FORMATTING DATE: 21 SEP. 2019
ENGLISH LANGUAGE: SEP. 26 2019

2019 GHANA MALARIA INDICATOR SURVEY WOMAN'S QUESTIONNAIRE

MINISTRY OF HEALTH
GHANA STATISTICAL SERVICE

IDENTIFICATION

LOCALITY NAME ________________
NAME OF HOUSEHOLD HEAD _________________
REGION ___________________
DISTRICT __________________
CLUSTER NUMBER _____________
HOUSEHOLD NUMBER _________________
NAME AND LINE NUMBER OF WOMAN _________________

INTERVIEWER VISITS

VISITS 1, 2, AND 3

DATE __________
INTERVIEWER'S NAME ________________
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER __________________(SPECIFY) 7

NEXT VISIT:

DATE _______________
TIME ______________

FINAL VISIT:

DAY ________
MONTH ________
YEAR 2019
INTERVIEWER'S NUMBER _____________
RESULT

COMPLETED 1
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

LANGUAGE OF INTERVIEW:

ENGLISH 01
AKAN 02
GA 03
EWE 04
DAGBANI 05
OTHER ________________(SPECIFY) 06

NATIVE LANGUAGE OF RESPONDENT:

ENGLISH 01
AKAN 02
GA 03
EWE 04
DAGBANI 05
OTHER ________________(SPECIFY) 06

TRANSLATOR USED

YES 1
NO 2

SUPERVISOR

NAME _____________
NUMBER ____________

INTRODUCTION AND CONSENT

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 AGREES TO BE INTERVIEWED 1 (CONTINUE)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME.

HOURS ______________
MINUTES ______________

102. In what month and year were you born?

MONTH __________________
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.

AGE IN COMPLETED YEARS ___________________

104. Have you ever attended school?

YES 1
NO 2 (SKIP TO 108)

105. 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
SSS/SHS 4
SECONDARY 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'.

GRADE ______________

107. CHECK 105: PRIMARY, MIDDLE, JSS/JHS, SSS/SHS OR SECONDARY (CONTINUE)
HIGHER (SKIP TO 109)

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 this sentence to me?

CANNOT READ AT ALL 1
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 IMPAIRED 5

109. What is your religion?

CATHOLIC 01
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?

AKAN 01
GA/DANGME 02
EWE 03
GUAN 04
MOLE-DAGBANI 05
GRUSI 06
GURMA 07
MANDE 08
OTHER ____________________(SPECIFY) 96

111. I will now ask you a few questions about health insurance.
Are you registered by any health insurance?

YES 1
NO 2 (SKIP TO 114)

112. Are you currently covered by any health insurance?

YES 1
NO 2 (SKIP TO 114)

113. What type of health insurance are you (covered/registered) by?
RECORD ALL MENTIONED.

NATIONAL/DISTRICT HEALTH INSURANCE (NHIS) A
HEALTH INSURANCE THROUGH EMPLOYER B
MUTUAL HEALTH ORGANIZATION/COMMUNITY-BASED HEALTH INSURANCE C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
OTHER ____________________(SPECIFY) X

114. Are you aware that malaria care is covered under the NHIS?

YES 1
NO 2

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?

YES 1
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?

YES 1
NO 2 (SKIP TO 204)

203a. How many sons live with you?
IF NONE, RECORD '00'.

SONS AT HOME ________

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

DAUGHTERS AT HOME ________

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

YES 1
NO 2 (SKIP TO 206)

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

SONS ELSEWHERE ________________

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

DAUGHTER ELSEWHERE ________________

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?

YES 1
NO 2 (SKIP TO 208)

207a. How many boys have died?
IF NONE, RECORD '00'.

BOYS DEAD ______________

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

GIRLS DEAD ______________

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

TOTAL BIRTHS ______________

209. CHECK 208: Just to make sure that I have this right: you have had in TOTAL ______ births during your life. Is that correct?

YES (CONTINUE)
NO (PROBE AND CORRECT 201-208 AS NECESSARY)

210. CHECK 208:

ONE OR MORE BIRTHS (CONTINUE)
NO BIRTHS (SKIP TO 225)

211. Now I would like to ask you about your most recent births. How many births have you had in 2014-2019?
RECORD NUMBER OF LIVE BIRTHS IN 2014-2019.

TOTAL IN 2014-2019 _____________
NONE 00 (SKIP TO 225)

212. Now I would like to record the names of all your births in 2014-2019, whether still alive or not, starting with the most recent one you had.

RECORD IN 213 THE NAMES OF ALL THE BIRTHS BORN IN 2014-2019. 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?
RECORD NAME.

