September 2015

MALARIA INDICATORS SURVEY IN MALI ("EIPM" 2015)
WOMAN'S QUESTIONNAIRE

MALI
NATIONAL INSTITUTE OF STATISTICS ("INSTAT")
NATIONAL PROGRAM IN THE FIGHT AGAINST MALARIA ("PNLP")
INFO-STAT ICF INTERNATIONAL

IDENTIFICATION

NAME OF LOCALITY ______
NAME OF HEAD OF HOUSEHOLD ______
CLUSTER NUMBER ______
CONCESSION NUMBER ______
HOUSEHOLD NUMBER ______
ADMINISTRATIVE REGION ______
ENVIRONMENT ( URBAN = 1, RURAL = 2) ______
DETAILED ENVIRONMENT (BAMAKO = 1, OTHER CITY = 2, RURAL = 3) ______
NAME AND LINE NUMBER OF WOMAN ______

INTERVIEWER'S VISITS

(Repeat up to 3 visits)

DATE ______
NAME OF INTERVIEWER ______
RESULT ______

NEXT VISIT:

DATE ______
TIME ______

FINAL VISIT

DAY ______
MONTH ______
YEAR 2015
INTERVIEWER'S 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) ______

CODE

01 FRENCH
02 BAMBARA/MALINKE
03 SONRAI/DJERMA
04 PEUL/FULFULDE
05 SENOUFO/MANIANKA
06 MARKA/SONINKE
07 DOGON
08 TAMASHEK/BELLA
09 BOBO/DAFING
10 BOZO/SOMONO
96 OTHER

TEAM LEADER

NAME ______

OFFICE REVIEW

NAME ______

EDIT

NAME ______

SECTION 1. SOCIODEMOGRAPHIC BACKGROUND OF RESPONDENT

INTRODUCTION AND INFORMED CONSENT

INFORMED CONSENT

Hello. My name is ______ and I work for the National Program in the Fight Against Malaria ("PNLP"), the National Institute of Statistics ("INSTAT") and INFO-STAT. We are conducting a national survey of malaria all over the country. The information that we collect will help your government improve health services. Your household has been selected for this survey. The questions usually take between 20 and 30 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 agree to participate because 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)

101. RECORD THE TIME.

HOUR ______
MINUTES ______

102. In what month and 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/OR 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: basic 1st cycle (primary), basic 2nd cycle (secondary 1), high school, technical, professional (secondary 2), or higher?

1 PRIMARY (1st cycle basic)
2 SECONDARY 1 (2nd cycle)
3 SECONDARY 2 (High School, Technical, etc.)
4 HIGHER

106. What is the highest (year/grade) that you reached at this level?

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

(Table)

LEVEL
Basic 1st cycle = 1

1 1st year
2 2nd year
3 3rd year
4 4th year
5 5th year
6 6th year

LEVEL
Basic 2nd cycle = 2

1 1st year
2 2nd year
3 3rd year

LEVEL
High School, Technical = 3

1 1st year
2 2nd year
3 3rd year
4 4th year
5 5th year

LEVEL
Higher = 4

1 1st year
2 2nd year
3 3rd year
4 4th year
5 5th year and higher

GRADE/YEAR ______

107. CHECK 105:

PRIMARY ______ (Continue to 108)
OTHER ______ (Skip to 109)

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 RESPONDENT'S LANGUAGE (SPECIFY LANGUAGE) ______
5 BLIND/VISUALLY IMPAIRED

109. What is your religion?

1 MUSLIM
2 CATHOLIC
3 PROTESTANT
4 TRADITIONAL/ANIMIST
5 WITHOUT RELIGION/NONE
6 OTHER (SPECIFY) ______

110. What is your ethnicity?

IF RESPONDENT STATES THAT SHE IS NOT MALIAN, ASK HER NATIONALITY.

