KENYA MALARIA INDICATOR SURVEY
HOUSEHOLD QUESTIONNAIRE
Division of National Malaria Programme
Kenya National Bureau of Statistics
NAME OF HOUSEHOLD HEAD __
CLUSTER NUMBER __
HOUSEHOLD NUMBER __
FIRST VISIT
INTERVIEWER'S NAME __
RESULT* __
NEXT VISIT:
TIME __
SECOND VISIT
INTERVIEWER'S NAME __
RESULT* __
NEXT VISIT:
TIME __
THIRD VISIT
INTERVIEWER'S NAME __
RESULT* __
FINAL VISIT
MONTH __
YEAR __
INT. NO. __
RESULT* __
TOTAL NUMBER OF VISITS __
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME OR AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER 9 (SPECIFY) __
TOTAL PERSONS IN HOUSEHOLD __
TOTAL ELIGIBLE WOMEN __
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE __
LANGUAGE OF QUESTIONNAIRE** 01
LANGUAGE OF INTERVIEW** __
NATIVE LANGUAGE OF RESPONDENT ** __
TRANSLATOR USED (YES = 1, NO = 2) __
LANGUAGE OF QUESTIONNAIRE** ENGLISH
**LANGUAGE CODES:
KISWAHILI 02
BORANA 03
EMBU 04
KALENJIN 05
KAMBA 06
KIKUYU07
KISII 08
LUHYA 09
MARAGOLI 10
LUO 11
MAASAI 12
MERU 13
MIJIKENDA 14
POKOT 15
SOMALI 16
TURKANA 17
OTHER 96 (SPECIFY) __
NUMBER __
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
MINUTES __
LINE NO.
1. __
USUAL RESIDENTS AND VISITORS
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 ASKING QUESTIONS 2-7 OR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE.
__
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
RELATIONSHIP TO HEAD OF HOUSEHOLD
3. What is the relationship of (NAME) to the head of the household?
SEE CODES BELOW.
__
CODES FOR Q.3: RELATIONSHIP TO HEAD OF HOUSEHOLD
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/FOSTER/STEPCHILD = 10
NOT RELATED = 11
DON'T KNOW = 98
SEX
4. Is (NAME) male or female?
FEMALE 2
RESIDENCE
5. Does (NAME) usually live here?
NO 2
6. Did (NAME) stay here last night?
NO 2
IF 95 OR MORE, RECORD '95'.
ELIGIBILITY
8. CIRCLE LINE NUMBER OF ALL WOMEN AGE 15-49
9. CIRCLE LINE NUMBER OF ALL CHILDREN AGE 0-14
101. What is the main source of drinking water for members of your household?
PIPED TO YARD/PLOT 12 (SKIP TO 105)
PIPED TO NEIGHBOR 13 (SKIP TO 105)
PUBLIC TAP/STANDPIPE 14 (SKIP TO 103)
UNPROTECTED WELL 32 (SKIP TO 103)
WATER FROM SPRING
PROTECTED SPRING 41 (SKIP TO 103)
UNPROTECTED SPRING 42 (SKIP TO 103)
TANKER TRUCK 61 (SKIP TO 103)
CART WITH SMALL TANK 71 (SKIP TO 103)
SURFACE WATER (RIVER/DAM/LAKE/POND/STREAM/CANAL/IRRIGATION CHANNEL) 81 (SKIP TO 103)
BOTTLED WATER 91
102. What is the main source of water used by your household for other purposes such as cooking and handwashing?
PIPED TO YARD/PLOT 12 (SKIP TO 105)
PIPED TO NEIGHBOR 13 (SKIP TO 105)
PUBLIC TAP/STANDPIPE 14
UNPROTECTED WELL 32
WATER FROM SPRING
PROTECTED SPRING 41
UNPROTECTED SPRING 42
TANKER TRUCK 61
CART WITH SMALL TANK 71
SURFACE WATER (RIVER/DAM/LAKE/POND/STREAM/CANAL/IRRIGATION CHANNEL) 81
BOTTLED WATER 91
103. Where is that water source located?
IN OWN YARD/PLOT 2 (SKIP TO 105)
ELSEWHERE 3
104. How long does it take to go there, get water, and come back?
DON'T KNOW 998
105. 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 16
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 (SKIP TO 109)
106. Do you share this toilet facility with other households?
NO 2 (SKIP TO 108)
107. Including your own household, how many household use this toilet facility?
10 OR MORE HOUSEHOLDS 95
DON'T KNOW 98
108. Where is this toilet facility located?
IN OWN YARD/PLOT 2
ELSEWHERE 3
109. In your household, what type of cooking device (cookstove) is mainly used for cooking?
SOLAR COOKER 02 (SKIP TO 111)
LIQUEFIED PETROLEUM GAS (LPG)/COOKING GAS STOVE 03 (SKIP TO 111)
PIPED NATURAL GAS STOVE 04 (SKIP TO 111)
BIOGAS STOVE 05 (SKIP TO 111)
LIQUID FUEL STOVE 06
MANUFACTURED SOLID FUEL STOVE 07
TRADITIONAL SOLID FUEL STOVE 08
THREE STONE STOVE/OPEN FIRE 09
110. What type of fuel or energy source is used in the cookstove?
GASOLINE/DIESEL 02
KERSONE/PARAFFIN 03
COAL/LIGNITE 04
CHARCOAL 05
WOOD 06
STRAW/SHRUBS/GRASS 07
AGRICULTURAL CROP 08
ANIMAL DUNG/WASTE 08
PROCESSED BIOMASS (PELLETS) OR WOODCHIPS 10
GARBAGE/PLASTIC 11
SAWDUST 12
OTHER 96 (SPECIFY) __
111. How many rooms in this household are used for sleeping?
112. Does this household own any livestock, herds, other farm animals, or poultry?
NO 2 (SKIP TO 114)
113. How many of the following (animals) livestock does this household own?
IF 95 OR MORE, RECORD '95'.
