KENYA MALARIA INDICATOR SURVEY FINAL VISIT INTERVIEWER VISITS HOUSEHOLD QUESTIONNAIRE
KENYA NATIONAL BUREAU OF STATISTICS
COUNTY
SUBLOCATION
NASSEP CLUSTER NUMBER
KMIS CLUSTER NUMBER
CLUSTER NAME
STRUCTURE NUMBER
HOUSEHOLD NUMBER
NAME OF HOUSEHOLD HEAD
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 9
OTHER (SPECIFY) 9
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INTO. NO.
RESULT
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 9
OTHER (SPECIFY) 9
TOTAL NUMBER OF VISITS
TOTAL PERSONS IN HOUSEHOLD
TOTAL ELIGIBLE WOMEN
TOTAL ELIGIBLE CHILDREN
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE
LANGUAGE OF QUESTIONNAIRE: 01 ENGLISH
LANGUAGE OF INTERVIEW
KISWAHILI 02
BORANA 03
KIKUYU 04
LUO 05
POKOT 06
EMBU 07
KISII 08
MAASAI 09
SOMALI 10
KALENJIN 11
LUHYA 12
MERU 13
TURKANA 14
KAMBA 15
MARAGOLI 16
MIJIKENDA 17
OTHER (SPECIFY) 18
NO 2
NAME
NUMBER
ADMINISTER CONSENT
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
MINUTES
1. LINE NO.
2. Please give me the names of the persons who usually live in your household and guests of the household who stayed here last night, starting with the head of the household. AFTER LISTING THE NAMES AND RECORDING THE RELATIONSHIP AND SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE. THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-9 FOR EACH PERSON.
RELATIONSHIP TO HEAD OF HOUSEHOLD
3. What is the relationship of (NAME) to the head of the household? SEE CODES BELOW.
WIFE OR HUSBAND 02
SON OR DAUGHTER 03
SON-IN-LAW OR DAUGHTER-IN-LAW 04
GRANDCHILD 05
PARENT 06
PARENT-IN-LAW 07
BROTHER OR SISTER 08
OTHER RELATIVE 09
ADOPTED/FORSTER/STEPCHILD 10
NOT RELATED 11
DON'T KNOW 98
4. Is (NAME) male or female?
FEMALE 2
5. Does (NAME) usually live here?
NO 2
6. Did (NAME) stay here last night?
NO 2
7. How old is (NAME)? IF 95 OR MORE, RECORD '95'
8. CIRCLE LINE NUMBER OF ALL WOMEN AGE 15-49
9. CIRCLE LINE NUMBER OF ALL CHILDREN AGE 0-14
2A. Just to make sure that I have a complete listing: are there any other people such as small children or infants that we have not listed?
NO
2B. Are there any other people who may not be members of your family, such as domestic servants, lodgers, or friends who usually live here?
NO
2C. Are there any guests or temporary visitors staying here, or anyone else who stayed here last night, who have not been listed?
NO
101. What is the main source of drinking water for members of your household?
PIPED TO YARD/PLOT 12 (GO TO 104)
PIPED TO NEIGHBOR 13 (GO TO 104)
PUBLIC TAP/STANDPIPE 14 (GO TO 102)
TUBE WELL OR BOREHOLE 21 (GO TO 102)
UNPROTECTED WELL 32 (GO TO 102)
UNPROTECTED SPRING 42 (GO TO 102)
TANKER TRUCK 61 (GO TO 102)
CART WITH SMALL TANK 71 (GO TO 102)
SURFACE WATER (RIVER/DAM/LAKE/POND/STREAM/CANAL/IRRIGATION CHANNEL) 81 (GO TO 102)
BOTTLED WATER 91
OTHER (SPECIFY) 96 (GO TO 102)
101A. What is the main source of water used by your household for other purposes such as cooking and handwashing?
PIPED TO YARD/PLOT 12 (GO TO 104)
PIPED TO NEIGHBOR 13 (GO TO 104)
PUBLIC TAP/STANDPIPE 14
TUBE WELL OR BOREHOLE 21
UNPROTECTED WELL 32
UNPROTECTED SPRING 42
TANKER TRUCK 61
CART WITH SMALL TANK 71
SURFACE WATER (RIVER/DAM/LAKE/POND/STREAM/CANAL/IRRIGATION CHANNEL) 81
OTHER (SPECIFY) 96
102. Where is that water source located?
IN OWN YARD/PLOT 2 (GO TO 104)
ELSEWHERE 3
103. How long does it take to go there, get water, and come back?
DON'T KNOW 998
104. What kind of toilet facility do members of your household usually use? IF NOT POSSIBLE TO DETERMINE, ASK PERMISSION TO OBSERVE THE FACILITY.