ETHNIC CODE (FOR MALIANS)

01 BAMBARA
02 MALINKE
03 PEUL/FULFULDE
04 SARAKOLE/SONINKE/MARKA/KASSONKE
05 SONRAI
06 DOGON/BOZO
07 TAMASHEK/BELLA/ARAB/MOOR
08 SENOUFO/MANIANKA
09 BOBO/MOSSI/SAMOKO

NATIONALITY CODE (FOR FOREIGNERS)

11 ECOWAS COUNTRY
12 OTHER AFRICAN COUNTRIES
13 OTHER NATIONALITIES
96 OTHER ETHNICITY (SPECIFY) ______
98 DK

111. In the last 6 months, have you heard or seen any messages about malaria?

1 YES
2 NO (Skip to 113)

112. How did you hear or see this message about malaria?

PROBE: Other sources?

RECORD ALL MENTIONED.

A RADIO
B TELEVISION
C WALL POSTER
D COMMUNITY HEALTH AGENT
E COMMUNITY EVENT
F NGO/COMMUNITY BASED PRESENTERS
G HEALTH PERSONNEL
H PUBLIC CRIERS/VILLAGE/MARKET/NEIGHBORHOOD
I HOSPITAL/HEALTH ESTABLISHMENT
J SCHOOL/TEACHERS
K FRIEND/NEIGHBOR/FAMILY/CHURCH/MOSQUE
L INTERNET/PHONE MESSAGES
X OTHER (SPECIFY) ______

113. Have you heard of indoor residual spraying?

1 YES
2 NO (Skip to 115)

114. Would you like your dwelling to be sprayed?

1 YES
2 NO

115. In your opinion, what is the main cause of malaria?

MOSQUITO BITE

PROBE: No other cause?

RECORD ALL MENTIONED

(All Skip to 117)
A MOSQUITO BITE
B OVERCONSUMPTION OF OIL/EGGS
C FATIGUE DUE TO WORK
D LACK OF SLEEP/FATIGUE
E DIRECT EXPOSURE TO SUN
F CONSUMPTION OF MANGOS/SUGARY FRUITS
G CONSUMPTION OF MILK
H DIRTY WATER/DIRTY ENVIRONMENT/FILTH
I UNCLEAN FOOD/POORLY CONSERVED FOOD/FLIES
J COLD FOOD/FROZEN FOOD
K COLD/HUMIDITY/RAINS
X OTHER (SPECIFY) ______
Z DK

116. In your opinion, when do the mosquitos which transmit malaria bite?

01 MORNING
02 NOON
03 AFTERNOON/EVENING
04 DUSK
05 FIRST HALF OF NIGHT
06 SECOND HALF OF NIGHT
07 DAWN
08 ALL DAY LONG/ALL THE TIME
98 DK

117. In your opinion, what are the symptoms of malaria?

PROBE: Other symptoms?

RECORD ALL MENTIONED.

A FEVER
B LACK OF APPETITE/VOMITING
C HIGH TEMPERATURE WITH CONVULSIONS
D HIGH TEMPERATURE WITH FAINTING
E PERSISTANT FEVER
F CONVULSIONS
G JAUNDICE
H YELLOW URINE/DARK COLORED URINE
I MIGRAINES/HEADACHES
J ACHES/JOINT PAINS
K DIARRHEA
L PALLOR/ITCHING
X OTHER (SPECIFY) ______
Z DK

118. What are effective ways to prevent malaria?

PROBE: No other way?

RECORD ALL MENTIONED.