IF UNKNOWN, RECORD '98'.
b) Exotic/grade cattle?
c) Horses?
d) Donkeys?
e) Mules?
f) Goats?
g) Sheep?
h) Chickens or other poultry?
i) Pigs?
b) EXOTIC/GRADE CATTLE __
c) HORSES __
d) DONKEYS __
e) MULES __
f) GOATS __
g) SHEEP __
h) CHICKENS/POULTRY __
i) PIGS __
114. Does any member of this household own any agricultural land?
NO 2 (SKIP TO 116)
115. 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)l IF 999995 OR MORE, RECORD '999995.0' IN APPROPRIATE BOX
HECTARES 2 __
PLOT SIZE (SQ FT) 3 __
DON'T KNOW 998
116. Does your household have:
b) A radio?
c) A television?
d) A fixed line telephone?
e) A computer?
f) A refrigerator?
g) A solar panel?
h) A table?
i) A chair?
j) A sofa?
k) A bed?
l) A cupboard?
m) A clock?
n) A microwave oven?
o) A DVD player?
p) A CD player?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
117. Does any member of this household own:
b) A mobile phone?
c) A bicycle?
d) A motorcycle or motor scooter?
e) An animal-drawn cart?
f) A car or truck?
g) A boat with a motor?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
118. Does any member of this household have an account in a bank or other financial institution?
NO 2
119. Does any member of this household use a mobile phone to make financial transactions such as sending or receiving money, paying bills, purchasing goods or services or receiving wages?
NO 2
119A. In the past year has this household ever used mosquito repellent spray (e.g. Doom), ointments, vaporizer coils, herbs, or plants to protect against mosquitoes/malaria?
NO 2
120. Does your household have any mosquito nets?
NO 2 (SKIP TO 132)
121. How many mosquito nets does your household have?
IF 7 OR MORE NETS, RECORD '7'.
ASK THE RESPONDENT TO SHOW YOU ALL THE NETS IN THE HOUSEHOLD. OBSERVE AND ANSWER THE QUESTIONS FOR EACH NET, ONE BY ONE.
122. ASSIGN EACH NET A SEQUENTIAL NUMBER AND RECORD THE NUMBER HERE.
NOT OBSERVED 2
124. 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
125. 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 (SUPANET EXTRA) 12
NETPROTECT 13
YORKOOL 14
DAWA PLUS 15
OTHER/DON'T KNOW BRAND (LLIN) 16
OTHER TYPE (NOT LLIN) 96
DON'T KNOW TYPE 98
126. Did you get the net through a distribution campaign, during an antenatal care visit, or during a child welfare visit?
YES, ANC 2 (SKIP TO 128)
YES, CHILD WELFARE VISIT 3 (SKIP TO 128)
NO 4
127. Where did you get the net?
PRIVATE HEALTH FACILITY 02
PHARMACY 03
SHOP/MARKET 04
CHW 05
RELIGIOUS INSTITUTION 06
SCHOOL 07
OTHER 96
DON'T KNOW 98
128. Did anyone sleep under this mosquito net last night?
NO 2 (SKIP TO 130)
NOT SURE 8 (SKIP TO 131)
129. Who slept under this mosquito net last night?
____________________________________________________
(RECORD THE PERSON'S NAME AND LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.)
LINE NUMBER __ (SKIP TO 131)
130. What was the main reason this net was not used last night?
DON'T LIKE NET SHAPE/COLOR/SIZE 02
DON'T LIKE SMELL 03
UNABLE TO HANG NET 04
SLEPT OUTDOORS 05
USUAL USER DIDN'T SLEEP HERE LAST NIGHT 06
NO MOSQUITOES/NO MALARIA 07
EXTRA NET/SAVING FOR LATER 08
NET TOO SMALL/SHORT 09
NET BROUGHT BEDBUGS 10
OTHER 96 (SPECIFY) __
131. GO BACK TO 122 FOR NEXT NET; OR, IF NO MORE NETS, GO TO 132.
ADDITIONAL HOUSEHOLD CHARACTERISTICS
132. OBSERVE MAIN MATERIAL OF THE FLOOR OF THE DWELLING.
RECORD OBSERVATION.
DUNG 12
PALM/BAMBOO 22
VINYL OR ASPHALT STRUP 32
CERAMIC TILES 33
CEMENT 34
CARPET 35
133. OBSERVE MAIN MATERIAL OF THE ROOF OF THE DWELLING.
RECORD OBSERVATION.
THATCH/PALM LEAF 12
SOD 13
PALM/BAMBOO 22
WOOD PLANKS 23
CARDBOARD 24
WOOD 32
CALAMINE/CEMENT FIBER 33
BRICK/CLAY TILES 34
CEMENT 35
ROOFING SHINGLES 36
134. OBSERVE MAIN MATERIAL OF THE EXTERIOR WALLS OF THE DWELLING.
RECORD OBSERVATION.
CANE/PALM/TRUNKS 12
DIRT 13
STONE WITH MUD 22
UNCOVERED ADOBE 23
PLYWOOD 24
CARDBOARD 25
REUSED WOOD 26
STONE WITH LIME/CEMENT 32
BRICKS 33
CEMENT BLOCKS 34
COVERED ADOBE 35
WOOD PLANKS/SHINGLES 36
MINUTES __
INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING THE INTERVIEW
COMMENTS ON SPECIFIC QUESTIONS: __
ANY OTHER COMMENTS: __