MALARIA INDICATORS SURVEY
WOMAN?S QUESTIONNAIRE

REPUBLIC OF GUINEA
NATIONAL INSTITUTE OF STATISTICS

IDENTIFICATION (1)

NAME OF LOCALITY: ______
NAME OF HEAD OF HOUSEHOLD: ______
CLUSTER NUMBER ______
HOUSEHOLD NUMBER ______
NAME AND LINE NUMBER OF WOMAN ______
ADMINISTRATIVE REGION ______
NATURAL REGION ______
HEALTH DISTRICT NUMBER ______
AREA OF RESIDENCE (1 = CITY OF CONAKRY, 2 = OTHER CITY, 3 = RURAL)
______

INTERVIEWERS? VISITS

(Repeat up to 3 visits)

DATE ______
NAME OF INTERVIEWER ______
RESULT ______

NEXT VISIT:
DATE ______
TIME ______

FINAL VISIT
DAY ______
MONTH ______
YEAR 2020
RESPONDENT NUMBER______
RESULT CODE ______

TOTAL NUMBER OF VISITS ______

RESULT CODES:

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

LANGUAGE OF QUESTIONNAIRE 1
LANGUAGE OF INTERVIEW ______
NATIVE LANGUAGE OF RESPONDENT ______
INTERPRETER (YES = 1, NO = 2) ______
LANGUAGE OF QUESTIONNAIRE FRENCH

LANGUAGE CODES:

01 FRENCH
02 SUSU
03 PEUL
04 MALINKE
05 KISII
04 TOMA
07 KPELLE
08 OTHER (SPECIFY) ______

TEAM NUMBER ______

TEAM LEADER
NAME ______
NUMBER ______

CAPI SUPERVISOR
NAME ______
NUMBER ______

INTRODUCTION AND CONSENT REQUEST

Hello. My name is ______. I work for the National Institute of Statistics. We are conducting a national survey of malaria in Guinea. The information that we collect will help the government improve health services. Your household was selected for this survey. We would like to ask you a few questions about your household. The questions usually take about 10-20 minutes. All the information that you give us is strictly confidential and will not be shared with anyone other than members of the survey team. You are not obligated to participate in this survey, but we hope that you will accept to answer our questions for your opinion is very important. If I happen to ask a question that you do not want to answer, tell me and I will go on to the next question; you can also stop the interview at any time.

If you want more information about the survey, you can also contact the person named on the card that was already given to your household.

Do you have any questions to ask me?
May I begin the interview now?

SIGNATURE OF INTERVIEWER ______
DATE ______

1 RESPONDENT AGREES TO BE INTERVIEWED (Continue to 101)
2 RESPONDENT DOES NOT AGREE TO BE INTERVIEWED (Skip to END)

SECTION 1. SOCIODEMOGRAPHIC CHARACTERISTICS OF RESPONDENT.

101. RECORD THE TIME.

HOURS ______
MINUTES ______

102. In what month and what year were you born?

MONTH ______
98 DK MONTH
YEAR ______
9998 DK YEAR

103. How old were you on your last birthday?

COMPARE AND CORRECT 102 AND/0R 103 IF INCONSISTENT.

AGE IN COMPLETED YEARS ______

104. Have you ever attended school?

1 YES
2 NO (Skip to 108)

105. What is the highest level of studies that you have reached: primary, secondary 1st cycle, secondary 2nd cycle, professional A, higher, or professional B?

1 PRIMARY
2 SECONDARY 1 (MIDDLE SCHOOL)
3 SECONDARY 2 (HIGH SCHOOL)
4 SPECIAL SECONDARY (PROF. A)
6 HIGHER
6 SPECIAL HIGHER (PROF. B)

106. What is the highest [GRADE/YEAR] that you have completed at this level?

IF LESS THAN ONE YEAR WAS COMPLETED AT THIS LEVEL, RECORD ?00?.

