NIGERIA MALARIA INDICATOR SURVEY
HOUSEHOLD QUESTIONNAIRE
NIGERIA
NATIONAL MALARIA ELIMINATION PROGRAMME
NATIONAL POPULATION COMISSION
STATE
LOCAL GOVERNMENT AREA
LOCALITY
ENUMERATION AREA
NAME OF HOUESHOLD HEAD
CLUSTER NUMBER
HOUSEHOLD NUMBER
DATE
INTERVIEWER'S NAME
RESULT
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
TOTAL NUMBER OF VISITS
RESULT CODES
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 8
OTHER (SPECIFY) 9
TOTAL PERSONS IN HOUSEHOLD__
TOTAL ELIGIBLE WOMEN__
LINE NUMBER OF RESPONDENT TO HOUSEHOLD SCHEDULE__
LANGUAGE OF QUESTIONNAIRE__
LANGUAGE OF INTERVIEW__
NATIVE LANGUAGE OF RESPONDENT__
TRANSLATOR USED
NO 2
LANGUAGE CODES
HAUSA 2
YORUBA 3
IGBO 4
OTHER 6
TEAM NUMBER__
TEAM SUPERVISOR
NAME__
NUMBER__
Greetings. My name is__. I am working with the National Malaria Elimination Program and the National Population Commission. We are conducting a survey about malaria all over Nigeria. The information we collect will help the government to plan health services. Your household was selected for the survey. I would like to ask you some questions about your household. The questions usually take about 15-20 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 following persons:
National Malaria Elimination Program Contact Person: Dr. Perpetua Uhomoibhi; Phone Number: 0805912416
National Population Commission Contact Person: Mrs. Bintu Abba; Phone Number: 08033138277
National Health Research Ethics Committee Contact Person: NHREC Secretary; Email: secretary@nhrec.net
NHREC Desk Officer; Email: deskofficer@nhrec.net. Phone Number: 095238367
Health Strategy and Delivery Foundation Contact Person: Dr. Ify Aniebo; Phone Number: 09063727555
IF INTERESTED, ALLOW RESPONDENT TO COPY CONTACT INFORMATION
We are also taking measures to reduce the risk of transmission of COVID-19, including wearing face masks, keeping a distance of 2 meters from respondents to the survey, and washing our hands frequently. Do you have any questions? May I begin the interview now?
SIGNATURE OF INTERVIEWER__
DATE__
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 ASKING QUESTIONS 2-7 FOR EACH PERSON. ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE.
RELTIONSHIP 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/FOSTER/STEPCHILD 10
NOT RELATED 11
CO-WIFE 12
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 0-5
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 (SKIP TO 105)
PIPED TO NEIGHBOR 13 (SKIP TO 105)
PUBLIC TAP/STANDPIPE 14 (SKIP TO 103)
DUG WELL
UNPROTECTED WELL 32 (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
SACHET NUMBER 92
OTHER (SPECIFY) 96 (SKIP TO 103)
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
DUG WELL
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
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 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 (SKIP TO 109)
OTHER (SPECIFY) 96
106. Do you share this toilet facility with other households?
NO 2 (SKIP TO 108)
107. Including your own household, how many households 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 cookstove is MAINLY used for cooking?
SOLAR COOKER 02 (SKIP TO 111)
LIQUIFIED PETROLEUM GAS (LPG)/COOKING GAS STOVE 03 (SKIP TO 111)
PIPED NATURAL GAS STOVE 04 (SKIP TO 111)
BIOGAS STOVE 05 (SKIP TO 111)
KEROSENE STOVE 06
MANUFACTURED SOLID FUEL STOVE 07
TRADITIONAL SOLID FUEL STOVE 08
THREE STONE STOVE/OPEN FIRE 09
NO FOOD COOKED IN HOUSEHOLD 95 (SKIP TO 111)
OTHER (SPECIFY) 96
110. What type of fuel or energy source is used in this cookstove?
GASOLINE/DIESEL 02
KEROSENE/PARAFFIN 03
COAL/LIGNITE 04
CHARCAL 05
WOOD 06
STRAW/SHRUBS/GRASS 07
AGRICULTURAL CROP 08
ANIMAL DUNG/WASTE 09
PROCESSED BIOMASS (PELLETS) OR WOODCHIPS 10
GARBAGE/PLASTIC 11
SAWDUST 12
OTHER (SPECIFY) 96
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 does this household own? IF NONE, RECORD '00'. IF 95 OR MORE, RECORD '95'. IF UNKNOWN, RECORD '98'.
a) Milk cows or bulls?
b) Other cattle?
c) Horses, donkeys, or mules?
d) Goats?
e) Sheep?
f) Chickens or other poultry?
g) Pigs?
h) Camels?