IF RESPONDENT SIMPLY STATES A MOSQUITO NET; ASK WHAT KIND OF MOSQUITO NET (INSECTICIDE TREATED OR UNTREATED)

A SLEEPING UNDER A MOSQUITO NET (UNTREATED)
B SLEEPING UNDER AN INSECTICIDAL NET (TREATED)
C TAKING PREVENTIVE MEDICATION
D USING AN INSECTICIDE/DIFFUSER/CREAM/LOTION
E USING ANTI-MOSQUITO COIL
F INFUSION/PLANT OR ROOT JUICE DRINK AS PREVENTIVE
G CLEANING UP SURROUNDINGS
H INDOOR RESIDUAL SPRAYING
I SCREENS ON WINDOWS
J USING ANTI-MOSQUITO FUMIGATION COIL
K USING ELECTRIC ZAPPERS
L AIR CONDITIONERS/FANS
M POWDER (SPRAYED)/INDOOR SPRAYING
N COVERING UP BODY
O AVOIDING OILY FOODS/OIL/FAT
W OTHER (SPECIFY) ______
X OTHER (SPECIFY) ______
Z DK

119. What methods do you use to protect yourself from malaria?

PROBE: No other method?

RECORD ALL MENTIONED

IF RESPONDENT SIMPLY STATES A MOSQUITO NET; ASK WHAT KIND OF MOSQUITO NET (INSECTICIDE TREATED OR UNTREATED)

A SLEEPING UNDER A MOSQUITO NET (UNTREATED)
B SLEEPING UNDER AN INSECTICIDAL NET (TREATED)
C TAKING PREVENTIVE MEDICATION
D USING AN INSECTICIDE/DIFFUSER/CREAM/LOTION
E USING ANTI-MOSQUITO COIL
F INFUSION/PLANT OR ROOT JUICE DRUNK AS PREVENTIVE
G CLEANING UP SURROUNDINGS
H INDOOR RESIDUAL SPRAYING
I SCREENS ON WINDOWS
J USING ANTI-MOSQUITO FUMIGATION COIL
K USING ELECTRIC ZAPPERS
L AIR CONDITIONERS/FANS
M POWDER (SPRAYED)/INDOOR SPRAYING
N COVERING UP BODY
O AVOIDING OILY FOODS/OIL/FAT
W OTHER (SPECIFY) ______
X OTHER (SPECIFY) ______
Z DK

119A. Which people are most vulnerable to malaria?

PROBE: No one else?

RECORD ALL MENTIONED.

A CHILDREN UNDER AGE OF FIVE
B CHILDREN
C PREGNANT WOMEN
D WOMEN
E MEN
F ELDERLY PEOPLE
G EVERYONE
H PEOPLE WITH LIGHT SKIN/WHITE
I PEOPLE WHO DON'T LIKE MOSQUITO NETS/PEOPLE WHO DON'T SLEEP UNDER MOSQUITO NET
X OTHER (SPECIFY) ______
Z DK

119B. In your opinion, what are effective ways to treat and cure malaria in a child when he/she is ill?

PROBE AND SHOW PHOTOS OF MEDICATION:

Any other way?

RECORD ALL MENTIONED.

IF RESPONDENT SIMPLY STATES A MOSQUITO NET; ASK WHAT TYPE OF MOSQUITO NET (INSECTICIDE TREATED OR UNTREATED)

(All Skip to 119D)
A TAKING MEDICINE
B SLEEPING UNDER A MOSQUITO NET (UNTREATED)
C SLEEPING UNDER AN INSECTICIDAL NET (TREATED)
D REDUCING THE FEVER
E GIVE TRADITIONAL MEDICINE: INFUSION/PLANT JUICE/ROOT JUICE TO DRINK
F OTHER TRADITIONAL MEDICINE (SPECIFY) ______
X OTHER WAY: (SPECIFY) ______
Z DK

119C. In your opinion, what are the medications that are effective for treating and curing malaria in a child when he/she is sick?

PROBE AND SHOW PHOTOS OF MEDICATION:

No other method?

RECORD ALL MENTIONED.