[GRADE/YEAR] ______

107. CHECK 105:

PRIMARY (CODE 1) OR SECONDARY (CODE 2, 3, OR 4) ______ (Continue to 108)
SUPERIOR (CODE 5 OR 6) ______ (Skip to 110)

108. Now I would like you to read this sentence to me.

SHOW CARD TO RESPONDENT.

IF RESPONDENT CANNOT READ THE WHOLE SENTENCE, PROBE:
Can you read part of the sentence?

1 CANNOT READ AT ALL
2 CAN READ ONLY PARTS OF THE SENTENCE
3 CAN READ ENTIRE SENTENCE
4 NO CARD IN LANGUAGE REQUESTED (SPECIFY LANGUAGE) ______
5 BLIND/VISUALLY IMPAIRED

109. CHECK 108:

CODE ?2?, ?3?, OR ?4? CIRCLED ______ (Continue to 110)
CODE ?1? OR ?5? CIRCLED ______ (Skip to 111)

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

1 AT LEAST ONCE A WEEK
2 LESS THAN ONCE A WEEK
3 NOT AT ALL

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

1 AT LEAST ONCE A WEEK
2 LESS THAN ONCE A WEEK
3 NOT AT ALL

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

1 AT LEAST ONCE A WEEK
2 LESS THAN ONCE A WEEK
3 NOT AT ALL

113. Do you have a mobile phone?

1 YES
2 NO (Skip to 115)

114. Is your mobile phone a smart phone?

1 YES
2 NO

115. Have you ever used the internet from any place or any device?

1 YES
2 NO (Skip to 118)

116. In the last 12 months, have you used the internet?

IF NECESSARY, PROBE TO DETERMINE IF USED IN ANY PLACE WITH ANY DEVICE.

1 YES
2 NO (Skip to 118)

117. In the last month, how many times have you used the internet: almost every day, at least once a week, less than once a week or not at all?

1 ALMOST EVERY DAY
2 AT LEAST ONCE A WEEK
3 LESS THAN ONCE A WEEK
4 NOT AT ALL

118. What is your religion?

01 MUSLIM
02 CHRISTIAN
03 ANIMISM
04 WITHOUT RELIGION
96 OTHER (SPECIFY) ______

119. What is your ethnicity?

01 SOUSSOU
02 PEULH
03 MALINKE
04 KISII
05 TOMA
06 GUERZE
96 OTHER (SPECIFY) ______

SECTION 2. REPRODUCTION

201. Now I would like to ask you some questions about all the births you have had in your lifetime. Have you ever given birth?

1 YES
2 NO (Skip to 206)

202. Do you have any sons or daughters to whom you gave birth who are currently living with you?

1 YES
2 NO (Skip to 204)

203. a) How many sons live with you?
b) How many daughters live with you?

IF NONE, RECORD ?00?.

a) SONS AT HOME ______
b) DAUGHTERS AT HOME ______

204. Do you have any sons or daughters to whom you gave birth who are still living but do not live with you?

1 YES
2 NO (Skip to 206)

205. a) How many sons are living but do not live with you?
b) How many daughters are living but do not live with you?

IF NONE, RECORD ?00?.

a) SONS ELSEWHERE ______
b) DAUGHTERS ELSEWHERE ______

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

IF NO, PROBE: No baby who cried, made a sound, tried to breathe, or showed other signs of life for a short time?

1 YES
2 NO (Skip to 208)

207. a) How many boys died?
b) How many girls died?

IF NONE, RECORD ?00?.

a) DECEASED BOYS ______
b) DECEASED GIRLS ______

208. TOTAL UP THE ANSWERS TO 203, 205, AND 207 AND RECORD THE TOTAL.
IF NONE, RECORD ?00?.

TOTAL BIRTHS ______

209. CHECK 208:

I would like to be sure I understood correctly: you have had a TOTAL of ______ births in your life. Is that correct?

YES ______ (Continue to 210)
NO ______ PROBE AND CORRECT 201 - 208 AS NECESSARY

210. CHECK 208:

ONE OR MORE BIRTHS ______ (Continue to 211)
NO BIRTHS ______ (Skip to 224)

211. Now I would like to ask you questions about your most recent births. How many births did you have between 2016 - 2021?

