FORMATTING DATE: 29 SEP. 2016
ENGLISH LANGUAGE: 29 SEP. 2016
2016 GHANA MALARIA INDICATOR SURVEY WOMAN'S
MINISTRY OF HEALTH
GHANA STATISTICAL SERVICES
IDENTIFICATION
LOCALITY NAME __________________
NAME OF HOUSEHOLD HEAD _____________________
REGION ________
DISTRICT ___________
CLUSTER NUMBER __________
HOUSEHOLD NUMBER ___________
NAME AND LINE NUMBER OF WOMAN ____________________
VISITS 1, 2, AND 3
INTERVIEWER'S NAME ______________
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER ____________(SPECIFY) 7
NEXT VISIT:
TIME: ______________
FINAL VISIT
MONTH _________
YEAR 2016
INTERVIEWER NUMBER __________
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER ____________(SPECIFY) 7
TOTAL NUMBER OF VISITS ___________
LANGUAGE OF QUESTIONNAIRE: ENGLISH 01
AKAN 02
GA 03
EWE 04
OTHER ____________(SPECIFY) 06
AKAN 02
GA 03
EWE 04
OTHER ____________(SPECIFY) 06
NO 2
NUMBER ____________
Hello. My name is _______________. I am working with Ghana Statistical Service and the Ministry of Health. We are conducting a survey about malaria all over Ghana. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 30 to 60 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 DOES NOT AGREE TO BE INTERVIEWED 2 (END)
SECTION 1. RESPONDENT'S BACKGROUND
101. RECORD THE TIME.
MINUTES __________
102. In what month and year were you born?
DON'T KNOW MONTH 98
YEAR ___________
DON'T KNOW YEAR 9998
103. How old were you at your last birthday?
COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT.
104. Have you ever attended school?
NO 2 (SKIP TO 108)
105. What is the highest level of school you attended: primary, middle, JSS/JHS, SSS/SHS, secondary, or higher?
MIDDLE 2
JSS/JHS 3
SECONDARY 4
SSS/SHS 5
HIGHER 6
106. What is the highest GRADE you completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.
HIGHER (SKIP TO 109)
SECTION 1. RESPONDENT'S BACKGROUND
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?
ABLE TO READ ONLY PART OF THE SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE ___________________(SPECIFY LANGUAGE) 4
BLIND/VISUALLY IMPAAIRED 5
ANGLICAN 02
METHODIST 03
PRESBYTERIAN 04
PENTECOSTAL/CHARISMATIC 05
OTHER CHRISTIAN 06
ISLAM 07
TRADITIONAL/SPIRITUALIST 08
NO RELIGION 95
OTHER ____________(SPECIFY) 96
110. To which ethnic group do you belong?
GA/DANGME 02
EWE 03
GUAN 04
MOLE-DAGBANI 05
GRUSI 06
GURMA 07
MANDE 08
OTHER _________(SPECIFY) 96
110A. Now I would like you to talk about malaria. In your opinion, what causes malaria? What else?
RECORD ALL MENTIONED.
STANDING/WORKING IN THE SUN B
EATING CONTAMINATED FOOD C
MOSQUITO BITES D
MALARIA PARASITE (P. FALCIPARUM) E
HEREDITARY F
DIRTY SURROUNDINGS G
WEEDY SURROUNDINGS H
STAGNANT WATER I
OTHER ________________(SPECIFY) X
DON'T KNOW Z
110B. How would you know that someone has malaria? What else?
RECORD ALL MENTIONED.
VOMITING/DIARRHEA B
STRONG HEADACHES/DIZZINESS C
LOSS OF APPETITE D
WEAKNESS OF THE BODY E
COUGH F
CHILLS G
BITTERNESS IN THE MOUTH H
OTHER ________(SPECIFY) X
DON'T KNOW Z
110C. How can one protect him/herself against malaria?
RECORD ALL MENTIONED.
SLEEP UNDER AN INSECTICIDE-TREATED MOSQUITO NET B
USE MOSQUITO REPELLENT C
SPRAY THE HOUSE/ROOMS WITH INSECTICIDE D
CLEAR WEEDS AROUND THE HOUSE E
FILL IN STAGNANT WATERS (PUDDLES) F
KEEP SURROUNDING CLEAN G
PUT MOSQUITO SCREEN ON WINDOWS H
OTHER ___________________(SPECIFY) X
DON'T KNOW Z
NO 2
DON'T KNOW 8
111. In the past six months, have you seen or heard any messages about malaria?
NO 2 (SKIP TO 117)
112A. Where did you see or hear these messages? Where else?