ANTIMALARIALS

A ARTEMISININ COMBINATION THERAPY (ACT)
B SP/FANSIDAR
C CHLOROQUINE
D AMODIAQUINE
E QUININE TABLET
F QUININE INJECTION/IV
G ARTESUNATE (RECTALLY)
H ARTESUNATE (INJECTION/IV)
I OTHER ANTIMALARIAL: (SPECIFY) ______

ANTIBIOTICS

J TABLETS/SYRUP
K INJECTION

OTHER MEDICATION

L ASPIRIN
M PARACETAMOL
N ACETAMINOPHEN
O IBUPROFEN
P "KUNBILENI"

W OTHER MEDICATION (SPECIFY) ______
X OTHER MEDICATION (SPECIFY) ______

Z DK

[###translator's note: unable to find any reference to Code P "Kunbileni"]

119D. In your opinion, what are effective ways to treat and cure malaria in an adult when he/she is sick?

PROBE AND SHOW PHOTOS OF MEDICINES:

No other way?

RECORD ALL THAT IS MENTIONED.

IF RESPONDENT SIMPLY STATES A MOSQUITO NET; ASK WHAT KIND OF MOSQUITO NET (INSECTICIDAL NET OR UNTREATED NET)

(All Skip to 120)
A TAKING MEDICINE
B SLEEPING UNDER A MOSQUITO NET (UNTREATED)
C SLEEPING UNDER AN INSECTICIDAL NET (TREATED)
D REDUCING THE FEVER
E GIVE TRADITIONAL MEDICINE: INFUSION/PLANT JUICE/ROOT JUICE TO DRINK
F OTHER TRADITIONAL MEDICINE (SPECIFY) ______
X OTHER WAY: (SPECIFY) ______
Z DK

119E. In your opinion, which medicines are effective in treating and curing malaria in an adult when he/she is ill?

PROBE AND SHOW PHOTOS OF MEDICINES:

No other way?

RECORD ALL MENTIONED

ANTIMALARIALS

ANTIBIOTICS

J TABLETS/SYRUP
K INJECTION

OTHER MEDICATION

L ASPIRIN
M PARACETAMOL
N ACETAMINOPHEN
O IBUPROFEN
P "KUNBILENI"

W OTHER MEDICATION (SPECIFY) ______
X OTHER MEDICATION (SPECIFY) ______
Z DK

120. Have you regularly heard awareness-raising messages about malaria on your local radio?

1 YES
2 NO (Continue to 121)

What languages were these messages broadcast in?

A FRENCH
B BAMBARA
C MALINKE
D PEUL/FULFULDE
E SARAKOLE/SONINKE/MARKA
F SONRAI
G DOGON/BOZO
H TAMASHEK/BELLA/ARABIC/MOOR
I SENOUFO/MINIANKA
J BOZO
X OTHER (SPECIFY) ______

Were these messages understandable?

1 YES
2 NO

At what time of day were these messages broadcast?

A MORNING
B NOON
C AFTERNOON
D EVENING

121. Have you regularly heard/seen awareness-raising messages about malaria on your local television?

1 YES
2 NO (Continue to 122)

What languages were these messages broadcast in?

A FRENCH
B BAMBARA
C MALINKE
D PEUL/FULFULDE
E SARAKOLE/SONINKE/MARKA
F SONRAI
G DOGON/BOZO
H TAMASHEK/BELLA/ARABIC/MOOR
I SENOUFO/MINIANKA
J BOZO
X OTHER (SPECIFY) ______

Were these messages understandable?

1 YES
2 NO

At what time of day were these messages broadcast?

A MORNING
B NOON
C AFTERNOON
D EVENING

122. Have your regularly heard awareness-raising messages about malaria from Community Health Agents, Community-Based Organizations?

1 YES
2 NO (Continue to 123)

What languages were these messages broadcast in?

A FRENCH
B BAMBARA
C MALINKE
D PEUL/FULFULDE
E SARAKOLE/SONINKE/MARKA
F SONRAI
G DOGON/BOZO
H TAMASHEK/BELLA/ARABIC/MOOR
I SENOUFO/MINIANKA
J BOZO
X OTHER (SPECIFY) ______

Were these messages understandable?

