2012 MALAWI MALARIA INDICATOR SURVEY
WOMAN'S QUESTIONNAIRE
PLACE NAME __
DISTRICT __
CLUSTER NUMBER __
HOUSEHOLD NUMBER __
NAME OF HOUSEHOLD HEAD __
NAME AND LINE NUMBER OF WOMAN __
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. NUMBER __
RESULT __
TOTAL NUMBER OF VISITS __
*RESULT CODES:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPICATATED 6
OTHER 7 (SPECIFY) __
LANGUAGE OF QUESTIONNAIRE** ENGLISH
LANGUAGE OF INTERVIEW** __
NATIVE LANGUAGE OF RESPONDENT** __
TRANSLATOR USED (1 = NOT AT ALL; 2 = SOMETIME; 3 = ALL THE TIME) __
**LANGUAGE CODES:
TUMBUKA 2
YAO 3
ENGLISH 4
OTHER 6 (SPECIFY) __
SUPERVISOR
NAME __
OFFICE EDITOR __
KEYED BY __
SECTION 1. RESPONDENT'S BACKGROUND
INTRODUCTION AND CONSENT
INFORMED CONSENT
Hello. My name is ___________________________. I am working with the Ministry of Health. We are conducting a survey about health all over Malawi. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 10-20 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 THE INTERVIEWER: ________________________ DATE: _____________
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
MINUTES __
102. In what month and year were you born?
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.
104. Have you ever attended school?
NO 2 (SKIP TO 108)
105. What is the highest level of school you attended: primary, secondary, or higher?
SECONDARY 2
HIGHER 3
106. What is the highest (grade/form/year) you completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.
SECONDARY OR 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 the sentence to me?
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE 4 (SPECIFY LANGUAGE) __
BLIND/VISUALLY IMPAIRED 5
CCAP 02
ANGLICAN 03
SEVENTH DAY ADVENT/BAPTIST 04
OTHER-CHRISTIAN 05
MUSLIM 06
NO RELIGION 07
OTHER 96 (SPECIFY) __
110. What is your tribe or ethnic group?
TUMBUKA 02
LOMWE 03
TONGA 04
YAO 05
SENA 06
NKHONDE 07
NGONI 08
OTHER 96 (SPECIFY) __
201. Now I would like to ask about all the births you have had during your life. Have you ever given birth?
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?
NO 2 (SKIP TO 204)
203. How many sons live with you?
And how many daughters live with you?
IF NONE, RECORD '00'.
DAUGHTERS AT HOME __
204. Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?
NO 2 (SKIP TO 206)
204. How many sons are alive but do not live with you?
And how many daughters are alive but do not live with you?
IF NONE, RECORD '00'.
DAUGHTERS 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 or showed signs of life but did not survive?
NO 2 (SKIP TO 208)
207. How many boys have died?
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'.
NONE 00 (SKIP TO 224)
Just to make sure that I have this right: you have had in TOTAL ______ births during your life. Is that correct?
NO (PROBE AND CORRECT 201-208 AS NECESSARY)
ONE BIRTH:
Was this child born in the last six years?
IF NO CIRCLE '00'.
TWO OR MORE BIRTHS:
How many of these children were born in the last six years?
NONE 00 (SKIP TO 224)
211. Now I would like to record the names of all your births in the last six years, whether still alive or not, starting with the most recent one you had.
RECORD NAMES OF ALL THE BIRTHS IN THE LAST 6 YEARS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS.
212. What name was given to your (most recent/previous baby)?
RECORD NAME.
BIRTH HISTORY NUMBER
213. Is (NAME) a boy or a girl?
GIRL 2
214. Were any of these births twins?
MULTIPLE 2
215. In what month and year was (NAME) born?
PROBE: When is his/her birthday?
YEAR __
NO 2 (NEXT BIRTH)
217. IF ALIVE: How old was (NAME) at his/her last birthday?
RECORD AGE IN COMPLETED YEARS.