RECORD ALL MENTIONED.
TELEVISION B
POSTER/BILLBOARD C
NEWSPAPER/MAGAZINE D
LEAFLET/BROCHURE E
HEALTH WORKER F
COMMUNITY HEALTH WORKER G
COMMUNITY VOLUNTEER/CBA H
WORD OF MOUTH I
COMMUNITY EVENT J
ANYWHERE ELSE ________________(SPECIFY) X
DON'T REMEMBER Z
112. CHECK 112A: IF A COMMUNICATION CHANNEL WAS MENTIONED AT 112A, CIRCLE 0; IF NOT ASK:
Have you seen or heard these messages:
YES 1
NO 2
b. On the television?
YES 1
NO 2
c. On a poster or a billboard?
YES 1
NO 2
d. In a newspaper or a magazine?
YES 1
NO 2
e. On a leaflet or a brochure?
YES 1
NO 2
f. From a health worker?
YES 1
NO 2
g. From a community health worker (CHW)?
YES 1
NO 2
h. A community volunteer or a community based agent?
YES 1
NO 2
i. Word of mouth?
YES 1
NO 2
j. At a community event?
YES 1
NO 2
113. What messages about malaria have you seen or heard in the past 6 months? What else?
RECORD ALL MENTIONED.
SLEEP UNDER AN INSECTICIDE-TREATED MOSQUITO NET B
PREGNANT WOMEN SHOULD TAKE DRUGS TO PREVENT MALARIA C
SP PROTECTS PREGNANT WOMEN AND UNBORN BABY FROM GETTING MALARIA D
ALWAYS TEST BEFORE TREATING MALARIA E
TREAT MALARIA WITH ACTs F
MALARIA KILLS G
OTHER ______________(SPECIFY) X
DON'T KNOW/DON'T REMEMBER Z
114. In the past six months, have you seen/heard any of the following malaria messages on television or radio:
YES, RADIO 2
YES, TV AND RADIO 3
NO 4
b. Advert that recommended everyone should sleep under treated net by Kwabena (musician)?
YES, RADIO 2
YES, TV AND RADIO 3
NO 4
c. Advert where people were asked to test first before taking malaria medicines?
YES, RADIO 2
YES, TV AND RADIO 3
NO 4
115. During the past six months, have you seen/heard any advert on the use of ACTs/malaria medicines?
NO 2 (SKIP TO 117)
116. Where did you see/hear the advert on the use of ACTs/malaria medicines? Any other media?
RECORD ALL MENTIONED.
RADIO B
NEWSPAPER/MAGAZINE C
POSTER/LEAFLETS D
BILLBOARD E
OTHER _______________(SPECIFY) X
DON'T KNOW/DON'T REMEMBER Z
117. Have you participated in any community event (durbar/meeting), educating community members on prevention and control of malaria?
NO 2
118. I will now ask you a few questions about health insurance. Are you currently covered by any health insurance?
PROBE TO MAKE SURE THAT THE INSURANCE COVERAGE IS ACTIVE AT THE TIME OF INTERVIEW.
NO 2 (SKIP TO 120)
119. What type of health insurance are you currently covered by?
RECORD ALL MENTIONED.
HEALTH INSURANCE THROUGH EMPLOYER B
MUTUAL HEALTH ORGANIZATION/COMMUNITY-BASED HEALTH INSURANCE C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
OTHER ______________(SPECIFY) X
120. Now I would like to ask you a few questions about episodes of malaria. During the past 12 months, have you experienced an episode of malaria?
NO 2 (SKIP TO 132)
121. The last time you had malaria, did you seek advice or treatment from any source?
NO 2 (SKIP TO 124)
122. Where did you seek advice or treatment? Anywhere else?
PROBE TO IDENTIFY THE TYPE OF SOURCE: IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE(S).