RECORD TOTAL NUMBER OF BIRTHS IN 2016 - 2021 ______
00 NONE (Skip to 224)

212. Now I would like to record the names of all the births you had in 2016 - 2021, whether they are still living or not, beginning with the most recent birth.

RECORD THE NAME OF ALL BIRTHS IN 2016 - 2021 IN Q.213. RECORD TWINS/TRIPLETS ON SEPARATE ROWS. IF THERE ARE MORE THAN 5 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, BEGINNING ON THE SECOND ROW.

(Repeat 213 - 221 for up to 5 births)

213. What name was given to your (last/preceding) baby?

RECORD THE NAME.
NUMBER IN BIRTH HISTORY.

01 ______

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

1 BOY
2 GIRL

215. Is (NAME) a single or multiple birth?

1 SINGLE
2 MULTIPLE

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

DAY ______
MONTH ______
YEAR ______

217. Is (NAME) still alive?

1 YES
2 NO (Go to NEXT BIRTH)

218. IF LIVING:
How old was (NAME) on his/her last birthday?

RECORD AGE IN COMPLETED YEARS.

AGE IN YEARS ______

219. IF LIVING:
Does (NAME) live with you?

1 YES
2 NO

220. IF LIVING:

RECORD CHILD?S LINE NUMBER FROM HOUSEHOLD SCHEDULE.
RECORD ?00? IF CHILD IS NOT LISTED IN HOUSEHOLD.

LINE NUMBER FROM HOUSEHOLD SCHEDULE ______ (Go to NEXT BIRTH)

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

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

222. Have you had other live births since that of (NAME OF LAST BIRTH)?

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

223. COMPARE 211 WITH NUMBER OF BIRTHS IN BIRTH HISTORY

NUMBERS ARE EQUAL ______ (Continue to 224)
NUMBERS ARE DIFFERENT ______ (PROBE AND CORRECT)

224. Are you pregnant now?

1 YES
2 NO (Skip to 301)
8 UNSURE (Skip to 301)

225. How many weeks or months pregnant are you?

RECORD THE NUMBER OF COMPLETED WEEKS OR MONTHS.

1 WEEKS ______
2 MONTHS ______

SECTION 3. PREGNANCY AND INTERMITTENT PREVENTIVE TREATMENT

301. CHECK 216:

ONE OR MORE BIRTH RESULTS 0 - 35 MONTHS BEFORE SURVEY ______ (Continue to 302)
NO BIRTH RESULTS 0 - 35 MONTHS BEFORE SURVEY ______ (Skip to 401)

302. RECORD NAME OF LAST BIRTH FROM 213, ROW 01:

LAST BIRTH:
NAME: ______

303. Now I would like to ask you some questions about your last birth.
When you got pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?

1 YES
2 NO (Skip to 308)

304. Whom did you see?
Anyone else?

PROBE TO DETERMINE EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEALTH PROFESSIONAL

A DOCTOR
B NURSE/MIDWIFE
C TECHNICAL HEALTH AGENT (?ATS?)

OTHER PERSONNEL

D TRADITIONAL BIRTH ATTENDANT
E VILLAGE/COMMUNITY HEALTH AGENT

X OTHER (SPECIFY) ______

305. Where did you receive antenatal care for this pregnancy?
No other place?

PROBE TO DETERMINE TYPE OF PLACE.

IF UNABLE TO DETERMINE IF PLACE IS PUBLIC OR PRIVATE SECTOR, OR AN NGO, RECORD ?X? AND WRITE THE NAME OF THE PLACE.

