UGANDA BUREAU OF STATISTICS
UGANDA MALARIA INDICATOR SURVEY 2009
WOMAN'S QUESTIONNAIRE -- ENGLISH

SECTION 1A: IDENTIFICATION

REGION_
DISTRICT_
COUNTY_
SUBCOUNTRY/TOWN_
PARISH/LC2 NAME_
EA NAME_
HOUSEHOLD NUMBER_
NAME AND LINE NUMBER OF WOMAN_

SECTION 1B: INTERVIEWER VISITS

FIRST VISIT

DATE_
INTERVIEWER'S NAME_
RESULT*_

NEXT VISIT:

DATE_
TIME_

SECOND VISIT:

DATE_
INTERVIEWER'S NAME_
RESULT*_

NEXT VISIT:

DATE_
TIME_

THIRD VISIT

DATE_
INTERVIEWER'S NAME_
RESULT*_

FINAL VISIT

DAY_
MONTH_
YEAR_
INT. NUMBER_
RESULT_

TOTAL NUMBER OF VISITS_

*RESULT CODES:
1. COMPLETED
2. NOT AT HOME
3. POSTPONED
4. REFUSED
5. PARTLY COMPLETED
6. INCAPACITATED
7. OTHER (SPECIFY)_

LANGUAGE OF QUESTIONNAIRE 7
LANGUAGE USED IN THE INTERVIEW_
NATIVE LANGUAGE OF RESPONDENT_
TRANSLATOR USED (NOT AT ALL=1; SOMETIMES=2, ALL THE TIME=3)_
LANGUAGE USED:

ATESO-KARAMOJONG
LUGANDA
LUGBARA
LUO
RUNYANKOLE-RUKIGA
RUNYORO-RUTORO
ENGLISH
OTHER

SUPERVISOR

NAME_
DATE_

FIELD EDITOR

NAME_
DATE_

OFFICE EDITOR_

KEYED BY_

INTRODUCTION AND CONSENT

Hello. My name is _____________________________. I am working with the MOH and UBOS. We are conducting a national survey about malaria and would very much appreciate your participation in this survey. This information will help the government to plan health services. These questions will take about 15 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shared with anyone other than members of our survey team.

Participation in this survey is voluntary, and if we should come to 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. However, we hope you will participate in the survey since your views are important.

At this time, do you want to ask me anything about the survey? May I begin the interview now?

Signature of interviewer:_
DATE: _

RESPONDENT AGREES TO BE INTERVIEWED 1 (CONTINUE)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME

HOURS_
MINUTES_
MORNING 1
AFTERNOON 2
EVENING/NIGHT 3

102. In what month and year were you born?

MONTH_
DON'T KNOW MONTH 98
YEAR_
DON'T KNOW YEAR 9998

103. How old are you? COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT.

AGE IN COMPLETED YEARS_

104. Have you ever attended school?

YES 1
NO 2 (SKIP TO 107)

105. What is the highest level of school you attended: primary, '0' level, 'A' level, or university or tertiary?

PRIMARY 1
'O' LEVEL 2
'A' LEVEL 3
UNIVERSITY/TERTIARY 4

106. What is the highest (class/year) you completed at that level? IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

CLASS/YEAR_

107. Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
CANNOT READ 8

108. Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

109. Do you watch television almost every day, at least once week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

110. As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. In the last seven days, have you done any of these things or any other work?

YES 1 (SKIP TO 113)
NO 2

111. Although you did not work in the last seven years, do you have any job or business from which you were absent for leave, illness, vacation or any such reason?

YES 1 (SKIP TO 113)
NO 2

112. Have you done any work in the last 12 months?

YES 1
NO 2 (SKIP TO 115)

113. Are (were) you paid in cash or kind in this work of are (were) you not paid at all?

CASH ONLY 1
CASH AND KIND 2
IN-KIND ONLY 3
NOT PAID 4

114. What is your occupation, that is, what kind of work do you mainly do? INTERVIEWER: PROBE TO OBTAIN DETAILED INFORMATION ON THE KIND OF WORK RESPONDENT DOES. (SKIP TO 116)

