Knowledge and perception on HIV premarital counseling and testing among unmarried young people of Kintampo town in the republic of Ghana,

Contact address: [e-mail]

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ANNEX 1. QUESTIONNAIRE FOR THE SURVEY		CODE^code
KNOWLEDGE AND PERCEPTIONS TOWARDS PREMARITAL COUNSELLING AND TESTING (PCT) ON HIV INFECTION AMONG UNMARRIED YOUNG ADULTS IN KINTAMPO DISTRICT	FORM NO	FORMNO

ADMINISTER THIS QUESTIONNAIRE TO UNMARRIED ADULTS BETWEEN 15-30 YEARS

1. BACKGROUND and ID:

CODE^C(*)ode

Sub District

CODESD

Village/Code

CODEVILL

Compound Number

CODECO

Respondent ID:

CODERES

KDSS PERMANENT ID

CODKDSS

Date of visit: ..................................................

DATEVISIT

Staff code: ......................................................................................

CODESTAF

2. SOCIO-DEMOGRAPHIC BACKGROUND OF RESPONDENT

1 Sex

1. Male

2. Female

BSEX

2 a .Highest educational level reached

1. None	2. Primary school	3. Middle/continuation school/JSS			BEDULEV
4.Technical/commercial/SSS secondary school	5. Post-middle college - teacher training, secretarial	6. Post secondary - nursing, teacher, polytechnic, etc.
7. University	8. Not known	///////////////////////////////////////
b. Number of years successfully completed at the highest level reached [88 = NK]						BEDUYRS

3.What is your religion?

1.Catholic

2. Protestant

3. Pentecostal

4. Muslim

5. Traditional African

6. No religion

7. Other:

BRELIGN

4.What ethnic group do you belong to?

11. Akan: Bono, Ashanti, Fanti

12. . Mo

13. Gonja, Dagomba,

14. Konkomba, Basare

BETHNIC

15.Frafra, , Grushie,

16.Mamprusi, Kusasi

17. Dagarti, Sisala, Wala

18. Other

5. a. Age

BAGE

b. Age group^*(*):

1. 15 -19 yrs

2. 20 - 24

3. 25 - 30

BAGEGRP

6. Profession

1. Farmer

2. Government worker

3.Trader

BPROFES

4. Student/Pupil

5. Other:

7.Location/Residence area

1. Rural

2. Urban

BLOCATN

* ^Code : The last right columns contain field names (codes) that will be used in data entry and analysis.

* ^* For every uneducated respondent who does not remember his/her age, the interviewer can look at him/her and estimate his/her age group.