HOME

A HER HOME
B OTHER HOME

PUBLIC SECTOR

C NATIONAL HOSPITAL
D REGIONAL HOSPITAL
E PREFECTURE HOSPITAL/COMMUNITY MEDICAL CENTER (?CMC?)
F HEALTH CENTER
G RURAL HEALTH POST
H OTHER PUBLIC SECTOR (SPECIFY) ______

PRIVATE MEDICAL SECTOR

I PRIVATE HOSPITAL
J PRIVATE CLINIC
K FAMILY PLANNING CLINIC/ GUINEAN ASSOCIATION FOR FAMILY WELL-BEING (?AGBEF?)
L PRIVATE MIDWIFE?S OFFICE
M RELIGIOUS/ASSOCIATION HEALTH CENTER
N OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ______

X OTHER (SPECIFY) ______

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

1 WEEKS ______
2 MONTHS ______
998 DK

307. During this pregnancy, how many times did you receive antenatal care?

NUMBER OF TIMES ______
98 DK

308. During this pregnancy, did you take SP/Fansidar to prevent malaria?

1 YES
2 NO (Skip to 401)
8 DK (Skip to 401)

309. During this pregnancy, how many times did you take SP/Fansidar?

NUMBER OF TIMES ______

310. Were you given the SP/Fansidar during an antenatal visit, during another visit to a health facility, or did you get it elsewhere?

IF MORE THAN 1 SOURCE, RECORD THE FIRST SOURCE ON THE LIST.

1 ANTENATAL VISIT
2 OTHER VISIT TO HEALTH FACILITY
6 ELSEWHERE

310A. Did you take the SP/Fansidar in the presence of a health agent, at home, or elsewhere?

1 IN PRESENCE OF HEALTH AGENT
2 AT HOME
3 ELSEWHERE

SECTION 4. FEVER IN CHILDREN

401. CHECK 216 AND 217 IN BIRTH HISTORY: ANY SURVIVING CHILDREN BORN 0 - 59 MONTHS BEFORE SURVEY?

ONE OR MORE SURVIVING CHILDREN BORN 0 - 59 MONTHS BEFORE SURVEY ______ (Continue to 402)
NO SURVIVING CHILDREN BORN 0 - 59 MONTHS BEFORE SURVEY ______ (Skip to 417)

402. Now I would like to ask you some questions about the health of your children born in the last five years. (We will talk about one child at a time, beginning with the youngest).

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

NAME OF CHILD ______
BIRTH HISTORY NUMBER ______

404. In the last two weeks, has (NAME) been sick with a fever at any time?

1 YES
2 NO
8 DK

[###translator?s note: unclear skip instructions]

405. Did anyone draw blood from (NAME)?s finger or heel at any time during (NAME)?s illness?

1 YES
2 NO
8 DK

[###translator?s note: unclear skip instructions]

406. Did a health care provider tell you that (NAME) had malaria?

1 YES
2 NO
8 DK

407. Did you seek out any advice or treatment for the illness?

1 YES
2 NO (Skip to 412)

408. Where did you go to seek advice or treatment?

Anywhere else?

PROBE TO DETERMINE TYPE OF PLACE.

IF UNABLE TO DETERMINE IF PLACE IS PUBLIC OR PRIVATE SECTOR OR AN NGO, RECORD ?X? AND WRITE THE NAME OF THE PLACE.

PUBLIC SECTOR

A NATIONAL HOSPITAL
B REGIONAL HOSPITAL
C PREFECTURE HOSPITAL/COMMUNITY MEDICAL CENTER (?CMC?)
D HEALTH CENTER
E RURAL HEALTH POST
F COMMUNITY HEALTH AGENT
G COMMUNITY HEALTH POST
H OUTREACH CLINIC/MOBILE CLINIC
I OTHER PUBLIC SECTOR (SPECIFY) ______

PRIVATE MEDICAL SECTOR

J PRIVATE CLINIC
K PHARMACY
L PRIVATE DOCTOR
M PRIVATE MIDWIFE?S OFFICE
N RELIGIOUS/ASSOCIATION HEALTH CENTER
O FAMILY PLANNING CLINIC/ GUINEAN ASSOCIATION FOR FAMILY WELL-BEING (?AGBEF?)
P OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ______

OTHER SOURCE

Q SHOP
R TRADITIONAL PRACTITIONER
S MARKET
T ITINERANT MEDICINE PEDDLER
U FRIEND/RELATIVE
X OTHER (SPECIFY) ______

409. CHECK 408:

TWO OR MORE CODES CIRCLED ______ (Continue to 410)
ONLY ONE CODE CIRCLED ______ (Skip to 411)

410. Where did you go first to seek advice or treatment?

USE LETTER CODES FROM 408.