114. Does any member of this household own any agricultural land?
NO 2 (SKIP TO 116)
115. How many plots/acres/hectares of agricultural land do members of this household own? IF 95 OR MORE, CIRCLE '950'.
ACRES__ 02
HECTARES__ 03
95 OR MORE PLOTS/ACRES/HECTARES 950
DON'T KNOW 998
116. Does your household have:
a) Electricity?
b) A radio?
c) A television?
d) A non-mobile telephone?
e) A computer?
f) A refrigerator?
g) A table?
h) A chair?
i) A bed?
j) A sofa?
k) A cupboard?
l) An air conditioner?
m) An electric iron?
n) A generator?
o) A fan?
NO 2
117. Does any member of this household own:
a) A watch?
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?
h) A canoe?
i) A keke napep?
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
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 husband get the mosquito net? IF LESS THAN ONEE 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
OLYSET 12
ICONLIFE 13
DURANET 14
NETPROTECT 15
BASE INTERCEPTOR 16
YORKOOL 17
MAGNET 18
DAWAPLUS 2.0 19
ROYAL SECURITY 20
ROYAL SENTRY 21
PERMANET 2.0 22
PERMANET 3.0 23
VEERALIN 24
INTERCEPTOR G2 25
ROYAL GUARD 26
OTHER/DON'T KNOW BRAND (LLIN) 36
DON'T KNOW TYPE 98
126. Did you get the net through a mass distribution campaign, during an antenatal care visit, or during an immunization visit?
YES, ANC 2 (SKIP TO 128)
YES, IMMUNIZATION 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 (SPECIFY) 96
DON'T KNOW 98
128. Did anyone else sleep inside this mosquito net last night?
NO 2 (SKIP TO 130)
NOT SURE 8 (SKIP TO 131)
129. Who slept inside this mosquito net last night? RECORD THE PERSON'S NAME AND LINE NUMBER FROM HOUSEHOLD SCHEDULE.
LINE NUMBER__
130. What was the MAIN REASON this net was not used last night?
NO MALARIA 02
TOO HOT 03
DON'T LIKE SMELL 04
FEEL 'CLOSED IN' 05
NET TOO OLD/TORN 06
NET TOO DIRTY 07
NET NOT AVAILABLE LAST NIGHT (WASHING) 08
USUAL USERS DID NOT SLEEP HERE LAST NIGHT 09
NET NOT NEEDED LAST NIGHT 10
BED BUGS 11
OTHER (SPECIFY) 96
DON'T KNOW 98
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 STRIPS 32
CERAMIC TILES 33
CEMENT 34
CARPET 35
133. OBSERVE MAIN MATERIAL OF THE ROOF OF THE DWELLING. RECORD OBSERVATION.
THATCH/PALM LEAF 12
GRASS 13
PALM/BAMBOO 22
WOOD PLANKS 23
CARDBOARD 24
WOOD 32
CALAMINE/CEMENT FIBER 33
CERAMIC TILES 34
CEMENT 35
ROOFING SHINGLES 36
ASBESTOS 37
134. OBSERVE MAIN MATERIAL OF THE EXTERIOR WALLS OF THE DWELLING. RECORD OBSERVATION.
CANE/PALM/TRUNKS 12
DIRT 13
STONE WITH MUD 22
UNOVERED ADOBE 23
PLYWOOD 24
CARDBOARD 25
REUSED WOOD 26
STONE WITH LIME/CEMENT 32
BRICKS 33
CEMENT BLOCKS 34
COVERED ADOBE 35
WOOD PLANKS/SINGLES 36
MINUTES__
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT INTERVIEW
COMMENTS ON SPECIFIC QUESTIONS
ANY OTHER COMMENTS
1. This section should be adapted for country-specific survey design
2. Remove the section for recording the name and ID number of the CAPI supervisor if the survey does not have CAPI supervisors who are separate from the team supervisors.
3. Increase the time reported to the respondent if modules are added to the questionnaire
4. Countries that use sachet water (small plastic bags of water) as a source of drinking water should add SACHET WATER as a separate coding category after BOTTLED WATER, and follow the same question flow as households that use BOTTLED WATER (ask Q.102, source of water for other purposes) Similarly, countries that have water kiosks should add WATER KIOSK as a separate coding category, and follow the same question flow as households that use BOTTLED WATER.
5. Coding categories to be developed locally; however, the broad categories must be maintained.
6. Add other country specific animals, such as oxen, water buffalo, camels, llamas, alpacas, pigs, ducks, geese, or elephants.
7. Each country should add to the list at least five items of furniture (such as a table, chair, sofa, bed, armoire, cupboard, or cabinet). In addition, each country should add at least four additional household appliances so that the list includes at least three items that even a poor household may have, at least three items that a middle income household may have, and at least three items that a high income household may have. Some possible additions are clock, water pump, grain grinder, fan, blender, water heater, generator, washing machine, microwave oven, DVD player, CD player, camera, air conditioner or cooler, or sewing machine.
8. Adapt question locally to use the name of the mass distribution campaign
9. Adapt list of response codes to country context as needed.