218. IF ALIVE: Is (NAME) living with you?
NO 2
219. IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD)
220. Were there any other live births between (NAME) and (NAME OF BIRTH ON PREVIOUS LINE), including any children who died after birth?
NO 2 (NEXT BIRTH)
221. Have you had any live births since the birth of (NAME OF MOST RECENT BIRTH)? IF YES, RECORD BIRTH(S) IN TABLE.
NO 2
222. COMPARE 210 WITH NUMBER OF BITHS IN HISTORY ABOVE AND MARK:
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)
ENTER THE NUMBER OF BIRTHS IN 2006 OR LATER
NONE 0
NO 2 (SKIP TO 226)
UNSURE 8 (SKIP TO 226)
225. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.
NO BIRTHS IN 2006 OR LATER OR IS BLANK (SKIP TO 501)
SECTION 3A. PREGNANCY AND INTERMITTENT PREVENTATIVE TREATMENT
301. CHECK 215: ENTER IN THE TABLE THE NAME AND THE SURVIVAL STATUS OF THE MOST RECENT BIRTH.
Now I would like to ask some questions about your last pregnancy that resulted in a live birth.
301. FROM 212 AND 216, LINE 01:
LAST BIRTH
LIVING __
DEAD __
302. When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?
NO 2 (SKIP TO 304)
303. Whom did you see?
Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
NURSE/MIDWIFE B
PATIENT ATTENDANT C
HAS D
OTHER X (SPECIFY) __
304. During this pregnancy, did you take any drugs to keep you from getting malaria?
NO 2 (SKIP TO 310)
DON'T KNOW 8 (SKIP TO 310)
305. What drugs did you take to prevent malaria?
RECORD ALL MENTIONED.
IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.
CHLOROQUINE B
OTHER X (SPECIFY) __
DON'T KNOW Z
SP/FANSIDAR TAKEN FOR MALARIA PREVENTION
CODE 'A' NOT CIRCLED (SKIP TO 310)
307. How many times did you take (SP/Fansidar or Novidar SP) during this pregnancy?
ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY
OTHER (SKIP TO 310)
309. Did you get the (SP/Fansidar) during any antenatal care visit, during another visit to a health facility or from another source?
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6
310. Did you take the (SP/Fansidar or Novidar SP) under direct observation by the health worker each time, or did you take it at home?
AT HOME 2
ELSEWHERE 3
NO LIVING CHILDREN BORN IN 2006 OR LATER (GO TO 501)
401. CHECK 215: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH IN 2006 OR LATER, ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES.)
Now I would like to ask some questions about the health of your children born since January 2006. (We will talk about each separately).
402. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY
LAST BIRTH
LIVING __
DEAD __ (GO TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 501)
404. Has (NAME) been ill with a fever at any time in the last 2 weeks?
NO 2 (GO TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 501)
DON'T KNOW 8 (GO TO 403 IN NEXT COLUMN, OR, IF NO MORE BIRTHS, GO TO 501)
404A. How many days ago did the fever start?
IF LESS THAN ONE DAY, RECORD '00'.
405. Did you seek advice or treatment for the illness from any source?
NO 2 (SKIP TO 410)
406. Where did you seek advice or treatment?
Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
______________________________
(NAME OF PLACE(S))
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST/OUTREACH C
MOBILE CLINIC D
HAS E
OTHER PUBLIC F
HEALTH CENTER H
PHARMACY K
PRIVATE DOCTOR L
MOBILE CLINIC M
HAS N
OTHER PRIVATE MEDICAL O
MACRO Q
YOUTH DROP IN CENTRE R
TRADITIONAL PRACTITIONER T
406A. How many days after the fever began did you first seek treatment for (NAME)?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
406B. How much did you spend on the treatment including consultation on fees, if any?
FREE 99995
DON'T KNOW 99998
406C. How much did you spend on drugs?
FREE 99995
DON'T KNOW 99998
ONLY ONE CODE CIRCLED (SKIP TO 409)
408. Where did you first seek advice or treatment?
USE LETTER CODE FROM 406.