115. What have you been doing for most of the time over the last 12 months?

GOING TO SCHOOL/STUDYING 01
LOOKING FOR WORK 02
RETIRED 03
TOO ILL TO WORK 04
HANDICAPPED, CANNOT WORK 05
HOUSEWORK/CHILD CARE 06
OTHER (SPECIFY)_ 96

116. What is your ethnic group?

BAGANDA 01
BANYANKORE 02
ITESO 03
LUGBARA/MADI 04
BASOGA 05
LANGI 06
BAKIGA 07
KARIMOJONG 08
ACHOLI 09
BAGISU/SABINY 10
ALUR/JOPADHOLA 11
BANYORO 12
BATORO 13
OTHER (SPECIFY)_ 96

SECTION 2. REPRODUCTION

201. Now I would like to ask about all the births you have had during your life. Have you ever given birth?

YES 1
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?

YES 1
NO 2 (SKIP TO 204)

203. How many sons live with you? And 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 have birth who are alive but do not live with you?

YES 1
NO 2 (SKIP TO 206)

205. 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'.

SONS ELSEWHERE_
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?

YES 1
NO 2 (SKIP TO 208)

207. How many boys have died? And how many girls have died? IF NONE, RECORD '00'.

BOYS DEAD_
GIRLS DEAD_

208. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'.

TOTAL_

209. CHECK 208: Just to make sure I have this right: you have had in TOTAL births during your life. Is that correct?

YES (CONTINUE)
NO (PROBE AND CORRECT 201-208 AS NECESSARY)

210. Are you pregnant now?

YES 1
NO 2
UNSURE 8

211. CHECK 208:

ONE OR MORE BIRTHS (CONTINUE)
NO BIRTHS Q.208 IS '00' (SKIP TO 224)

212. Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had. RECORD NAMES OF ALL THE BIRTHS IN 213. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. (IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW).

213. What name was given to your (first/next) baby? (NAME)

214. Were any of these births twins?

SING 1
MULT 2

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

BOY 1
GIRL 2

216. In what month and year was (NAME) born? PROBE: What is his/her birthday?

MONTH_
YEAR_

217. Is (NAME) still alive?

YES 1
NO 2 (SKIP TO 221)

218. IF ALIVE: How old was (NAME) at his/her last birthday? RECORD AGE IN COMPLETED YEARS.

AGE IN YEARS_

219. IF ALIVE: Is (NAME) living with you?

YES 1
NO 2

220. IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD)

LINE NUMBER_ (SKIP TO NEXT BIRTH)

221. IF DEAD: How old was (NAME) when he/she died? IF '1 YR' PROBE: How many months old was (NAME)? RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1_
MONTHS 2_
YEARS 3 _

223. Have you had any live births since the birth of (NAME OF LAST BIRTH)? IF YES, RECORD BIRTHS IN TABLE.

YES 1
NO 2

224. COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:

NUMBERS ARE SAME:

CHECK:
FOR EACH BIRTH: MONTH AND YEAR OF BIRTH IS RECORDED.
FOR EACH BIRTH SINCE OCTOBER 2004: MONTH AND YEAR OF BIRTH ARE RECORDED.
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED.
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED.
FOR AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS.

NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

225. CHECK 216 AND ENTER THE NUMBER OF BIRTHS IN 2004 OR LATER. IF NONE, RECORD '0'.

SECTION 3. ANTENATAL CARE AND CHILDREN'S FEVER TREATMENT

301. CHECK 216 AND 225:

ONE OR MORE BIRTHS IN 2004 OR LATER (CONTINUE)
NO BIRTHS/ NO BIRTH IN 2004 OR LATER (SKIP TO 350)

302. CHECK 216 AND ENTER IN 303 THE NAME AND LINE NUMBER OF THE MOST RECENT BIRTH SINCE 2004 EVEN IF THE CHILD IS NO LONGER ALIVE. Now I would like to ask you some questions about your last pregnancy that ended in a live birth.