1 YES
2 NO

123. Have you regularly heard awareness-raising messages about malaria in places of worship (mosque, church) or from community leaders?

1 YES
2 NO (Continue to 124)

What languages were these messages broadcast in?

A FRENCH
B BAMBARA
C MALINKE
D PEUL/FULFULDE
E SARAKOLE/SONINKE/MARKA
F SONRAI
G DOGON/BOZO
H TAMASHEK/BELLA/ARABIC/MOOR
I SENOUFO/MINIANKA
J BOZO
X OTHER (SPECIFY) ______

Were these messages understandable?

1 YES
2 NO

124. In the last 12 months, have you:

1 Heard any songs/clips on the malaria awareness-raising campaign on the radio?
2 Heard/seen any songs on the malaria awareness-raising campaign on the television?
3 Seen any clips on the malaria awareness-raising campaign on the television?

1 HEARD MESSAGE ON RADIO

1 YES
2 NO

2 HEARD/SEEN MESSAGE ON TELEVISION

1 YES
2 NO

3 SEEN CLIPS ON TELEVISION

1 YES
2 NO

125. What shape of insecticidal mosquito net do you prefer?

1 CONICAL
2 RECTANGULAR
3 NO PREFERENCE

126. What color of insecticidal mosquito net do you prefer?

1 WHITE
2 GREEN
3 BLUE
4 NO PREFERENCE
5 BLACK/GREY
7 RED/PINK
6 OTHER (SPECIFY) ______

127. Do you own an insecticidal mosquito net?

1 YES
2 NO (Skip to 129)

128. Are you satisfied with the size of your insecticidal mosquito net?

1 YES
2 NO

129. Did you sleep under an insecticidal mosquito net last night?

1 YES
2 NO (Skip to 130)

129A. At what point did you go to sleep under the mosquito net last night: before the evening meal or at another time (to be specified)?

(All Skip to 201)
1 BEFORE EVENING MEAL/BEFORE 20:30
2 AFTER EVENING MEAL/AFTER TV NEWS/AFTER "SAFO" PRAYER 20:30 TO 23:00
3 23:00 TO 1 IN MORNING
4 AFTER 1 IN MORNING
8 DK

[###translator's note: unable to translate "SAFO" prayer]

130. Why didn't you sleep under a mosquito net last night?

PROBE: No other reason?

RECORD ALL MENTIONED

A BAD SMELL
B CAUSES IRRITATIONS/COUGH
C MAKES SICK
D MAKES NAUSEOUS/SUFFOCATES
E DANGEROUS CHEMICAL PRODUCT
F PRODUCT USED CAN KILL FETUS/CAUSE MISCARRIAGES
G CAN SUFFOCATE/BREATHING DIFFICULTIES
H DON'T LIKE SHAPE
I HEAT
J MOSQUITO NET GETS DIRTY QUICKLY
K DON'T LIKE MOSQUITO NET
L NO MOSQUITO NET
M SIZE NOT SATISFACTORY
N MOSQUITO NET NOT EFFECTIVE
O NO REASON
P MOSQUITO NET NOT IN GOOD CONDITION/TORN
X OTHER (SPECIFY) ______
Z DK

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. How many sons live with you?
How many daughters live with you?

IF NONE, RECORD '00'.

SONS AT HOME ______
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. How many sons are living but do not live with you?
How many daughters are living but do not live with you?

IF NONE, RECORD '00'.

SONS ELSEWHERE ______
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 or showed other signs of life but who didn't survive?

1 YES
2 NO (Skip to 208)

207. How many boys died?
How many girls died?

IF NONE, RECORD '00'.

DECEASED BOYS ______
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 BIRTH ______ (Continue to question)

Was this child born in the last six years?

TWO OR MORE BIRTHS ______ (Continue to question)

How many of these children were born in the last six years?

