REPUBLIC OF CAMEROON
MINISTRY OF PUBLIC HEALTH
NATIONAL MALARIA PROGRAMME

IDENTIFICATION

REGION
DIVISION
SUB-DIVISION
LACALITY
NAME OF HOUSEHOLD HEAD
CLUSTER NUMBER
STRUCTURE NUMBER
HOUSEHOLD NUMBER
NAME AND LINE NUMBER OF WOMAN

INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT*

NEXT VISIT: DATE
TIME

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT*

NEXT VISIT: DATE
TIME

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT*

FINAL VISIT
DAY
MONTH
YEAR 2022
INT. NO.
RESULT*

TOTAL VISITS

*RESULT CODES:
1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY)

LANGUAGE OF QUESTIONNAIRE** 01
LANGUAGE OF INTERVIEW**
NATIVE LANGUAGE OF RESPONDENT**
TRANSLATOR USED (YES = 1, NO = 2)
LANGUAGE OF QUESTIONNAIRE** ENGLISH
**LANGUAGE CODES:
01 ENGLISH
02 FRENCH
03 FUFULDE
04 PIDGIN
96 OTHER (SPECIFY)

TEAM
NUMBER

TEAM SUPERVISOR
NAME
NUMBER

INTRODUCTION AND CONSENT

Hello. My name is. I am working with the NATIONAL INSTITUTE OF STATISTICS. In collaboration with the MINISTRY OF PUBLIC HEALTH, we are conducting a survey about malaria all over CAMEROON. The information we collect will help plan health services. Your household was selected for the survey. The questions usually take about 10 to 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?

SIGNATURE OF INTERVIEWER DATE
RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

SECTION 1. RESPONDENTS BACKGROUND

101) RECORD THE TIME.

102) In what month and year were you born?

103) How old were you at your last birthday? COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT.

104) Have you ever attended school?

105) What is the highest level of school you attended: primary, 1st secondary cycle, 2nd secondary cycle or higher?

106) What is the highest [GRADE/FORM/YEAR] you completed at that level? IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

Codes for Q.
LEVEL
CLASS/FORM/YEAR
PRIMARY
LESS THAN 1YR =0
SIL/Class =1
CP/CPS/class2 =2
CE1/Class3 =3
CE2/Class4 =4
CM1/Class5 =5
CM2/Class6 =6
SECONDARY 1st Cycle
LESS THAN 1YR =0
6e/1ere A.T/Form1 =1
5e/2e A.T./Form2 =2
4e/3e A.T./Form3 =3
3e/4e A.T./Form4 =4
SECONDARY 2nd Cycle
LESS THAN 1YR =0
2nde G ou T/Form 5 =1
1ere G ou T/Lower 6 =2
Terminale G ou T/Upper 6 =3
HIGHER
LESS THAN 1YR =0
1e an/1st yr =1
We an/2nd yr =1
3e an/3rd yr =3
4e an/4th yr + =4

107) CHECK 105:
PRIMARY OR 1ST SECONDARY CYCLE OR 2ND SECONDARY CYCLE (GO TO 108)
HIGHER (GO TO 110)

108) Now I would like you to read this sentence to me. SHOW CARD TO RESPONDENT. IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

109) CHECK 108:
CODE '2', '3' OR '4' CIRCLED (GO TO 110)
CODE '1' OR '5' CIRCLED (GO TO 111)

110) Do you read a newspaper or magazine at least once a week, less than once a week or not at all?

111) Do you listen to the radio at least once a week, less than once a week or not at all?

112) Do you watch television at least once a week, less than once a week or not at all?

113) Do you own a mobile phone?

114) Is your mobile phone a smart phone?

115) Have you ever used the Internet from any location on any device?

116) In the last 12 months, have you used the Internet? IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.

117) During the last one month, how often did you use the Internet almost every day, at least once a week; less than once a week, or not at all?

118) What is your religion?

119) What is your ethnic group? RECORD THE ETHNICITY AND LEAVE THE CODING BOXES EMPTY. FOR THE FOREIGNERS, RECORD FOREIGN.

