PACKARD WESTERN KENYA BASELINE SURVEY 2010

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Q419 Why did you choose this facility PROBE: ANY OTHER REASON Kwa nini ulichagua kituo hiki ULIZA: Sababu nyingine yoyote MULTIPLE RESPONSES SERVICES ARE FREE/ AFFORDABLE……. FACILITY OPEN/CONVENIENT HOURS OF OPERATION…..……………………..………… STAFF ARE POLITE AND RESPECTFUL… CONVENIENT TO MY HOME……………… CONVENIENT TO MY WORK……………… CONVENIENT TO WHERE I SHOP………… CONVENIENT USING AVAILABLE TRANSPORT…………………………………. GOOD QUALITY SERVICES……………… OFFER SERVICES REQUIRED…………… PROVIDERS AVAILABLE………………… ACCEPT INSURANCE………………………… OFFER CREDIT FACILITIES………………… FACILITY HAS A GOOD REPUTATION……. IT PROVIDES MULTIPLE SERVICES……… REFERRED THERE…………………………… A B C D E F G H I J K L M N O Q420 At your last visit, did you receive any information or counseling on family planning/contraception OTHER___________________________ (SPECIFY) YES . . . . . . . . . . . . . . . . . . . . . . …………. NO . . . . . . . . . . . . . . . . . . . . . . . ………… X 1 2 Q422 Ulipokwenda mara ya mwisho, ulipata habari ama ushauri wowote kuhusu kupanga uzazi/ njia ya kuzuia mimba Q421 Did you receive a method or a referral for family planning/ contraceptive method at that time Je, ulipewa njia yoyote ama ulitumwa mahali pengine kupata njia ya kupanga uzazi/ njia ya kuzuia mimba wakati huo YES, RECEIVED A METHOD. . . . . . . ….. . . YES, RECEIVED A PRESCRIPTION………... YES, RECEIVED A REFERRAL . . . . . . . . …. NO, DID NOT RECEIVE ANY OF THESE…. 1 2 3 4 Q422 In the last year, have you gone to a health facility for an HIV test Katika muda wa mwaka mmoja uliopita umekwenda kituo cha afya ili kupimwa virusi vya ukimwi YES . . . . . . . . . . . . . . . . . . . . . . ……………. NO . . . . . . . . . . . . . . . . . . . . . . . ……………. 1 2 Q427 Q423 Where did you go most recently for an HIV test Ulikwenda wapi hivi karibuni kupimwa virusi vya ukimwi PROBE: What is the name of this place And where is it located ULIZA: Mahali hapo paitwa je Na pako wapi NAME OF FACILITY___________________________ PHYSICAL LOCATION____ ____________________ LAND MARK_________________________________ Page 38
Q424 What type of facility is this Kituo hiki ni cha aina gani PUBLIC SECTOR GOVERNMENT HOSPITAL . . . . . GOVT. HEALTH CENTER . . . . . . GOVERNMENT DISPENSARY . . OTHER PUBLIC______________ (SPECIFY) 11 12 13 16 PRIVATE MEDICAL SECTOR FAITH-BASED, CHURCH, MISSION HOSPITAL/CLINIC………………...... PRIVATE HOSPITAL/CLINIC........... NURSING/MATERNITY HOME…… CHW/TBA…………………………….. TRADITIONAL HEALER…………… PHARMACY………………………… CHEMIST/DUKA LA DAWA……….. OTHER PRIVATE ______________ (SPECIFY) 21 22 23 24 25 26 27 28 Q425 Q426 Q427 At the time of your last test, did you receive any information or counseling on family planning/contraception Ulipokwenda kupimwa mara ya mwisho, je ulipata habari au ushauri wowote kuhusu njia za kupanga uzazi/kuzuia mimba Did you receive a method or a referral for family planning/contraceptive method at that time Ulipokea njia ama ulitumwa pahali pengine kupokea njia za kupanga uzazi/kuzuia mimba kwa wakati huo What is the name of the pharmacy that you usually go to for medicine And where is it located Duka la dawa ambapo wewe huenda kwa kawaida kupata dawa linaitwaje Na liko wapi OTHER SOURCE WORKSITE CLINIC…………….…… MOBILE CLINIC . . . . . . . . . . . . . . . . YOUTH CENTER…………………… VCT/CCC………………….