408A. How far is your house from the (FIRST PLACE IN 408)?
15 KM+ 2
408B. What is the total amount that you spent for transport to and from the (FIRST PLACE IN 408)?
FREE 99995
DON'T KNOW 99998
408C. Did any member of your household go with you to the (FIRST PLACE IN 408)?
NO 2 (SKIP TO 408E)
408D. What is the total amount that you spent for his/her transport?
FREE 99995
DON'T KNOW 99998
BOTH ARE FREE OR DK (SKIP TO 408G)
408F. What was the source of the payment (if any) you used during the child's sickness with fever?
OCCASIONAL INCOME B
BORROWED C
SALE OF ASSETS D
OTHER X (SPECIFY) __
408G. Did you take any days off work in order to care for your child's sickness?
NO 2 (SKIP TO 409)
409. At any time during the illness, did (NAME) have blood taken from his/her finger or heel for testing?
NO 2 (SKIP TO 409C)
DON'T KNOW 8 (SKIP TO 409C)
409A. Was the blood tested for malaria?
NO 2 (SKIP TO 409C)
DON'T KNOW 8 (SKIP TO 409C)
409B. Were you told the test result?
NO 2
DON'T KNOW 8
409C. Is (NAME) still sick with a fever?
NO 2
DON'T KNOW 8
410. At any time during the illness, did (NAME) take drugs for the illness?
NO 2 (GO TO 429)
DON'T KNOW 8 (GO TO 429)
411. What drugs did (NAME) take?
Any other drugs?
RECORD ALL MENTIONED.
CHLOROQUINE B
AMODIAQUINE C
QUININE D
LA (COARTEM) E
ARTESUNATE F
AA/ASAQ (COMBINED AMODIAQUINE AND ARTESUNATE) G
OTHER ANTIMALARIAL H (SPECIFY) __
INJECTION J
ACETAMINOPHEN/PANADOL/PARACETAMOL L
IBUPROFEN M
DON'T KNOW Z
412. CHECK 411: ANY CODE A-H CIRCLED?
NO (GO TO 429)
413. CHECK 411: SP/FANSIDAR/NOVIDAR SP ('A') GIVEN)
CODE 'A' NOT CIRCLED (SKIP TO 415)
414. How long after the fever started did (NAME) first take SP/Fansidar/Novidar SP?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
414A. For how many days did (NAME) take SP/Fansidar/Novidar SP?
414B. Did you have SP/Fansidar/Novidar SP at home or did you get it from somewhere else?
IF SOMEWHERE ELSE, PROBE FOR SOURCE.
IF MORE THAN ONE SOURCE, ASK: Where did you get the SP/Fansidar/Novidar SP?
GOVERNMENT HEALTH FACILITY/WORKER 2
PRIVATE HEALTH FACILITY/WORKER 3
SHOP 4
OTHER 6 (SPECIFY) __
DON'T KNOW 8
414C. Did you purchase the SP/Fansidar/Novidar SP?
NO 2 (SKIP TO 415)
414D. How much did you pay for the SP/Fansidar/Novidar SP?
DON'T KNOW 99998
415. CHECK 411: CHLOROQUINE ('B') GIVEN
CODE 'B' NOT CIRCLED (SKIP TO 417)
416. How long after the fever started did (NAME) first take chloroquine?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
416A. For how many days did (NAME) take chloroquine?
416B. Did you have chloroquine at home or did you get it from somewhere else?
IF SOMEWHERE ELSE, PROBE FOR SOURCE.
IF MORE THAN ONE SOURCE, ASK: Where did you get the chloroquine?
GOVERNMENT HEALTH FACILITY/WORKER 2
PRIVATE HEALTH FACILITY/WORKER 3
SHOP 4
OTHER 6 (SPECIFY) __
DON'T KNOW 8
416C. Did you purchase the chloroquine?
NO 2 (SKIP TO 415)
416D. How much did you pay for the chloroquine?