PUBLIC SECTOR
GOVERNMENT HEALTH CENTER/CLINIC B
GOVERNMENT HEALTH POST/CHPS C
MOBILE CLINIC D
FIELDWORKER/CHW E
OTHER PUBLIC SECTOR _________________(SPECIFY) F
PRIVATE MEDICAL SECTOR
PHARMACY H
CHEMIST/DRUG STORE I
FGP/PPAG CLINIC J
PRIVATE DOCTOR K
MOBILE CLINIC L
FIELDWORKER/CHW M
OTHER PRIVATE MEDICAL SECTOR ________________(SPECIFY) N
OTHER _________________(SPECIFY) X
123. To confirm the malaria diagnosis, did you provide a blood sample for malaria testing?
NO 2
124. To treat the malaria, were you prescribed any antimalaria medicine or did you take any antimalaria without a prescription?
YES, TOOK WITHOUT PRESCRIPTION 2
NEITHER PRESCRIBED NOR TAKEN 3 (SKIP TO 132)
125. What antimalaria medicine (were you prescribed/did you take) to treat the malaria?
RECORD ALL MENTIONED.
PLEASE NOTE BRAND NAMES:
Malafan
Palidar
Suldox
DP/DIHYDROARTEMISININPIPERAQUINE
Duo-cotexcin
AA/ARTESUNATE AMODIAQUINE
Arsuamoon
Camoquine plus
G sunate
Co-arsucam
AL/ARTEMETHER LUMEFANTRINE
Lumartem
Artefan
Lonart
Gen-m
Artemos plus
CHLOROQUINE B
DP/DIHYDROARTEMISININ-PIPERAQUINE C
QUININE D
AA/ARTESUNATE AMODIAQUINE E
ARTEMISININ F
AL/ARTEMETHER-LUMEFANTRINE G
HERBAL MEDICINE H
OTHER ______________(SPECIFY) X
DON'T KNOW Z
126. Did you purchase the antimalaria medicine?
NO 2 (SKIP TO 132)
127. Did you have to pay out of pocket for the antimalarial medicines?
NO 2
YES, TOOK WITHOUT PRESCRIPTION OR NOT ASKED (SKIP TO 132)
129. Did you purchase the antimalaria medicine at the same place where you sought care?
NO 2
130. Where did you purchase the antimalarial medicine?
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST/CHPS C
MOBILE CLINIC D
FIELDWORKER/CHW E
OTHER PUBLIC SECTOR ___________(SPECIFY) F
PRIVATE MEDICAL SECTOR
PHARMACY H
CHEMIST/DRUG STORE I
FPA/PPAG CLINIC J
PRIVATE DOCTOR K
MOBILE CLINIC L
FIELDWORKER/CHW M
OTHER PRIVATE MEDICAL SECTOR _____________(SPECIFY) N
OTHER SOURCE
TRADITIONAL PRACTITIONER P
MARKET Q
ITINERANT DRUG SELLER R
OTHER ____________(SPECIFY) X
131. Did you have to pay out of pocket for other services you received related to the malaria infection?
NO 2
132. Are you aware that malaria care is covered under the NHIS?
NO 2
201. Now I would like to ask about all the births you have had during your life. Have you ever given birth?
NO 2 (SKIP TO 206)
202. Do you have any sons or daughters to whom you have given birth who are now living with you?
NO 2 (SKIP TO 204)
203a. How many sons live with you?
IF NONE, RECORD '00'.
203b. And how many daughters live with you?
IF NONE, RECORD '00'.
204. Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?
NO 2 (SKIP TO 206)
205a. How many sons are alive but do not live with you?
IF NONE, RECORD '00'.
205b. 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?
NO 2 (SKIP TO 208)
207a. How many boys have died?
IF NONE, RECORD '00'.
207b. 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 TOTAL _______ births during your life. Is that correct?
NO (PROBE AND CORRECT 201-208 AS NECESSARY)
NO BIRTHS (SKIP TO 225)
211. Now I'd like to ask you about your most recent births. How many births have you had in 2011-2016?
RECORD NUMBER OF LIVE BIRTHS IN 2011-2016?
NONE 00 (SKIP TO 225)
212. Now I would like to record the names of all your births in 2011-2016, whether still alive or not, starting with the most recent one you had.
RECORD IN 213 THE NAMES OF ALL THE BIRTHS BORN IN 2011-2016. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS. IF THERE ARE MORE THAN 5 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE STARTING WITH THE SECOND ROW.
213. What name was given to your (most recent/previous) baby?
BIRTH HISTORY NUMBER.