SECTION 2. REPRODUCTION

201) Now I would like to ask about all the births you have had during your life. Have you ever given birth?

202) Do you have any sons or daughters to whom you have given birth who are now living with you?

203) a) How many sons live with you? b) And how many daughters live with you? IF NONE, RECORD '00'.

204) Do you have any sons or daughters to whom you have given who are alive but do not live with you?

205) a) How many sons are alive but do not live with you? b) And how many daughters are alive but do not live with you? IF NONE, RECORD '00'.

206) Have you ever given birth to a boy or girl who was born alive but later died? 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?

207) a) How many boys have died? b) And how many girls have died? IF NONE, RECORD'00'.

208) SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'.

209) CHECK 208: Just to make sure that I have this right: you have had in TOAL births during your life. Is that correct?
YES (GO TO 210)
NO (PROBE AND CORRECT 201-208 AS NECESSARY)

210) CHECK 208:
ONE OR MORE BIRTHS (GO TO 211)
NO BIRTHS (GO TO 224)

211) Now I'd like to ask you about your more recent births. How many births have you had from 2017 to 2022? RECORD NUMBER OF LIVE BIRTHS IN 2017-2022

212) Now I would like to record the names of all your births in 2017-2022, whether still alive or not, starting with the most recent one you had. RECORD IN 213 THE NAMES OF ALL THE BIRTHS BORN IN 2017-2022. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS. IF THERE ARE MORE THAN 3 BIRTHS, USE AND ADDITIONAL QUESTIONNAIRE.

213) What name was given to your (most recent/previous) baby? RECORD NAME. BIRTH HISTORY NUMBER.

214) Is (NAME) a boy or a girl?

215) Was (NAME) a single birth, a twin, or a triplet? IF MULTIPLE PREGNANCY: COPY VALUE FOR 215 IN NEXT ROW(S).

216) On what day, month, and year was (NAME) born?

217) FOR ROW 01, ASK: Have you had any live births since the birth of (NAME OF MOST RECENT BIRTH), including any children who died after birth? AFTER ROW 01: IF 215=1 OR THIS IS THE LAST BIRTH OF A MULTIPLE PREGNANCY, ASK: Were there any other live births between (NAME) and (NAME OF FOLLOWING BIRTH), including any children who died after birth? IF 2151 AND THIS IS NOT THE LAST BIRTH OF THE PREGNANCY, SKIP TO 213 IN

217A) Did you have any other live births before the birth of (NAME) and during or after January 2017?

217B) READ THE LIST OF LIVE BIRTHS IN ORDER TO THE RESPONDENT, STARTING FROM THE MOST RECENT BIRTH, AND ASK IF THEY ARE ALL THAT SHE HAS HAD IN OR SINCE JANUARY 2017, AND IF THEY ARE LISTED IN ORDER. DOES THE RESPONDENT AGREE? IF NOT, PROBE FOR THE CORRECT INFORMATION AND REVISE THE BIRTH HISTORY ACCORDINGLY. IF YES, PROCEED TO 218 ROW 1.

218) Is (NAME) still alive?

219) IF ALIVE: How old was (NAME) at (his/her) last birthday? RECORD AGE IN COMPLETED YEARS.

220) IF ALIVE: is (NAME) living with you?

221) IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD. RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD.

223) COMPARE 211 WITH NUMBER OF BIRTH IN BIRTH HISTORY
NUMBERS ARE THE SAME (GO TO 224)
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224) Are you pregnant now?

225) How many weeks or months pregnant are you? RECORD NUMBER OF COMPLETED WEEKS OR MONTHS.

SECTION 3. PREGNANCY AND INTERMITTENT PREVENTIVE TREATMENT

301) CHECK 216 AND 219:
ONE OR MORE BIRTHS 0-35 MONTHS BEFORE THE SURVEY (GO TO 302)
NO BIRTHS 0-35 MONTHS BEFORE THE SURVEY (GO TO 401)

302) RECORD THE NAME OF THE MOST RECENT BIRTH FROM 213, LINE 01:

303) Now I would like to ask you some questions about your last pregnancy that resulted in a live birth. While you were pregnant with (NAME) did you see anyone for antenatal care for this pregnancy?

