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26 SEPT 2016


2016 GHANA MALARIA INDICATOR SURVEY FIELDWORKER QUESTIONNAIRE

GHANA STATISTICAL SERVICES

LANGUAGE OF QUESTIONNAIRE: ENGLISH

100. What is your name?

NAME _____________

101. RECORD FIELDWORKER NUMBER

NUMBER ___________

INSTRUCTIONS

We are collecting information on the 2016 GMIS field staff. Please fill in the information below. The information will be part of the survey data files. Your name will not be in the data files; your information will remain anonymous. If there is any question you do not want to answer you may skip it and go to the next question.

102. In what region do you live?

WESTERN 01
CENTRAL 02
GREATER ACCRA 03
VOLTA 04
EASTERN 05
ASHANTI 06
BRONG AHAFO 07
NOTHERN 08
UPPER EAST 09
UPPER WEST 10

103. Do you live in a city, town, or rural area?

CITY 1
TOWN 2
RURAL 3

104. How old are you?
RECORD AGE IN COMPLETED YEARS.

AGE ________

105. Are you male or female?

MALE 1
FEMALE 2

106. What is your current marital status?

CURRENTLY MARRIED 1
LIVING WITH A MAN/WOMAN 2
WIDOWED 3
DIVORCED 4
SEPARATED 5
NEVER MARRIED OR LIVED WITH A MAN/WOMAN 6

107. How many living children do you have?
INCLUDE ONLY CHILDREN WHO ARE YOUR BIOLOGICAL CHILDREN.

LIVING CHILDREN _______

108. Have you ever had a child who died?

YES 1
NO 2

109. What is the highest level of school you attended: primary, middle, JSS/JHS, SSS/SHS, secondary, or higher?

PRIMARY 1
MIDDLE 2
JSS/JHS 3
SECONDARY 4
SSS/SHS 5
HIGHER 6

110. What is the highest GRADE you completed at the level?
IF COMPLETED LESS THAN ONE YEAR AT THE LEVEL, RECORD '00'.

GRADE ______

111. What is your religion?

CATHOLIC 01
ANGLICAN 02
METHODIST 03
PRESBYERIAN 04
PENTECOSTAL/CHARISMATIC 05
OTHER CHRISTIAN 06
ISLAM 07
TRADITIONAL/SPIRITUALIST 08

NO RELIGION 95
OTHER ______________(SPECIFY) 96

112. What is your ethnicity?

AKAN 01
GA/DANGME 02
EWE 03
GUAN 04
MOLE-DAGBANI 05
GRUSI 06
GURMA 07
MANDE 08

OTHER ____________(SPECIFY) 96

113. What languages can you speak?
RECORD ALL LANGUAGES YOU CAN SPEAK.

AKAN A
GA B
EWE C
ENGLISH D
OTHER _________(SPECIFY) X

114. What is your mother tongue/native language (language spoken at home growing up)?

AKAN A
GA B
EWE C
OTHER __________(SPECIFY) X

115. Have you ever worked on a DHS survey prior to this one?

YES 1
NO 2

116. Have you ever worked on any other survey prior to this one (not a DHS)?

YES 1
NO 2

117. Were you already working for the National Public Health Reference Laboratory (NPHRL) or the Ghana Statistical Service (GSS) at the time you were employed to work on this MIS?

YES, NPHRL 1
YES, GSS 2
NO 3 (SKIP TO 119)

118. Are you a permanent or temporary employee of the National Public Health Reference Laboratory (NPHRL) or the Ghana Statistical Service (GSS)?

PERMANENT 1
TEMPORARY 2

119. If you have comments, please write them here.