DON'T KNOW 99998
417. CHECK 411: AMODIAQUINE ('C') GIVEN
CODE 'C' NOT CIRCLED (SKIP TO 419)
418. How long after the fever started did (NAME) first take AMODIAQUINE?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
418A. For how many days did (NAME) take AMODIAQUINE?
418B. Did you have AMODIAQUINE at home or did you get it from somewhere else?
IF SOMEWHERE ELSE, PROBE FOR SOURCE.
IF MORE THAN ONE SOURCE, ASK: Where did you get the AMODIAQUINE?
GOVERNMENT HEALTH FACILITY/WORKER 2
PRIVATE HEALTH FACILITY/WORKER 3
SHOP 4
OTHER 6 (SPECIFY) __
DON'T KNOW 8
418C. Did you purchase the AMODIAQUINE?
NO 2 (SKIP TO 415)
418D. How much did you pay for the AMODIAQUINE?
DON'T KNOW 99998
419. CHECK 411: QUININE ('D') GIVEN
CODE 'D' NOT CIRCLED (SKIP TO 421)
420. How long after the fever started did (NAME) first take QUININE?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MRE DAYS AFTER FEVER 3
DON'T KNOW 8
420A. For how many days did (NAME) take QUININE?
420B. Did you have QUININE at home or did you get it from somewhere else?
IF SOMEWHERE ELSE, PROBE FOR SOURCE.
IF MORE THAN ONE SOURCE, ASK: Where did you get the QUININE?
GOVERNMENT HEALTH FACILITY/WORKER 2
PRIVATE HEALTH FACILITY/WORKER 3
SHOP 4
OTHER 6 (SPECIFY) __
DON'T KNOW 8
420C. Did you purchase the QUININE?
NO 2 (SKIP TO 415)
420D. How much did you pay for the QUININE?
DON'T KNOW 99998
421. CHECK 411: LA (COARTEM) (E) GIVEN
CODE 'E'NOT CIRCLED (SKIP TO 423)
422. How long after the fever started did (NAME) first take LA/COARTEM?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
422A. For how many days did (NAME) take LA/COARTEM?
422B. Did you have LA/COARTEM at home or did you get it from somewhere else?
IF SOMEWHERE ELSE, PROBE FOR SOURCE.
IF MORE THAN ONE SOURCE, ASK: Where did you get the LA/COARTEM?
GOVERNMENT HEALTH FACILITY/WORKER 2
PRIVATE HEALTH FACILITY/WORKER 3
SHOP 4
OTHER 6 (SPECIFY) __
DON'T KNOW 8
422C. Did you purchase the LA/COARTEM?
NO 2 (SKIP TO 415)
422. How much did you pay for the LA/COARTEM?
DON'T KNOW 99998
423. CHECK 411: ARTESUNATE (F) GIVEN
CODE 'F' NOT CIRCLED (SKIP TO 425)
424. How long after the fever started did (NAME) first take ARTESUNATE?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS OR MORE AFTER FEVER 3
DON'T KNOW 8
424A. For how many days did (NAME) take ARTESUNATE?
424B. Did you have ARTESUNATE at home or did you get it from somewhere else?
IF SOMEWHERE ELSE, PROBE FOR SOURCE.
IF MORE THAN ONE SOURCE, ASK: Where did you get the ARTESUNATE?
GOVERNMENT HEALTH FACILITY/WORKER 2
PRIVATE HEALTH FACILITY/WORKER 3
SHOP 4
OTHER 6 (SPECIFY) __
DON'T KNOW 8
424C. Did you purchase the ARTESUNATE?
NO 2 (SKIP TO 415)
424D. How much did you pay for the ARTESUNATE?
DON'T KNOW 99998
425. CHECK 411: AA/ASAQ (COMBINED AMODIAQUINE AND ARTESUNATE) (G) GIVEN
CODE 'G' NOT CIRCLED (SKIP TO 427)
426. How long after the fever started did (NAME) first take AA/ASAQ?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
426A. For how many days did (NAME) take AA/ASAQ?