303. NAME AND LINE NUMBER FROM 213.

NAME OF LAST BIRTH_
LINE NUMBER _

304. Did you see anyone for antenatal care for this pregnancy? IF YES: Whom did you see? Anyone else? PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED

HEALTH PERSONNEL

DOCTOR A
NURSE/MIDWIFE B
MEDICAL ASSISTANT/CLINICAL OFFICER C
NURSING AIDE D

OTHER PERSON

TRADITIONAL BIRTH ASSISTANT E
OTHER (SPECIFY) _ X

NO ONE Y

305. CHECK 304. SAW NO ONE FOR ANTENATAL CARE.

CODE 'Y' CIRCLED (CONTINUE)
CODE 'A', 'B', 'C', 'D', 'E' OR 'X' CIRCLED (SKIP TO 307)

306. What was the main reason why you did not see anyone for antenatal care?

CLINIC TOO FAR 1
HAD NO MONEY 2
HAD NO TIME 3
NOT AWARE HAD TO ATTEND 4
DID NOT WANT TO ATTEND 5
OTHER (SPECIFY)_ 6
DON'T KNOW 8
(ALL SKIP TO 308)

307. Where did you receive antenatal care for this pregnancy? Anywhere else? RECORD ALL MENTIONED. IF UNABLE TO DETERMINE IF A HEALTHCARE FACILITY IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE. NAME OF PLACE_

HOME

YOUR HOME A
TBA'S HOME B
OTHER HOME C

PUBLIC SECTOR

GOVERNMENT HOSPITAL D
GOVERNMENT HEALTH CENTER E
GOVERNMENT HEALTH POST F
OTHER PUBLIC (SPECIFY_) G

PRIVATE MED. SECTOR

PRIVATE HOSPITAL/CLINIC H
OTHER PRIVATE MEDICAL (SPECIFY_) I

OTHER (SPECIFY_) X

308. During this pregnancy, did you take any drugs to keep you from getting malaria?

YES 1
NO 2
DON'T' KNOW 8 (SKIP TO 316)

309. What drugs did you take? RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW HER THE TYPICAL ANTIMALARIAL DRUGS. TREATMENT WITH SP/FANSIDAR USUALLY CONSISTS OF TAKING 3 BIG WHITE TABLETS AT THE HEALTH FACILITY.

SP/FANSIDAR A
CHLOROQUINE B
OTHER (SPECIFY)_ X
DON'T KNOW Z

310. CHECK 309. SP/FANSIDAR TAKEN FOR MALARIA PREVENTION?

CODE 'A' CIRCLED (CONTINUE)
CODE 'A' NOT CIRCLED (SKIP TO 316)

311. How many times did you take SP/FANSIDAR during this pregnancy?

NUMBER OF TIMES_

312. CHECK 311. NUMBER OF TIMES SP/FANSIDAR TAKEN DURING THIS PREGNANCY.

ONE TIME (CONTINUE)
TWO OR MORE TIMES (SKIP TO 315)

313. Can you tell me why you took or received SP/FANSIDAR only one time?

NOT OFFERED AT CLINIC, UNKNOWN REASON 1
TOO LATE IN PREGNANCY 2
REACTED TO FIRST DOSE 3
DID NOT WANT TO TAKE 4
OTHER (SPECIFY)_ 6
DON'T KNOW 8

314. CHECK 304. ANTENATAL CARE FROM HEALTH PERSONNEL DURING PREGNANCY.

CODE 'A', 'B', 'C', 'D', 'E' OR 'X' (CONTINUE)
OTHER (SKIP TO 316)

315. Did you get the SP/FANSIDAR during any antenatal care visit, during another visit to a health facility or from another source?

ANTENATAL CARE VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

316. CHECK 216 AND 225.

ONE OR MORE BIRTHS IN 2004 OR LATER (CONTINUE)
NO BIRTHS/NO BIRTH IN 2004 OR LATER (SKIP TO 350)

317. CHECK 216 AND ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2004 OR LATER. ASK QUESTIONS ABOUT THE BIRTHS AS APPROPRIATE. 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 you some questions about the health of all your children born in the last five years. We will talk about each separately.

317A. LINE NUMBER FROM 213

LINE NO. _

317B. FROM 213 AND 217

NAME_
LIVING (CONTINUE)
DEAD (CONTINUE)

317C. Did you ever breastfeed (NAME)?

YES 1
NO 2 (SKIP TO 317G)

317D. CHECK 317B: IS CHILD STILL LIVING?

LIVING (CONTINUE)
DEAD (SKIP TO 349)

317E. Are you still breastfeeding (NAME)?

YES 1 (SKIP TO 318)
NO 2

317F. For how many months did you breastfeed (NAME)?