……….... OTHER ______________________ (SPECIFY) DON'T KNOW . . . . . . . . . . . . . . …… . . YES . . . . . . . . . . . . . . . . . . . . . . …………….. NO . . . . . . . . . . . . . . . . . . . . . . . …………….. YES, RECEIVED A CONDOM……………… YES, RECEIVED A METHOD OTHER THAN A CONDOM………………... . . . . . . . . . . . YES, RECEIVED A PRESCRIPTION. . . . . . . YES, RECEIVED A REFERRAL . . . . . . . . . . NO, DID NOT RECEIVE ANY OF THESE…. 31 32 33 34 96 NAME OF PHARMACY_________________________ PHYSICAL LOCATION____ ____________________ LAND MARK_________________________________ 98 1 2 Q427 1 2 3 4 5 Q428 KQ23 Have you ever received any information or counseling on family planning/contraception while purchasing or obtaining medicine from this pharmacy Umewahi kupokea habari au ushauri kuhusu njia za kupanga uzazi/kuzuia mimba wakati unaponunua dawa kutoka kwenye duka hili la dawa When considering the type of facility you would go to for health services, to what extent would you say you are influenced by the facility’s achievements as demonstrated by medals and certificates of recognition for good work or services Would you say not at all, rarely, sometimes or always. Wakati unapofikiria kuhusu aina ya kituo ambacho utaenda kupokea huduma za afya, ni kwa kiasi gani waweza sema unashawishika na umashuhuri wa kituo hicho kwa vyeti na medali walizozipokea kwa kutambua kazi yao nzuri ama huduma zao YES . . . . . . . . . . . . . . . . . . . . . . ……………. NO . . . . . . . . . . . . . . . . . . . . . . . ……………. NOT AT ALL…………………………………… RARELY………………………………………… SOMETIMES…………………………………… OFTEN/ALWAYS………………………………… 1 2 1 2 3 4 Page 39
Page 1 and 2: QUESTIONNAIRE NO: [__|__|__|__|__|_
Page 3 and 4: Costs and Payment for Participation
Page 5 and 6: Q109 Please read for me the sentenc
Page 7 and 8: Q212 Q213 Have you ever had a pregn
Page 9 and 10: (Q21 7C) Line no. (Q218) What name
Page 11 and 12: (Q21 7C) Line no. (Q218) What name
Page 13 and 14: Q239 What type of facility did you
Page 15 and 16: SECTION 3: CONTRACEPTION CHECK FOR
Page 17 and 18: Q303 CHECK 301 (KNOWLEDGE OF ANY CO
Page 19 and 20: Q309 CHECK Q235 CURRENTLY PREGNANT
Page 21 and 22: KQ5 How many living children did yo
Page 23 and 24: Q330 FOR A WOMAN WHO HAS BEEN STERI
Page 25 and 26: Q337 What method(s) did you use (th
Page 27 and 28: KQ10 Before you started using last
Page 29 and 30: Q350 Which is this place or person
Page 31 and 32: Q371 Q372 Why did/do you prefer to
Page 33 and 34: SECTION 4: MATERNAL AND CHILD HEALT
Page 35 and 36: KQ19 KQ20 Where did [NAME] receive
Page 37: Q414 Did you receive any informatio
Page 41 and 42: Q507 In the last twelve (12) months
Page 43 and 44: Q601 SECTION 6: FERTILITY PREFERENC
Page 45 and 46: Q610 Does your husband/partner want
Page 47 and 48: Q701 SECTION 7: SPOUSAL AND INTERPE
Page 49 and 50: Q720 Do you think there are some pe
Page 51 and 52: Q730 Q731 Q732 Q733 Q734 Q735 RECOR
Page 53 and 54: SECTION 8: GENDER INEQUITY MEASURES
Page 55 and 56: Q819 CHECK Q510 AND Q511: EVER MARR
Page 57 and 58: Now I am going to read some stateme
Page 59 and 60: Q903 Which newspaper(s) do you read
Page 61 and 62: Q920 Q921 What time of the day do y
Page 63 and 64: Q936 In the past three months, have
Page 65 and 66: Q938. What are the names and types
Page 67 and 68: Q1008 How long do you usually stay
Page 69 and 70: FOLLOW-UP CONTACTS Q1100 Q1101 WOMA

PACKARD WESTERN KENYA BASELINE SURVEY 2010

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