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Questionnaire on Sexually Transmitted Infections

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Questionnaire on Sexually Transmitted Infections
Questionnaire on Sexually Transmitted Infections

For face-to-face interviewing women aged 15 to 49 in FilaBavi, Vietnam

Date of interview:...../...../.....time….. Date of supervision:......./......./........
Name of interviewer:.............Duration…….. Name of field supervisor:.....................
Comments of interviewer on respondent’s Comments of field supervisor cooperation……………………………… …………………………………………. ………………………………………… ………………………………………….

I. General information:
Commune................ Cluster number................ Household code................
Name ............................................... Age................ ID number................
Ethnic group: (1. Kinh (2. Muong (3. Other
1. a, Your occupation: (1. Farmer (2. Government staff (3. Worker (4. Trader (5. Student (6. Housewife (7. Unemployed (8. Hired labor (9. Service (please specify)....................................................................... (10. Other (please specify)....................................................................................... b, Do you have to soak your body into water while working? (0. No (1. Yes
2. Your education: (1. Illiterate (2. Primary (3. Secondary school (4. High school (5. College or University
3. a, Your marital status at present: (1. Unmarried (2. Married, living with husband/partner (3. Separated (4. Divorced (5. Widowed b, Year of your first marriage?………………
4. Have you had any children? (0. No (1. Yes, If yes, how many …………
5. Which of the following events have you ever experienced?
| | |No |Yes |How many times |When was the last time? |
|1 |Induced abortion | | | | |
|2 |Miscarriage
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