00 NONE (Skip to 224)
TOTAL IN LAST SIX YEARS ______

211. Now I would like to record the names of all the births you have had in the last six years (since 2009), whether they are still living or not, beginning with the most recent birth.

RECORD THE NAME OF ALL BIRTHS IN LAST SIX YEARS (since 2009) IN Q. 212. RECORD TWINS/TRIPLETS ON SEPARATE ROWS.

(Repeat 212 - 220 for up to 7 births)

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

(NAME)
01 ______

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

1 BOY
2 GIRL

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

1 SINGLE
2 MULTIPLE

215. In what month and year was (NAME) born?

PROBE:
What is his/her date of birth?

MONTH ______
YEAR ______

216. Is (NAME) still alive?

1 YES
2 NO (Go to NEXT BIRTH)

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

RECORD AGE IN COMPLETED YEARS.

AGE IN YEARS ______

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

1 YES
2 NO

219. IF LIVING:

RECORD CHILD'S LINE NUMBER FROM HOUSEHOLD SCHEDULE.
(RECORD '00' IF CHILD IS NOT LISTED IN HOUSEHOLD).

LINE NUMBER ______ (Go to NEXT BIRTH)

220.Were there other live births between (NAME) and (NAME OF BIRTH ON PRECEDING LINE)?

1 YES
2 NO

221. Have you had other live births since that of (NAME OF LAST BIRTH)? IF YES, RECORD THE BIRTH(S) IN BIRTH TABLE.

1 YES
2 NO

222. COMPARE 210 TO THE NUMBER OF BIRTHS RECORDED IN THE TABLE ABOVE AND CHECK OFF:

NUMBERS ARE EQUAL ______ (Continue to 223)
NUMBERS ARE DIFFERENT ______ (PROBE AND CORRECT)

223. CHECK 215.

RECORD THE NUMBER OF BIRTHS IN 2010 OR LATER.

IF NONE, RECORD '0'.

NUMBER OF BIRTHS ______
0 NONE

224. Are you pregnant now?

1 YES
2 NO (Skip to 226)
8 UNSURE (Skip to 226)

225. How many months pregnant are you?

RECORD THE NUMBER OF COMPLETED MONTHS.

MONTHS ______

226. CHECK 223:

ONE OR MORE BIRTHS IN 2010 OR LATER ______ (Continue to 301)
NO BIRTHS IN 2010 OR LATER ______ (Skip to 435)

SECTION 3. PREGNANCY AND INTERMITTENT PREVENTIVE TREATMENT

301. MARK THE NAME AND SURVIVORSHIP STATUS OF LAST BIRTH IN 302.

Now, I would like to ask you some questions about your last pregnancy in the last 6 years.

302. ACCORDING TO Q. 212 AND Q. 216 (ROW 01)

LAST BIRTH:

NAME: ______
LIVING ______ (Continue to 303)
DECEASED ______ (Continue to 303)

303. When you were pregnant with (NAME), did you see anyone for antenatal care?

1 YES
2 NO (SKIP TO 305)

304. Whom did you see?

Anyone else?

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

HEALTH PROFESSIONAL

A DOCTOR/GYNECOLOGIST
B NURSE
C MIDWIFE
D VILLAGE MIDWIFE "MATRONE"
E ASSISTANT TRAINED BIRTH ATTENDANTS

OTHER PERSONNEL

F TRADITIONAL BIRTH ATTENDANT
G VILLAGE/COMMUNITY HEALTH AGENT

X OTHER (SPECIFY) ______

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

NUMBER OF TIMES ______
98 DK

306. During this pregnancy, did you take any medication to prevent malaria?

1 YES
2 NO (Skip to 313A)
8 DK (Skip to 313A)

307. What medication did you take to prevent malaria?

RECORD ALL MENTIONED.