FLUSH TO SEPTIC TANK 12
FLUSH TO PIT LATRINE 13
FLUSH TO SOMEWHERE ELSE 14
FLUSH, DON'T KNOW WHERE 15
PIT LATRINE WITH SLAB 22
PIT LATRINE WITHOUT SLAB/OPEN PIT 23
BUCKET TOILET 41
HANGING TOILET/HANGING LATRINE 51
NO FACILITY/BUSH/FIELD 61 (GO TO 107)
OTHER 96
105. Do you share this toilet facility with other households?
NO 2 (GO TO 107)
106. Including your own household, how many households use this toilet facility?
10 OR MORE HOUSEHOLD 95
DON'T KNOW 98
107. How many rooms in this household are used for sleeping?
108. Does this household own any livestock, herds, other farm animals, or poultry?
NO 2 (GO TO 110)
109. How many of the following animals does this household own? IF NONE, RECORD '00'. IF 95 OR MORE, RECORD '95'. IF UNKNOWN, RECORD '98'.
a. Local cattle (indigenous)?
b. Exotic/grade cattle?
c. Horses, donkeys, or mules?
d. Goats?
e. Sheep?
f. Chickens or other poultry?
110. Does any member of your household own any agricultural land?
NO 2 (GO TO 112)
111. How many acres or hectares of agricultural land do members of this household own? ACRES / HECTARES: IF 995 OR MORE, RECORD '995.0' IN APPROPRIATE BOX. PLOT SIZE (SQ FT): IF 999995 OR MORE, RECORD '999995.0' IN APPROPRIATE BOX.
HECTARES 2 ___
PLOT SIZE (SQ FT) 3 ___
DON'T KNOW 9999998
112. Does your household have:
Electricity?
NO 2
A radio?
NO 2
A television?
NO 2
A non-mobile telephone?
NO 2
A computer?
NO 2
A refrigerator?
NO 2
A solar panel?
NO 2
A table?
NO 2
A chair?
NO 2
A sofa?
NO 2
A bed?
NO 2
A cupboard?
NO 2
A clock?
NO 2
A microwave oven?
NO 2
A DVD player?
NO 2
A CD player?
NO 2
113. Does any member of this household own:
A watch?
NO 2
A mobile phone?
NO 2
A bicycle?
NO 2
A motorcycle or motor scooter?
NO 2
An animal-drawn cart?
NO 2
A car or truck?
NO 2
A boat with a motor?
NO 2
113A. Did the household head ever attend school?
NO 2 (GO TO 114)
113B. What is the highest level of education the household head attended: primary, vocational, secondary, or higher?
POST-PRIMARY/VOCATIONAL 2
SECONDARY/'A' LEVEL 3
COLLEGE (MIDDLE LEVEL) 4
UNIVERSITY 5
113C. Did the household head complete that level?
NO 2
114. Does any member of this household have a bank account?
NO 2
117. Does your household have any mosquito nets?
NO 2 (GO TO 128A)
118. How many mosquito nets does your household have? IF 7 OR MORE NETS, RECORD '7'.
119. ASK THE RESPONDENT TO SHOW YOU ALL THE NETS IN THE HOUSEHOLD. IF MORE THAN 3 NETS, USE ADDITIONAL QUESTIONNAIRE(S).
NOT OBSERVED 2
120. How many months ago did your household get the mosquito net? IF LESS THAN ONE MONTH AGO, RECORD '00'.
MORE THAN 36 MONTHS AGO 95
NOT SURE 98
121. OBSERVE OR ASK BRAND/TYPE OF MOSQUITO NET. IF BRAND IS UNKNOWN AND YOU CANNOT OBSERVE THE NET, SHOW PICTURES OF TYPICAL NET TYPES/BRANDS TO RESPONDENT.
PERMANET (SUPNET EXTRA) 12
NETPROTECT 13
YORKOOL 14
OTHER/DON'T KNOW BRAND 16
OTHER TYPE 96
DON'T KNOW TYPE 98
121A. OBSERVE FOR OR ASK IF HOLES IN NET. RECORD THE SIZE OF THE LARGEST HOLE.
HOLE LARGER THAN THUMB BUT SMALLER THAN FIST/HAND 2-10CM 2
HOLE LARGER THAN FIST BUT SMALLER THAN HEAD 10-25CM 3
HOLE LARGER THAN HEAD, MORE THAN 25CM 4
NO HOLES 5
125. Where did you get the net?
OTHER CAMPAIGN 02
GOVT/FBO CLINI/HOSPITAL 03
DUKA/RURAL SHOP 04
SUPERMARKET RETAIL SHOP 05
FRIEND/RELATIVE 06
OTHER 96
DON'T KNOW 98
125A. How much did you pay for the net?