FIRST PLACE ______

411. How many days after the illness began did you seek advice or treatment for (NAME)?

IF SAME DAY, RECORD ?00?.

DAYS ______

412. Did (NAME) take medicine for the illness at any time during the illness?

1 YES
2 NO (Skip to 416)
8 DK (Skip to 416)

413. What medicine did (NAME) take?
No other medicine?

RECORD ALL MENTIONED.
IF MEDICINE IS NOT KNOWN, ASK TO SEE THE BOX OR PRESCRIPTION.

ANTIMALARIALS

A ACT ARTEMISININ COMBINATION THERAPY
B SP/FANSIDAR
C CHLOROQUINE
D AMODIAQUINE
QUININE
E TABLETS
F INJECTION/IV
ARTESUNATE
G RECTAL TREATMENT
H INJECTION/IV
I INJECTABLE ARTEMETHER
J OTHER ANTIMALARIAL (SPECIFY) ______

ANTIBIOTICS

K AMOXICILLIN
L COTRIMOXAZOLE
M OTHER TABLET/SYRUP
N OTHER INJECTION/IV

OTHER MEDICATION

O ASPIRIN
P ACETAMINOPHEN
Q PARACETAMOL/PANADOL
R IBUPROFEN

X OTHER (SPECIFY) ______
Z DK

414. CHECK 413: ACT ARTEMISININ COMBINATION THERAPY (?A?) GIVEN

CODE ?A? CIRCLED ______ (Continue to 415)
CODE ?A? NOT CIRCLED ______ (Skip to 416)

415. How soon after the fever began did (NAME) start to take ACT artemisinin combination therapy?

1 0 SAME DAY
1 NEXT DAY
2 TWO DAYS AFTER THE FEVER
3 THREE OR MORE DAYS AFTER THE FEVER
8 DK

416. CHECK 216 AND 217 IN BIRTH HISTORY: ANY SURVIVING CHILD BORN 0 - 59 MONTHS BEFORE THE SURVEY?

NO OTHER SURVIVING CHILDREN BORN 0 - 59 MONTHS BEFORE SURVEY ______ (Continue to 501)
OTHER SURVIVING CHILDREN BORN 0 - 59 MONTHS BEFORE SURVEY ______ (Go to 403)

SECTION 5. KNOWLEDGE AND BELIEFS

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

1 YES
2 NO (Skip to 503)

502. Where did you see or hear these messages?

Anywhere else?

A RADIO
B TELEVISION
C POSTER/BILLBOARD
D NEWSPAPER/MAGAZINE
E FLIER/BROCHURE
F HEALTHCARE PROVIDER
G COMMUNITY HEALTH AGENT/COMMUNITY POST
H SOCIAL MEDIA
I RELIGIOUS LEADERS

X SOMEWHERE ELSE (SPECIFY) ______
Z DON?T REMEMBER

503. Are there ways to prevent contracting malaria?

1 YES
2 NO (Skip to 505)

504. What are the things that people can do to prevent contracting malaria?

RECORD ALL MENTIONED

A SLEEP UNDER A MOSQUITO NET
B SLEEP UNDER AN INSECTICIDAL MOSQUITO NET
C USE PRODUCTS TO REPEL MOSQUITOS
D TAKE PREVENTIVE MEDICINE
E SPRAY HOUSE WITH INSECTICIDE
F COVER STANDING WATER (PUDDLES)
G KEEP SURROUNDINGS CLEAN
H PUT MOSQUITO NETS ON WINDOWS
X OTHER (SPECIFY) ______
Z DK

505. Now I am going to read you some statements and I would like you to say if you agree or disagree with these statements. If you do not know, answer, ?I don?t know?.

In this community, people only have malaria during the rainy season.
Do you agree or disagree?