A SP/FANSIDAR
B CHLOROQUINE
C QUININE
D ARTESUNATE
E AMODIAQUINE
F ARTEMISININ COMBINATION
G TRADITIONAL MEDICINE
X OTHER (SPECIFY) ______
Z DK

308. CHECK 307:

SP/FANSIDAR TAKEN FOR MALARIA

CODE 'A' CIRCLED ______ (Continue to 309)
CODE 'A' NOT CIRCLED ______ (Skip to 313A)

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

(PROBE TO GET NUMBER)

NUMBER OF TIMES ______

310. How many tablets did you take in all?

(PROBE TO GET NUMBER)

NUMBER OF TABLETS ______

310A. YOU HAVE JUST SAID THAT YOU SOMETIMES TOOK SP/FANSIDAR. WE WOULD LIKE TO ASK YOU SOME INFORMATION ABOUT THESE TIMES YOU TOOK SP/FANSIDAR.

(ASK QUESTIONS BY ROW)

(Repeat Q. 310A - 313 for up to 6 rows)

(ROW 1) 1) The first (second, third, etc.) time,

IF THERE ARE NO MORE TIMES THAT SP/FANSIDAR WAS TAKEN, SKIP TO QUESTION 314.

310B. How many tablets did you take?

(PROBE TO GET NUMBER)

NUMBER OF TABLETS ______

311. Did you get them from a health facility during an antenatal visit, during a different visit to the facility, or did you get them at home or elsewhere?

1 ANTENATAL VISIT IN HEALTH FACILITY (Continue to 312)
2 OTHER VISIT IN HEALTH FACILITY (Continue to 312)
3 AT HOME (Go to 310A/NEXT ROW)
6 ELSEWHERE/OTHER (SPECIFY) ______ (Go to 310A/NEXT ROW)

312. Did you take them in the presence of a health agent during an antenatal visit or another visit, or did you take them at home or elsewhere?

TOOK THEM:

1 IN PRESENCE OF HEALTH AGENT (Continue to 313)
2 AT HOME (Go to 310A/NEXT ROW)
6 ELSEWHERE/OTHER (SPECIFY) ______ (Go to 310A/NEXT ROW)

313. In whose presence at the health facility did you take them?

HEALTH PROFESSIONAL

1 DOCTOR
2 NURSE
3 MIDWIFE
4 TRAINED VILLAGE MIDWIFE "MATRONE"

OTHER PERSONNEL

5 COMMUNITY HEALTH AGENT

6 OTHER (SPECIFY) ______

313A. Why didn't you take SP/Fansidar or other medication during this pregnancy to prevent malaria?

RECORD ALL MENTIONED.

A ALREADY SICK/TAKING OTHER MEDICATION
B DON'T TRUST TREATMENT
C DON'T LIKE MEDICATION
D TAKING TRADITIONAL MEDICINE
E NOT SICK WITH MALARIA
F NOT NECESSARY
G DISTANCE FROM HEALTH FACILITY/LACK OF MONEY
X OTHER (SPECIFY) ______
Z DK

314. CHECK 215 AND 216:

ONE OR MORE LIVING CHILDREN BORN IN 2010 OR LATER ______ (Continue to 401)
NO LIVING CHILDREN BORN IN 2010 OR LATER ______ (Skip to 435)

SECTION 4. CHILDREN'S HEALTH

401. CHECK 226:

ONE OR MORE BIRTHS IN 2010 OR LATER ______ (Continue to 402)
NO BIRTHS IN 2010 OR LATER ______ (Skip to 435)

402. CHECK 215: IN THE TABLE, RECORD THE LINE NUMBER, NAME AND SURVIVORSHIP STATUS FROM THE BIRTH HISTORY FOR EACH BIRTH OCCURRING IN 2010 OR LATER. ASK QUESTIONS ABOUT ALL THESE BIRTHS, BEGINNING WITH THE LAST BIRTH. (IF MORE THAN 3 BIRTHS, USE THE LAST THREE COLUMNS OF ADDITIONAL QUESTIONNAIRES).
Now I would like to ask you some questions about your children born in the last six years. (We will talk about one child at a time).