426B. Did you have AA/ASAQ at home or did you get it from somewhere else?
IF SOMEWHERE ELSE, PROBE FOR SOURCE.
IF MORE THAN ONE SOURCE, ASK: Where did you get the AA/ASAQ?
GOVERNMENT HEALTH FACILITY/WORKER 2
PRIVATE HEALTH FACILITY/WORKER 3
SHOP 4
OTHER 6 (SPECIFY) __
DON'T KNOW 8
426C. Did you purchase the AA/ASAQ?
NO 2 (SKIP TO 415)
426D. How much did you pay for the AA/ASAQ?
DON'T KNOW 99998
427. CHECK 411: OTHER ANTIMALARIAL ('H') GIVEN
CODE 'H' NOT CIRCLED (GO BACK TO 403 IN NEXT COLUMN, OR, IF NO MORE BIRTHS GO TO 429)
428. How long after the fever started did (NAME) first take (OTHER ANTIMALARIAL)?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
428A. For how many days did (NAME) take OTHER ANTIMALARIAL?
428B. Did you have OTHER ANTIMALRIAL at home or did you get it from somewhere else?
IF SOMEWHERE ELSE, PROBE FOR SOURCE.
IF MORE THAN ONE SOURCE, ASK: Where did you get the OTHER ANTIMALARIAL?
GOVERNMENT HEALTH FACILITY/WORKER 2
PRIVATE HEALTH FACILITY/WORKER 3
SHOP 4
OTHER 6 (SPECIFY) __
DON'T KNOW 8
428C. Did you purchase the OTHER ANTIMALARIAL?
NO 2 (SKIP TO 415)
428D. How much did you pay for the OTHER ANTIMALARIAL?
DON'T KNOW 99998
429. Was (NAME) admitted in a hospital the last 12 months?
NO 2 (SKIP TO 430)
429A. How much did you spend on admission if any?
DON'T KNOW 99998
430. GO BACK TO 403 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501.
501. Have you ever head of an illness called malaria?
NO 2 (SKIP TO 523)
502. What signs or symptoms would lead you to think that a person has malaria?
Anything else?
RECORD ALL MENTIONED.
FEELING COLD B
HEADACHE C
NAUSEA/VOMITING D
DIARRHEA E
DIZZINESS F
LOSS OF APPETITE G
BODY ACHE OR JOINT PAIN H
PALE EYES I
SALTY-TASTING PALMS J
FEELING WEAK K
REFUSE TO EAT OR DRINK L
OTHER X (SPECIFY) __
DON'T KNOW Z
503. What do you think is the cause of malaria?
Anything else?
RECORD ALL MENTIONED.
EATING IMMATURE SUGARCANE B
EATING COLD SIMA C
EATING DIRTY FOOD D
DRINKING DIRTY WATER E
GETTING SOAKED IN RAIN F
COLD OR CHANGING WEATHER G
WITCHCRAFT H
OTHER X (SPECIFY) __
DON'T KNOW Z
504. How can someone protect themselves against malaria?
Anything else?
RECORD ALL MENTIONED.
SLEEP UNDER AN INSECTICIDE-TREATED MOSQUITO NET B
USE MOSQUITO REPELLANT C
AVOID MOSQUITO BITES D
TAKE PREVENTIVE MEDICATION E
SPRAY HOUSE WITH INSECTICIDE F
USE MOSQUITO COILS G
CUT GRASS AROUND THE HOUSE H
FILL IN PUDDLES (STAGNANT WATER) I
KEEP HOUSE AND SURROUNDINGS CLEAN J
BURN LEAVES K
AVOID DRINKING DIRTY WATER L
AVOID EATING BAD FOOD M
PUT SCREENS ON WINDOWS N
AVOID GETTING SOAKED IN RAIN O
OTHER X (SPECIFY) __
DON'T KNOW Z
505. What are the danger signs of malaria?
Anything else?
RECORD ALL MENTIONED.