FREE 9995
NOT SURE 9998
126. Did anyone sleep under this mosquito net last night?
NO 2
NOT SURE 8 (GO TO 127B)
126A. Why didn't someone sleep under this net last night?
THERE ARE EXCESS NETS B
IT WAS TOO HOT C
THERE WERE NO MOSQUITOS D
THE NET WAS BEING WASHED E
PERSON NORMALLY USING NET DID NOT STAY HERE LAST NIGHT F
OTHER (SPECIFY) F
SKIP TO 127B.
127. Who slept under this mosquito net last night? RECORD THE PERSON'S NAME AND LINE NUMBER FROM HOUSEHOLD SCHEDULE.
LINE NO. ___
127B. OBSERVE FOR OR ASK IF THE NET IS HANGING FOR SLEEPING.
NOT HANGING 2
127C. What is the reason the net is not hanging for sleeping?
TOO SHORT TO GIVE PROTECTION B
NO SPACE TO HANG NET C
PERSON NORMALLY USING NET DID NOT STAY HERE LAST NIGHT D
OTHER (SPECIFY) X
128. GO BACK TO 119 FOR NEXT NET; OR, IF NO MORE NETS, GO TO 128A.
SOURCE AND USES OF MOSQUITO NETS
(MARKED 1: THESE QUESTIONS ONLY ASKED TO RESPONDENTS IN COUNTIES PARTICIPATING IN THE 2014-15 MASS NET DISTRIBUTION CAMPAIGN DURING OR BEFORE KMIS FIELDWORK: MIGORI, HOMA BAY, SIAYA, KISUMU, VIHIGA, AND WEST POKOT.)
128A. In the last 12 months, has anyone in your household given away a mosquito net?
NO 2
128B. In the last 12 months, has anyone in your household sold a mosquito net?
NO 2
128C. In many places, some people use bednets for other things than sleeping, such as curtains or fishing nets. Are nets being used for alternative uses in this community?
NO 2 (GO TO 128E)
128D. What types of nets are being used for alternative uses: nets 2 years old or newer, nets 3 years old or older, or both types of nets?
OLD NETS 2
BOTH OLD AND NEW 3
128E. The last time you disposed of your old nets, what did you do? RECORD ALL MENTIONED.
BURY B
THROW AWAY C
RECYCLE D
GAVE TO SOMEONE ELSE E
EXCHANGED FOR A NEW ONE F
OTHER (SPECIFY) X
DON'T KNOW Z
128F1. Did you hear about the 2014-15 mass net distribution campaign?
NO 2 (GO TO 128I)
128G1. From where did you hear about the 2014-15 net distribution campaign? RECORD ALL MENTIONED.
RADIO B
TELEVISION C
NEWSPAPER D
CHIEF'S BARAZAS E
HEALTH WORKERS F
HOME VISIT FOR REGISTRATION G
COMMUNITY LEADERS H
FAMILY FRIENDS I
OTHER (SPECIFY) X
128H1. What was the content of the messages you heard or saw? RECORD ALL MENTIONED.
GO COLLECT YOUR NET B
SLEEP UNDER YOUR NET EVERY NIGHT C
OTHER (SPECIFY) X
128I1. Have you heard or seen any communications on net use or malaria prevention in the past year that were not linked to the campaign?
NO 2 (GO TO 128N)
128J1. Did you hear the messages about net use or malaria prevention not linked to the campaign on the radio?
NO 2 (GO TO 128L)
128K1. Did any of the messages you heard on the radio include the phrase "lala ndani ya neti kila siku kila msimu"?
NO 2
128L1. Did you hear the messages about net use or malaria prevention not linked to the campaign in a health talk in your community?
NO 2 (GO TO 128N)
128M1. During the health talk in your community, was there a demonstration of how to hang a mosquito net?
NO 2
128N1. Have you attended a net hanging demonstration in the last year?
NO 2
128O1. Was your household registered to receive nets during the recent campaign within the past one year?
NO 2
DON'T KNOW (GO TO 128Q)
128P1. What was the reason your household was not registered?
REFUSED 2
NOT VISITED BY REGISTRAR 3
DID NOT KNOW ABOUT REGISTRATION 4
OTHER 6
128Q1. Did someone from your household go to a 2014-15 campaign distribution point to collect nets?
