
Vct center.......................................... 14
dentist.................................................. 15
family planning center ............. 16
mobile clinic..................................... 17
community health worker
office .................................................... 18
other public...................................... 19
(specify)
private hospital/clinic ............... 20
vct center.......................................... 21
dentist.................................................. 22
pharmacy............................................ 23
private doctor ................................ 24
nurse/health worker
private office/home ...................... 25
other private medical ................ 26
(specify)
other place
at home ................................................ 31
other..................................................... 96
(specify)
514
Did the person who gave you that injection Yes ................................................................. 1
take the syringe and needle from a new, no ................................................................... 2
unopened package?
don't know................................................ 8
515
Husbands and wives do not always agree on yes ................................................................. 1

everything. Please tell me if you think a wife is
justified in refusing to have sex with her no ................................................................... 2
husband when she knows he has a disease that dont know ............................................... 8
can be transmitted through sexual contact?
21
158
| Appendix D
skip
515
Coding categories
516
When a wife knows her husband has a disease Yes ................................................................. 1

that can be transmitted through sexual contact, no ................................................................... 2
is she justified in asking that they use a dont know ............................................... 8
condom when they have sex?
517
check 301:
female and code 3
circled in Q301
female and code 1 or 2

circled in q301
Male
518
skip
520
520
Can you say no to your husband/partner if you yes ................................................................. 1

do not want to have sexual intercourse?
no ................................................................... 2
depends/unsure ...................................... 8
519
Could you ask your husband/partner to use a yes ................................................................. 1

condom if you wanted him to?
no ................................................................... 2
depends/unsure ...................................... 8
520
Record the time
hour.....................................................
minutes ..............................................
521
Check cover page:

other province
haiphong province
go to the cover page, record
result of the interview then, go
to Q601
go to the cover page

and record result
of the interview
22
Appendix D |
159
Section 6. blood spot collection

no
601
603
Coding
categories
Find the parent or guardian of the youth. Write name and line number of
parent/guardian from the household questionnaire.
name___________
(if youth lives independently, write a note to indicate this at bottom,

circle '1' (yes) in Q. 603, and continue to Q. 604)
line no
Ask parent/guardian:
Do you have any questions about this?

Please tell me if you allow______________________ to take the test?
(name of 15 17 year old)
Do you have any questions about this?

Please tell me if you agree to participate in the HIV test?
606
160
yes................1
no .................2
go to q.605, and
(Circle '2'
parent refuse)
signature of
interviewer
________________
do not forget
to sign
Ask respondent:
As part of this survey, we are studying HIV/AIDS among women and men age 15 to 49 years. As you
may know, HIV is the virus that causes AIDS, and AIDS is a serious illness that often leads to the death.
We are conducting tests to measure the extent of the disease in Haiphong. The results of the survey will
assist the government in developing programs for preventing HIV and AIDS.
We request that you participate in the HIV testing part of this survey by permitting us to take a few drops
of blood from your finger. Only disposable, sterile intrusments that are clean and completely safe will be
used. The blood sample will be sent to a laboratory to be analyzed. To ensure confidentially, your name
will not be attached to the blood sample.
The results will be completely anonymous and for this reason we cannot provide you with results of the
test and no one will be able to trace the test back to you. However, if you want to know whether you have
HIV, I can tell you where you can go to get tested.
You can go to a Voluntary Counselling and Testing (VCT) Centre where you will receive free counselling
and HIV test results. We will provide you with a voucher for yourself, and a voucher for your partner,
which either of you can use at the VCT Centre in the next 60 days. With the voucher, there will be no
charge for this service.
I hope you will agree to participate in the testing. But if you decide not to have the test done, it is your
right and I will respect your decision
605
604
age 18-49
As part of this survey, we are studying HIV/AIDS among women and men age 15 to 49 years. As you
may know, HIV is the virus that causes AIDS, and AIDS is a serious illness that often leads to the death.
We are conducting tests to measure the extent of the disease in Haiphong. The results of the survey will
assist the government in developing programs for preventing HIV and AIDS.
We request that (NAME) participate in the HIV testing part of this survey by permitting us to take a few
drops of blood from her/his finger. Only disposable, sterile instruments that are clean and completely safe
will be used. The blood sample will be sent to a laboratory to be analyzed. To ensure confidentiality,
(NAME)s name will not be attached to the blood sample.
The results will be completely anonymous and for this reason we can not provide results of the test and
no one will be able to trace the test back to (NAME). However, if (NAME) wants to know whether he/she
has HIV, I can tell (NAME) where he/she can go to get tested.
(NAME) can go to a Voluntary Counselling and Testing (VCT) Centre where he/she will receive free
counselling and HIV test results. We will provide (NAME) with a voucher which he/she can use at the
VCT Centre in the next 60 days. With the voucher, there will be no charge for this service.
604
skip
check Q 103:
age 15-17
602
This page to be destroyed

before merging
Sample results
no .................2
go to Q.605, and
circle '3'
(respondent
refused)
signature of
interviewer
________________
do not forget
to sign
Sample taken ...................................... 1

parent refused .................................. 2
respondent refused ........................ 3
not present .......................................... 4
technical problem .......................... 5
other ....................................................... 6
___________________________________
(specify)
Bar code label

Paste 2nd label on filter paper
Paste 3rd label on blood sample transmittal
form
| Appendix D
yes................1
23
Paste first bar code label here
end
Interviewers observations
(to be filled in after completing interview)
Comments about
Respondent :
Comments on specific
Questions :
Any other comments:
Supervisors observations
Name of supervisor:
(sign and write clearly
fullname)
date
month
year 200
Appendix D |
161

Dhs VN 2005 Questionnaire

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Department of population and labour statistics

General statistical office (GSO)

National institute of hygiene and epidemiology (NIHE)

Vietnam population and aids indicator survey (vpais)

3 = entire household absent for

8 = dwelling not found

* codes for q.3 (relationship to head of hh)

Now we would like

Please give me the

If age 5 years or older

If age 5-17 years

** codes for q.7a

tick here if continuation sheet used

Just to make sure that I have a complete listing:

(enter each in table)

(enter each in table)

(enter each in table)

** codes for q.10

*** codes for q.16 through q.20

If age 0-17 years

Brothers 0-17 years

Does [NAME] have

If age 0-4 years

Does [NAME] Do all of

Sisters 0-17 years

Questions and filters

What is the main source of Piped water

What kind of toilet facility do Flush toilet........................................................ 11

Do you share this toilet facility yes ............................................................................. 1

Does your household have:

telephone (any kind) ..................

water pump ......................................

table and chairs ..........................

What type of fuel does your electricity ......................................................... 01

Questions and filters

Main material of the floor

Main material of the roof

Questions and filters

Main material of the walls

How many rooms in this rooms .........................................................

Does any member of your

boat with motor ..........................

boat without motor ..................

Does your household have any yes..............................................................................1

How many mosquito nets does

When you got the net, Yes ......................... 1

Since you got the Yes .......................1

How long ago was the months

not sure ...........98

How long ago did your months

If less than 1 month,

Did anyone sleep under Yes .......................1

Who slept under this

Record name and

Go back to q.53 for next net. If no more net, go to the individual

Department of population and labour statistics

National institute of hygiene and epidemiology (NIHE)

Vietnam population and aids indicator survey (vpais)

Section 1. respondents background

Hello. My name is _______________________________ and I am working with the Department of

espondent does not agree to be interviewed

Questions and filters