303a) What is the main reason you did not see anyone for antenatal care when you were pregnant with (NAME)?

304) Whom did you see? Anyone else? RECORD TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

NAME OF CHILD
BIRTH HISTORY NUMBER

305) Where did you receive antenatal care for this pregnancy? Anywhere else? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC, PRIVATE, OR NGO SECTOR, RECORD 'X' AND WRITE THE NAME OF THE PLACE(S).

305a) What is the main reason you did not go to a health facility to receive antenatal care during this pregnancy?

305b) What protective measure against COVID-19 have you noticed at the health facility or from the healthcare providers you received the antenatal care from? Any other measures? RECORD ALL MENTIONED.

306) How many weeks or months pregnant were you when you received antenatal care for this pregnancy?

307) How many times did you receive antenatal care during this pregnancy?

308) During this pregnancy, did you take SP/Fansidar pills to keep you from getting malaria?

309) How many times did you take the 3 SP/Fansidar pills during this pregnancy?

310) Did you get the SP/Fansidar during any antenatal care visit, during another visit to a health facility or form another source? IF MORE THAN ONE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST.

311) What is the main reason you did not take SP/Fansidar pills to keep you from getting malaria during this pregnancy?

SECTION 4. FEVER IN CHILDREN

401) CHECK 216, 218, AND 219 IN THE BIRTH HISTORY: ANY SURVIVING CHILDREN BORN 0-59 MONTHS BEFORE THE SURVEY?
ONE OR MORE SURVIVNG CHILDREN BORN 0-59 MONTHS BEFORE THE SURVEY (GO TO 402)
NO SURVIVING CHILDREN BORN 0-59 MONTHS BEOFRE THE SURVEY (GO TO 501)

402) Now I would like to ask some questions about the health of your children born in the last 5 years. (We will talk about each separately, starting with the youngest.)

403) RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 213 OF THE SURVIVING CHILDREN BORN 0-59 MONTHS BEFORE THE SURVEY, STARTING WITH THE LAST ONE.
NAME OF CHILD
BIRTH HISTORY NUMBER

404) Has (NAME) been ill with a fever at any time in the last 2 weeks?

404a) Did you fear that the fever might be a sign (NAME) may have COVID-19?

404b) Did you fear that the fever might be a sign that (NOM) may have malaria?

404c) Did you do anything or give treatment to (NOM) on your own, without seeking advice from a health care professional?

404d) What type of treatment or medication did you first provide to (NOM)?

404e) Where did you seek this treatment or medicine?

405) At any time during the illness, did (NAME) have blood taken from (NAME)'s finger or heel for testing?

406) Were you told by a healthcare provider that (NAME) had malaria?

407) Did you seek advice or treatment for the illness from any source?

NAME OF CHILD
BIRTH HISTORY NUMBER

408) Where did you seek advice or treatment? Anywhere else? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC, PRIVATE, OR NGO SECTOR, RECORD 'X' AND WRITE THE NAME OF THE PLACE(S).

408a) What is the main reason you did not go to a health facility for advice or treatment for this fever?

408b) What protective measures against COVID-19 have you noticed at the health facility or from the healthcare providers you received advice or treatment from? Any other measures? RECORD ALL MENTIONED

408c) How much money was did you spend in the FCFA at the health facility to receive advice or treatment for the (NAME)'s illness (NAME) on the following items: IF THE TREATMENT AND SERVICE WAS FREE, RECORD '000000' IF THE RESPONDENT CANNOT ESTIMATE, RECORD '99998' 1) Transport form the household to the health facility and back 2) Consultation fees 3) Diagnostic test cost 4) Drug costs 5) Other cost

409) CHECK 408:
TWO OR MORE CODES CIRCLED (GO TO 410)
ONLY ONE CODE CIRCLED (GO TO 411)
NOT ASKED (GO TO 412)

410) Where did you first seek advice or treatment? USE LETTER CODE FROM 408.