NO 2
DON'T KNOW (GO TO 128S)
128R1. What was the reason your household did not go to a 2014-15 campaign distribution point?
NOT INTERESTED 2
FORGOT OR MISSED THE DATE 3
OTHER (SPECIFY) 6
GO TO 128Z.
128S1. Did your household receive vouchers that look like this at a 2014-15 campaign distribution point? SHOW PICTURE OF VOUCHER TO RESPONDENT.
NO 2
128T1. Did your household receive any mosquito nets at a 2014-15 campaign distribution point?
NO 2 (GO TO 128Y)
128U1. How many mosquito nets did your household receive at a 2014-15 campaign distribution point?
128V1. You indicated that your household received [NUMBER FROM 128U] mosquito nets at a 2014- 15 campaign distribution point. Of these, how many are still in the possession of your household?
128W1. COMPARE 128U AND 128V AND MARK:
NUMBER ARE SAME (GO TO 128Z)
128X1. What happened to the missing mosquito nets? RECORD ALL MENTIONED.
NET WAS DESTROYED ACCIDENTLY B
NET WAS SOLD C
NET WAS GIVEN AWAY D
OTHER X
GO TO 128Z.
128Y1. Why did you not receive any mosquito nets at a 2014-15 campaign distribution point?
WAITING TIME TOO LONG 2
THEY REFUSED TO GIVE NETS 3
OTHER 6
DON'T KNOW 8
128Z. Which color of net would you prefer: blue or white or green?
BLUE 2
WHITE 3
DOES NOT CARE 4
129A. Which shape of net would you prefer: conical or rectangular?
RECTANGULAR 2
DOES NOT CARE 3
129B. How confident are you that you can hang a mosquito net in your household: are you extremely confident, very confident, a little confident, or not at all confident?
VERY CONFIDENT 2
A LITTLE CONFIDENT 3
NOT AT ALL CONFIDENT 4
129C. How important do you think it is for young children to sleep under a treated net: is it extremely important, very important, a little important, or not at all important?
VERY CONFIDENT IMPORTANT 2
A LITTLE CONFIDENT IMPORTANT 3
NOT AT ALL CONFIDENT IMPORTANT 4
129D. How frequently do you use mosquito nets for other things besides sleeping under: all the time, sometimes, rarely, or never?
SOMETIMES 2
RARELY 3
NEVER 4
129E. Now I would like to ask your opinion about some issues. I'm going to read some statements and I would like you to tell me if you agree strongly, agree somewhat, disagree somewhat, or disagree strongly. Treated nets are safe to sleep under. Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree?
SOMEWHAT AGREE 2
SOMEWHAT DISAGREE 3
STRONGLY AGREE 4
129F. Most people in this community sleep under an insecticide treated net every night during every season. Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree?
SOMEWHAT AGREE 2
SOMEWHAT DISAGREE 3
STRONGLY AGREE 4
129G. You can hang a net any place people sleep in your house. Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree?
SOMEWHAT AGREE 2
SOMEWHAT DISAGREE 3
STRONGLY AGREE 4
129H. People are at risk of getting malaria only during the rainy season. Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree?
SOMEWHAT AGREE 2
SOMEWHAT DISAGREE 3
STRONGLY AGREE 4
ADDITIONAL HOUSEHOLD CHARACTERISTICS
129. OBSERVE MAIN MATERIAL OF THE FLOOR OF THE DWELLING. RECORD OBSERVATION.
DUNG 12
PALM/BAMBOO 22
PVC/VINYL OR ASPHALT STRIPS 32
CERAMIC TILES 33
CEMENT 34
CARPET 35
130. OBSERVE MAIN MATERIAL OF THE ROOF OF THE DWELLING. RECORD OBSERVATION.
THATCH/GRASS/MAKUTI 12
DUNG/MUD/SOD 13
TIN CANS 22
CONCRETE 32
TILES 33
131. OBSERVE MAIN MATERIAL OF THE EXTERIOR WALLS OF THE DWELLING. RECORD OBSERVATION.
CANE/PALM/TRUNKS 12
DUNG/MUD/SOD 13
STONE WITH MUD 22
UNCOVERED ADOBE 23
PLYWOOD 24
CARDBOARD 25
REUSED WOOD 26
IRON SHEETS 27
STONE WITH LIME/CEMENT 32
BRICKS 33
CEMENT BLOCKS 34
COVERED ADOBE 35
WOOD PLANKS/SHINGLES 36
MINUTES
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT INTERVIEW
COMMENTS ON SPECIFIC QUESTIONS
ANY OTHER COMMENTS
INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW
SUPERVISOR'S OBSERVATIONS