BIRTH HISTORY NUMBER __________

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

BOY 1
GIRL 2

215. Were any of these births twins?

SINGLE 1
MULTIPLE 2

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

DAY ________
MONTH ________
YEAR _______

217. Is (NAME) still alive?

YES 1
NO 2 (NEXT BIRTH)

218. IF ALIVE: How old was (NAME) at (NAME)'s last birthday?
RECORD AGE IN COMPLETED YEARS.

AGE IN YEARS __________________

219. IF ALIVE: Is (NAME) living with you?

YES 1
NO 2

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

HOUSEHOLD LINE NUMBER ________________ (NEXT BIRTH)

221. Were there any other live births between (NAME) and (NAME OF PREVIOUS BIRTH), including any children who died after birth?

YES 1 (ADD BIRTH)
NO 2 (NEXT BIRTH)

222. Have you have any live births since the birth of (NAME OF MOST RECENT BIRTH)?

YES 1 (RECORD BIRTH(S) IN TABLE)
NO 2

223. COMPARE 211 WITH NUMBER OF BIRTHS IN BIRTH HISTORY

NUMBERS ARE SAME (CONTINUE)
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224. CHECK 211: ENTER THE NUMBER OF BIRTHS IN 2014-2019

NUMBER OF BIRTHS ____________
NONE 0

225. Are you pregnant now?

YES 1
NO 2 (SKIP TO 227)
UNSURE 8 (SKIP TO 227)

226. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.

MONTHS ____________

227. CHECK 224:

ONE OF MORE BIRTHS IN 2014-2019 (GO TO 301)
NO BIRTHS IN 2014-2019 (SKIP TO 501)
Q. 224 IS BLANK (SKIP TO 501)

SECTION 3. PREGNANCY AND INTERMITTENT PREVENTIVE TREATMENT

301. RECORD THE NAME AND SURVIVAL STATUS OF THE MOST RECENT BIRTH FROM 213 AND 217

NAME __________________

LIVING
DEAD

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?

YES 1
NO 2 (SKIP TO 304)

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

HEALTH PERSONNEL

DOCTOR A
NURSE/MIDWIFE B
COM. HEALTH OFFICER/NURSE C

OTHER PERSON

TRADITIONAL BIRTH ATTENDANT D
COMMUNITY/VILLAGE HEALTH WORKER E
TRADITIONAL HEALTH PRACTITIONER F

OTHER _______________________(SPECIFY) X

303A. Where did you receive antenatal care for this pregnancy? Anywhere else?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ________________

HOME

HER HOME A
OTHER HOME B

PUBLIC SECTOR

GOVERNMENT HOSPITAL C
GOVERNMENT HEALTH CENTER D
GOVERNMENT HEALTH POST E
OTHER PUBLIC SECTOR __________________(SPECIFY) F

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC G
OTHER PRIVATE MEDICAL SECTOR ____________________(SPECIFY) H

OTHER ___________________(SPECIFY) X

303B. How many months pregnant were you when you first received antenatal care for this pregnancy?

MONTHS _________
DON'T KNOW 98

303C. How many times did you receive antenatal care during this pregnancy?

NUMBER OF TIME ___________
DON'T KNOW 98

304. During this pregnancy, did you take SP/Fansidar to keep you from getting malaria?

YES 1
NO 2 (SKIP TO 307)
DON'T KNOW 8 (SKIP TO 307)

305. How many times did you take SP/Fansidar during this pregnancy?

TIMES ____________________

305A. CHECK 305: TOOK SP ONLY 1 OR 2 TIMES DURING THIS PREGNANCY

CODE '01' OR '02' TIMES ENTERED (CONTINUE)
OTHER (SKIP TO 306)

305B. Why did you take SP/Fansidar only one or two times during this pregnancy?
RECORD ALL MENTIONED.

FACILITY TOO FAR A
HAD NO MONEY B
SIDE EFFECTS C
NOT AWARE HAD TO TAKE MORE D
DID NOT WANT TO TAKE E
NOT GIVEN F
NOT AVAILABLE G
OTHER ________________(SPECIFY) X
DON'T KNOW Z

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.

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

307. CHECK 216 AND 217:

ONE OR MORE LIVING CHILDREN BORN IN 2014-2019 (GO TO 401)
NO LIVING CHILDREN BORN IN 2014-2019 (SKIP TO 501)

SECTION 4. FEVER IN CHILDREN

401. CHECK 213: RECORD THE BIRTH HISTORY NUMBER IN 402 AND THE NAME AND SURVIVAL STATUS IN 403 FOR EACH BIRTH IN 2014-2019. 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 2014. (We will talk about each separately.)

402. BIRTH HISTORY NUMBER FROM 213 IN BIRTH HISTORY.

BIRTH HISTORY NUMBER ______________________

403. FROM 213 AND 217:

NAME _______________

LIVING (CONTINUE)
DEAD (SKIP TO 428)

403A. Since 2017, 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 2017, 2018, or in 2017 and 2018?