214. Is (NAME) a boy or a girl?
GIRL 2
215. Were any of these birth twins?
MULTIPLE 2
216. On what day, month, and year was (NAME) born?
MONTH _______
YEAR _____
NO 2 (NEXT BIRTH)
218. IF ALIVE: How old was (NAME) at (NAME)'s last birthday?
RECORD AGE IN COMPLETED YEARS.
219. IF ALIVE: Is (NAME) living with you?
NO 2
220. IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD. RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD.
221. Were there any other live births between (NAME) and (NAME OF PREVIOUS BIRTH), including any children who died after birth?
NO (NEXT BIRTH) 2
222. Have you had any live births since the birth of (NAME OF MOST RECENT BIRTH)?
NO 2
223. COMPARE 211 WITH NUMBER OF BIRTHS IN BIRTH HISTORY
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)
224. CHECK 211: ENTER THE NUMBER OF BIRTHS IN 2011-2016
NONE 0
NO 2 (SKIP TO 227)
UNSURE 8 (SKIP TO 227)
226. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.
NO BIRTHS IN 2011-2016 (GO TO 431)
Q. 224 IS BLANK (GO TO 431)
SECTION 3. PREGNANCY AND INTERMITTENT PREVENTIVE TREATMENT
301. RECORD THE NAME AND SURVIVAL STATUS OF THE MOST RECENT BIRTH FROM 213 AND 217.
LIVING (CONTINUE)
DEAD (CONTINUE)
302. Now I would like to ask you some questions about your last pregnancy that resulted in a live birth.
When you got pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?
NO 2 (SKIP TO 304)
303. Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
NURSE/MIDWIFE B
COM. HEALTH OFFICER/NURSE C
OTHER PERSON
COMMUNITY/VILLAGE HEALTH WORKER F
TRADITIONAL HEALTH PRACTITIONER G
OTHER ______________(SPECIFY) X
304. During this pregnancy, did you take SP/Fansidar to keep you from getting malaria?
NO 2 (SKIP TO 307)
DON'T KNOW 8 (SKIP TO 307)
305. How many times did you take SP/Fansidar during this pregnancy?
306. Did you get the SP/Fansidar during any antenatal care visit, during another visit to a health facility or from another source?
IF MORE THAN ONE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST.
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6
NO LIVING CHILDREN BORN IN 2011-2016 (GO TO 431)
401. CHECK 213: RECORD THE BIRTH HISTORY NUMBER IN 402 AND THE NAME AND SURVIVAL STATUS IN 403 FOR EACH BIRTH IN 2011-2016. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE MOST RECENT BIRTH IF THERE ARE MORE THAN 2 BIRTHS, USE ADDITIONAL QUESTIONNAIRE(S).
Now I would like to ask some questions about the health of your children born since January 2011. (We will talk about each separately.)
402. BIRTH HISTORY NUMBER FROM 213 IN BIRTH HISTORY
NEXT MOST RECENT BIRTH
LIVING (CONTINUE)
DEAD (SKIP TO 430)
403A. Since 2015, was (NAME) enrolled in a program to receive a dose of medicine, every month for four months, to prevent malaria?
IF YES: were you enrolled in that program in 2015, 2016, or in 2015 and 2016?
YES, IN 2016 2
YES, IN 2015 AND IN 2016 3
NO, NEVER ENROLLED 4 (SKIP TO 404)
403B. How many doses did (NAME) take in 2015 or 2016?
DOSES IN 2016
404. Has (NAME) been ill with a fever at any time in the last 2 weeks?
NO 2 (SKIP TO 430)
DON'T KNOW 8 (SKIP TO 430)
405. At any time during the illness, did (NAME) have blood taken from (NAME)'s finger or heel for testing?
NO 2 (SKIP TO 406)
DON'T KNOW 8 (SKIP TO 406)
405A. What was the result of (NAME)'s blood test?