403. LINE NUMBER FROM 212 IN BIRTH HISTORY.

LAST BIRTH (SECOND-TO-LAST, THIRD-TO-LAST)
NUMBER BIRTH HISTORY ______

(Repeat Q. 403 - 434 for up to 3 births)

404. FROM QUESTIONS 212 AND 216

NAME ______
LIVING ______ (Continue to 405)
DECEASED ______ (GO TO 403 IN NEXT COLUMN OR IF NO MORE BIRTHS, SKIP TO Q. 435)

405. Was (NAME) sick with a fever at any time in the last two weeks?

1 YES
2 NO (Skip to Q.430)
8 DK (Skip to Q.430)

406. At any time during (NAME)'s illness, did someone take blood from a heel or finger?

1 YES
2 NO
8 DK

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

1 YES
2 NO (SKIP TO 411)

408. Where did you go to seek out help or treatment?

Anywhere else?

PROBE TO DETERMINE THE TYPE OF PLACE.

IF UNABLE TO DETERMINE IF PLACE IS PUBLIC OR PRIVATE SECTOR, RECORD NAME OF PLACE.

(NAME OF PLACE(S)) ______

PUBLIC SECTOR

A GOVERNMENT HOSPITAL
B GOVERNMENT HEALTH CENTER
C GOVERNMENT HEALTH POST
D HEALTH AGENT
E OTHER PUBLIC SECTOR (SPECIFY) ______

PRIVATE MEDICAL SECTOR

F PRIVATE HOSPITAL/CLINIC
G PHARMACY
H PRIVATE DOCTOR
I MOBILE CLINIC
J HEALTH AGENT
K OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ______

OTHER PLACE

L COMMUNITY HEALTH AGENT
M SHOP
N TRADITIONAL PRACTITIONER
O MARKET

X OTHER (SPECIFY) ______

409. CHECK 408:

2 OR MORE CODES CIRCLED ______ (Continue to 410)
1 SINGLE CODE CIRCLED ______ (Skip to 410A)

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

USE CODES FROM 408.

1ST PLACE ______

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

DAYS ______

411. Did (NAME) take medicine for the illness at any time during the course of the illness?

1 YES
2 NO (Skip to Q. 430)
8 DK (Skip to Q. 430)

412. What medication did (NAME) take?

PROBE AND SHOW PHOTOS OF MEDICATIONS:

Any other medication?

Any other medication?

Any other medication?

RECORD ALL MENTIONED.

ANTIMALARIALS

A ARTEMISININ COMBINATION THERAPY (ACT)
B SP/FANSIDAR
C CHLOROQUINE
D AMODIAQUINE
QUININE:
E TABLETS
F INJECTION/IV
ARTESUNATE:
G RECTALLY
H INJECTION/IV
I SP/FANSIDAR AND AMODIAQUINE (COMBINED)
J OTHER ANTIMALARIAL (SPECIFY) ______

ANTIBIOTICS

K TABLETS/SYRUP
L INJECTION

OTHER MEDICATION

M ASPIRIN/PARACETAMOL
N ACETAMINOPHEN
O IBUPROFEN
P "KUNBILENI"

TRADITIONAL MEDICINE

Q INFUSION/PLANT JUICE/ROOT JUICE
W OTHER (SPECIFY) ______
X OTHER (SPECIFY) ______
Z DK

413. CHECK 412:

ANY CODE A - J CIRCLED?

YES ______ (Continue to 414)
NO ______ (Skip to Q. 430)

414. CHECK 412:

ARTEMISININ COMBINATION THERAPY (ACT) (CODE 'A') GIVEN

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

415. How soon after the beginning of the fever did (NAME) start taking Artemisinin Combination Therapy (ACT)?