YES, IN 2017 1
YES, IN 2018 2
YES, IN 2017 AND IN 2018 3
NO, NEVER ENROLLED 4 (SKIP TO 404)

403B. How many rounds/months did (NAME) take in 2017 or 2018?

ROUNDS IN 2017

1. ________________

ROUNDS IN 2018

2. ________________

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

YES 1
NO 2 (SKIP TO 428)
DON'T KNOW 8 (SKIP TO 428)

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

YES 1
NO 2 (SKIP TO 406)
DON'T KNOW 8 (SKIP TO 406)

405A. When (NAME) had blood taken from (NAME)'s finger or heel for testing, were you told that (NAME) had malaria?

POSITIVE MALARIA 1
POSITIVE OTHER ILLNESS 2
NEGATIVE 3
DON'T KNOW/DON'T REMEMBER 8

406. Did you seek advice or treatment for the illness from any source?

YES 1
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).

(NAME OF PLACE) _____________________

PUBLIC SECTOR

GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST/CHPS C
MOBILE CLINIC D
FIELDWORKER/CHW E
OTHER PUBLIC SECTOR __________________(SPECIFY) F

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC G
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

SHOP O
TRADITIONAL PRACTITIONER P
MARKET Q
ITINERANT DRUG SELLER R

OTHER _________________(SPECIFY) X

407A. CHECK 407: ONLY CODE O-R CIRCLED?

YES (CONTINUE)
NO (SKIP TO 408)

407B. Why did you seek advice or treatment from this source?

CHILD JUST FELL ILL A
CHILD NOT VERY ILL B
CLINIC TOO FAR C
HAVE NO MONEY D
WAITING FOR CHILD'S FATHER E
DON'T KNOW WHAT TO DO F
THIS SITE WAS CLOSER G
TRUST THIS SOURCE H
INSTRUCTION BY HOUSEHOLD HEAD I
OTHER _____________(SPECIFY) X

408. CHECK 407:

TWO OR MORE CODES CIRCLED (CONTINUE)
ONLY ONE CODE CIRCLED (SKIP TO 410)

409. Where did you first seek advice or treatment?
USE LETTER CODE FROM 407.

FIRST PLACE __________________________

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

DAYS _______________________

411. At any time during the illness, did (NAME) take any drugs for the illness?

YES 1
NO 2 (SKIP TO 428)
DON'T KNOW 8 (SKIP TO 428)

412. What drugs did (NAME) take? Any other drugs?
RECORD ALL MENTIONED.

PLEASE NOTE BRAND NAMES:

ARTEMISININ COMBINATION THERAPY (ACT)

Coartem
Lumarterm
Artefan
Lonart
Gen-m
Artemos plus
P-alaxin
Duo-cotexcin
Artesunate amodiaquine wintrhop
Arsuamoon
Camoquine plus
G sunate
Co-arsucam

ANTIMALARIAL DRUGS

ARTEMISININ COMBINATION THERAPY (ACT) A
SP/FANSIDAR B
CHLOROQUINE C
AMODIAQUINE D
QUININE PILLS E
QUININE INJECTION/IV F
ARTESUNATE RECTAL G
ARTESUNATE INJECTION/IV H
OTHER ANTIMALARIAL _________________(SPECIFY) I

ANTIBIOTIC DRUGS

PILL/SYRUP J
INJECTION/IV K

OTHER DRUGS

ASPIRIN L
ACETAMINOPHEN M
IBUPROFEN N
HERBAL MEDICINE O

OTHER _________________(SPECIFY) X
DON'T KNOW Z

412A. CHECK 412: ONLY CODE J-O CIRCLED?

YES (CONTINUE)
NO (SKIP TO 413)

412B. Why did you not take an antimalarial drug?

FEVER WAS NOT MALARIA A
NONE AVAILABLE AT FACILITY B
PROVIDER DID NOT OFFER ANTIMALARIAL DRUG C
PROVIDER REFUSED TO GIVE ANTIMALARIAL D
AFRAID OF EFFECTS OF DRUGS ON HEALTH E
CHILD NOT VERY ILL F
CLINIC TOO FAR G
HAVE NO MONEY H
DO NOT KNOW TO TAKE ANTIMALARIAL I
MEDICINE AT HOME J
DID NOT THINK IT WAS MALARIA K
OTHER ______________(SPECIFY) X

413. CHECK 412: ANY CODE A-I CIRCLED?

YES (CONTINUE)
NO (SKIP TO 428)

414. CHECK 412: ARTEMISININ COMBINATION THERAPY ('A') GIVEN

CODE 'A' CIRCLED (CONTINUE)
CODE 'A' NOT CIRCLED (SKIP TO 416)

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