POSITIVE OTHER ILLNESSES 2
NEGATIVE 3
DON'T KNOW/DON'T REMEMBER 8
406. Did you seek advice or treatment for the illness for any source?
NO 2 (SKIP TO 411)
407. Where did you seek advice or treatment? Anywhere else?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE(S).
PUBLIC SECTOR
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST/CHPS C
MOBILE CLINIC D
FIELDWORKER/CHW E
OTHER PUBLIC SECTOR _________________(SPECIFY) F
PRIVATE MEDICAL SECTOR
PHARMACY H
CHEMIST/DRUG STORE I
FPG/PPAG CLINIC J
PRIVATE DOCTOR K
MOBILE CLINIC L
FIELDWORKER/CHW M
OTHER PRIVATE MEDICAL SECTOR _______________ (SPECIFY) N
OTHER SOURCE
TRADITIONAL PRACTITIONER P
MARKET Q
ITINERANT DRUG SELLER R
OTHER _____________(SPECIFY) X
ONLY ONE CODE CIRCLED (SKIP TO 410)
409. Where did you first seek advice or treatment?
USE LETTER CODE FROM 407
410. How many days after the illness began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY RECORD '00'.
411. At any time during the illness, did (NAME) take any drugs for the illness?
NO 2 (SKIP TO 430)
DON'T KNOW 8 (SKIP TO 430)
412. What drugs did (NAME) take? Any other drugs?
RECORD ALL MENTIONED.
PLEASE NOTE BRAND NAMES:
Malafan
Palidar
Suldox
DP/DIHYDROARTEMISININPIPERAQINE
Duo-cotexcin
AA/ARTESUNATE AMODIAQUINE
Arsuamoon
Camoquine plus
G sunate
Co-arsucam
AL/ARTEMETHER LUMEFANTRINE
Lumarterm
Artefan
Lonart
Gen-m
Artemos plus
CHLOROQUINE B
DIHIDROARTEMIS-PIPERAQUINE C
QUININE PILLS D
QUININE INJECTION/IV E
ARESUNATE AMODIAQUINE RECTAL/TABLETS F
ARESUNATE AMODIAQUINE INJECTION/IV G
ARTEMISININ H
ARTEMETHER-LUMEFANTRINE I
OTHER ANTIMALARIAL ____________(SPECIFY) J
ANTIBIOTIC DRUGS
INJECTION/IV L
OTHER DRUGS
PARACETAMOL/PANADOL N
ACETAMINOPHEN O
IBUPROFEN P
HERBAL MEDICINE Q
OTHER _____________(SPECIFY) X
DON'T KNOW Z
413. CHECK 412: ANY CODE A-J CIRCLED?
NO (SKIP TO 430)
414. CHECK 412: SP/SULFADOXINE PYRIMETH. ('A') GIVEN
CODE 'A' NOT CIRCLED (SKIP TO 416)
415. How long after the fever started did (NAME) first take SP/sulphadoxine-pyrimethamine?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
416. CHECK 412: CHLOROQUINE ('B') GIVEN
CODE 'B' NOT CIRCLED (SKIP TO 418)
417. How long after the fever started did (NAME) first take chloroquine?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
418. CHECK 412: DIHYDROARTEMISININ-PIPERAQUINE ('C') GIVEN
CODE 'C' NOT CIRCLED (SKIP TO 420)
419. How long after the fever started did (NAME) first take dihydroartemisinin-piperaquine?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
420. CHECK 412: QUININE ('D' OR 'E') GIVEN
CODE 'D' OR 'E' NOT CIRCLED (SKIP TO 422)
421. How long after the fever started did (NAME) first take quinine?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
422. CHECK 412: ARTESUNATE AMODIAQUINE ('F' OR 'G') GIVEN
CODE 'F' OR 'G' NOT CIRCLED (SKIP TO 424)
423. How long after the fever started did (NAME) first take artesunate with amodiaquine?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
424. CHECK 412: ARTEMISININ ('H') GIVEN
CODE 'H' NOT CIRCLED (SKIP TO 426)
425. How long after the fever started did (NAME) first take artemisinin?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
426. CHECK 412: ARTEMETHER LUMEFANTRINE ('I') GIVEN
CODE 'I' NOT CIRCLED (SKIP TO 428)
427. How long after the fever started did (NAME) first take artemether lumefantrine?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
428. CHECK 412: OTHER ANTIMALARIAL ('J') GIVEN
CODE 'J' NOT CIRCLED (SKIP TO 430)
429. How long after the fever started did (NAME) first take (OTHER ANTIMALARIAL)?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
430. GO BACK TO 403 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 431.
MINUTES ________________
INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT INTERVIEW:
________________________________________________
COMMENTS ON SPECIFIC QUESTIONS:
________________________________________________
ANY OTHER COMMENTS:
________________________________________________
SUPERVISOR'S OBBSERVATIONS
________________________________________________