MONTHS_
DON'T KNOW 98

317G. CHECK 317B. IS CHILD LIVING?

LIVING (CONTINUE)
DEAD (SKIP TO 349)

318. Has (NAME) been ill with a fever at any time in the last 2 weeks?

YES 1
NO 2 (SKIP TO 349)
DON'T KNOW 8

319. Now I would like to know how much (NAME) was given to drink (including breast milk) during the illness with a fever. Was he/she given less than usual to drink, about the same amount, or more than usual to drink? IF LESS, PROBE: Was he/she given much less than usual to
drink or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

320. When (NAME) had a fever, was he/she given less than usual to eat, about the same amount, more than usual or nothing to eat? IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8

321. Did you seek advice or treatment for the illness from any source?

YES 1 (SKIP TO 322)
NO 2

321A. Why have you not sought advice or treatment from any source?

CHILD JUST FELL ILL A (SKIP TO 326)
CHILD NOT VERY ILL B (SKIP TO 326)
CLINIC TOO FAR C (SKIP TO 326)
HAVE NO MONEY D (SKIP TO 326)
WAITING FOR CHILD'S FATHER E (SKIP TO 326)
DON'T KNOW WHAT TO DO F (SKIP TO 326)
ALREADY HAD MEDICINE AT HOME G (SKIP TO 326)
OTHER(SPECIFY) _ X (SKIP TO 326)

322. Where did you seek advice or treatment? Anywhere else? RECORD ALL MENTIONED. IF UNABLE TO DETERMINE IF A HEALTH FACILITY IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE. NAME OF THE PLACE(S)_

PUBLIC SECTOR

GOVT HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
CLINIC/OUTREACH SERVICES D
COMMUNITY HEALTH WORKER/CMD E
OTHER PUBLIC(SPECIFY)_ F

PRIVATE MED. SECTOR

PVT. HOSPITAL/CLINIC G
PHARMACY/DRUG SHOP H
PVT DOCTOR I
CLINIC/OUTREACH SERVICES J
COMMUNITY HEALTH WORKER/CMD K
OTHER PRIVATE MED.(SPECIFY)_ L

OTHER SOURCE

SHOP M
TRADITIONAL PRACTITIONER N

OTHER(SPECIFY)_ X

323. CHECK 322:

TWO OR MORE CODES CIRCLED (CONTINUE)
ONLY ONE CODE CIRCLED (SKIP TO 325)

324. Where did you first seek advice or treatment? USE LETTER CODE FROM 322.

FIRST PLACE_

324A. How far did you travel for this advice or treatment?

LESS THAN 1KM 1
BETWEEN 1-4 KM 2
MORE THAN 5KM 3
DON'T KNOW 8

325. How many days after the fever began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY, RECORD '00'

DAYS_

325A. At any time during the illness, did (NAME) have blood taken from his/her finger or heel for testing?

YES 1
NO 2
DON'T KNOW 8

326. Is (NAME) still sick with a fever?

YES 1
NO 2
DON'T KNOW 8

327. At any time during the illness, did (NAME) take any drugs for the illness?

YES 1
NO 2 (GO BACK TO 317A IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 350)
DON'T KNOW 8 (GO BACK TO 317A IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 350)

328. What drugs did (NAME) take? Any other drugs? RECORD ALL MENTIONED.

ANTIMALARIAL DRUG

SP/FANSIDAR A
CHLOROQUINE B
CHLOROQUINE WITH FANSIDAR C
HOMAPAK RED D
HOMAPAK GREEN E
COARTEM/ACT F
OTHER ANTI-MALARIAL(SPECIFY)_ G

ANTIBIOTIC DRUGS

PILL/SYRUP H
INJECTION I

OTHER DRUGS

PANADOL J
ASPIRIN K
IBUPROFEN L
OTHER(SPECIFY)_ X
DON'T KNOW Z

329. CHECK 328: ANY CODE A-G CIRCLED?

YES (CONTINUE)
NO (GO BACK TO 317A IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 348A)

331. CHECK 328: SP/FANSIDAR ('A') GIVEN

CODE 'A' CIRCLED (CONTINUE)
CODE 'A' NOT CIRCLED (SKIP TO 334)

332. How long after the fever started did (NAME) first take SP/Fansidar?