411) How many days after the illness began did you first seek advice or treatment for (NAME)? IF THE SAME DAY RECORD '00'.

411a) Were you offered a COVID-19 test where you sought advice or treatment for this fever?

412) At any time during the illness, did (NAME) take any medicine or treatment for the illness?

412a) What is the main reason (NAME) did not take any treatment or medication against the illness?

413) What medicine or treatment did (NAME) take? Any other medicine or treatment? RECORD ALL MENTIONED. IF MEDICINE NOT KNOWN, ASK TO SEE THE PACKAGE OR PRESCRIPTION.

414) CHECK 413: ARTEMISININ COMBINATION THERAPY ('A') GIVEN
CODE 'A' CIRCLED (GO TO 415)
CODE 'A' NOT CIRCLED (GO TO 416)

415) How long after the fever started did (NAME) first take an artemisinin combination therapy?

416) CHECK 216 AND 218 IN BIRTH HISTORY: ANY MORE SURVIVING CHILDREN BORN 0-59 MONTHS BEFORE THE SURVEY?
NO MORE SURVIVING CHILDREN BORN 0-59 MONTHS BEFORE THE SURVEY (GO TO 501)
MORE SURVIVING CHILDREN BORN 0-59 MONTHS BEFORE THE SURVEY (GO TO 403)

SECTION 5. MALARIA KNOWLEDGE AND BELIEFS

501) In the past six months, have you seen or heard any messages about malaria?

502) Where did you see or hear these messages? PROBE: Anywhere else? RECORD ALL MENTIONED.

502a) In the past six months, have you seen, received or heard any messages or advice about not delaying seeking advice or treatment at a health facility when one has fever or thinks they might have malaria?

503) Are there ways to avoid getting malaria?

504) What are the things that people can do to prevent themselves from getting malaria? RECORD ALL MENTIONED.

505) Now I am going to read some statements and I would like you to tell me whether you agree or disagree with each statement. If you don't know, say, don't know. People in this community only get malaria during the rainy season. Do you agree or disagree?

506) When a child has a fever, you almost always worry it might be malaria. do you agree or disagree?

507) Getting malaria is not a problem because it can be easily treated. Do you agree or disagree?

508) Only weak children can die from malaria. Do you agree or disagree?

509) You can sleep under a mosquito net for the entire night when there are lots of mosquitos. Do you agree or disagree?

510) You can sleep under a mosquito net for the entire night when there are a few mosquitos. Do you agree or disagree?

511) You do not like sleeping under a mosquito net when the weather is too warm. Do you agree or disagree?

512) When a child has a fever, it is best to start by giving them any medicine you have at home. Do you agree or disagree?

513) People in your community usually take their children to a health care provider or a community health worker on the same day or day after they develop a fever. Do you agree or disagree? IF RESPONDENT DOESN'T KNOW, PROBE: Would you say more than half or less than half of the

514) People in your community who have a mosquito net usually sleep under a mosquito net every night. Do you agree or disagree? IF RESPONDENT DOESN'T KNOW, PROBE: Would you say more than half or less than half of the community does this?

515) Fever may be a symptoms of malaria and also a symptom of COVID-19.. Do you agree or disagree?

516) COVID-19 can be transmitted by mosquito bites. Do you agree or disagree?

517) People in your community are afraid to go to health facilities when they have fever or when they think they might have malaria for fear of being infected with or being told they have COVID-19. Do you agree or disagree?

518) Have you ever seen, received or heard a message that children under 5 years with malaria receive free medicines for malaria treatment at a public health facility or from a community health worker? IF YES, ASK: Was it in the last 12 months, or more than 1 ago?

519) In your village or neighborhood, do you know of a community health worker or a person recognized by the Ministry of Health who is responsible for giving health advice, distributing mosquito nets free of charge and administering malaria medicines free of charge to children under 5 years?

520) RECORD THE TIME.

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT INTERVIEW:

COMMENTS ON SPECIFIC QUESTIONS:

ANY OTHER COMMENTS:

SUPERVISOR'S OBSERVATIONS