FAINTING B
ANY FEVER C
HIGH FEVER D
STIFF NECK E
FEELING WEAK F
NOT ACTIVE G
CHILLS/SHIVERING H
UNABLE TO EAT I
VOMITING J
CRYING ALL THE TIME K
RESTLESS L
DIARRHEA M
OTHER X (SPECIFY) __
DON'T KNOW Z
506 In your opinion, which people are most affected by malaria in your community?
Anybody else?
RECORD ALL MENTIONED.
ADULTS B
PREGNANT WOMEN C
OLDER ADULTS D
EVERYONE E
OTHER X (SPECIFY) __
DON'T KNOW Z
507. In the last six months, have you listened or saw messages or information about malaria?
NO 2 (SKIP TO 511)
508. Where did you hear or see these messages or information?
Anywhere else?
RECORD ALL MENTIONED.
COMMUNITY HEALTH WORKER B
FRIENDS/FAMILY C
WORKPLACE D
DRAMA GROUPS E
PEER EDUCATORS F
POSTER/BILLBAORDS G
TELEVISION H
RADIO I
NEWSPAPER J
OTHER X (SPECIFY) __
DON'T KNOW Z
509. How many months ago was the last time you heard or saw the message?
510. What type of messages about malaria did you hear or saw?
Anything else?
RECORD ALL MENTIONED.
MALARIA CAN KILL B
MOSQUITO SPREAD MALARIA C
SLEEPING UNDER A MOSQUITO NET IS IMPORTANT D
WHO SHOULD SLEEP UNDER A MOSQUITO NET F
SEEK TREATMENT FOR FEVER G
SEEK TREATMENT FOR FEVER PROMPTLY (WITHIN 24 HOURS) I
IMPORTANCE OF HOUSE SPRAYING J
NOT PLASTERING WALLS AFTER SPRAYING K
ENVIRONMENTAL SANITATION ACTIVITIES L
OTHER X (SPECIFY) __
DON'T KNOW Z
511. Has anyone ever provided you with information on malaria at your home?
NO 2 (SKIP TO 515)
512. Who gave you the information at your home?
Anybody else?
RECORD ALL MENTIONED.
COMMUNITY HEALTH WORKER B
FRIENDS/FAMILY C
EMPLOYER D
PEER EDUCATORS E
OTHER X (SPECIFY) __
DON'T KNOW Z
513. How long ago did someone visit your house to provide you with information about malaria?
514. What type of messages about malaria did you hear or saw?
Anything else?
RECORD ALL MENTIONED.
MALARIA CAN KILL B
MOSQUITO SPREAD MALARIA C
SLEEPING UNDER A MOSQUITO NET IS IMPORTANT D
WHO SHOULD SLEEP UNDER A MOSQUITO NET F
SEEK TREATMENT FOR FEVER G
SEEK TREATMENT FOR FEVER PROMPTLY (WITHIN 24 HOURS) I
IMPORTANCE OF HOUSE SPRAYING J
NOT PLASTERING WALLS AFTER SPRAYING K
ENVIRONMENTAL SANITATION ACTIVITIES L
OTHER X (SPECIFY) __
DON'T KNOW Z
515. CHECK HOUSEHOLD QUESTIONNAIRE 121:
HAS NO MOSQUITO NET (SKIP TO 523)
516. Has the community health worker in your village ever helped hang a mosquito net in this house?
NO 2
517. Has any mosquito net in this house been used for any reason other than sleeping?
NO 2 (SKIP TO 519)
Anything else?
RECORD ALL MENTIONED.
COVER/PROTECTION B
WINDOW SCREEN C
CLOTHING/WEDDING VEIL D
OTHER X (SPECIFY) __
DON'T KNOW Z
519. How often do your children sleep under a mosquito net?
SOMETIMES 2
NEVER 3
MINUTES __
INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ON SPECIFIC QUESTIONS __
ANY OTHER COMMENTS __
SUPERVISOR'S OBSERVATIONS __
DATE __
EDITOR'S OBSERVATIONS __
DATE __