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2014 UGANDA MALARIA INDICATOR SURVEY
WOMEN'S QUESTIONNAIRE

UGANDA
IDRC/MOH/UBOS

IDENTIFICATION (1)

REGION ___
DISTRICT ___
COUNTY ___
SUBCOUNTY/TOWN ___
PARISH/LC2 NAME ____
EA NAME ____
UMIS NUMBER ___

URBAN 1
PERI URBAN 2
RURAL 3

NAME AND LINE NUMBER OF WOMAN ___
HOUSEHOULD NUMBER ____
HOUSEHOLD SAMPLE NUMBER ___

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:

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPCITATED 6
OTHER (SPECIFY) 7

LANGUAGE OF THE QUESTIONNAIRE 7
LANGUAGE USED IN THE INTERVIEW ___
NATIVE LANGUAGE OF RESPONDENT ___
TRANSLATOR USED (NOT AT ALL =1, SOMETIMES = 2, ALL THE TIME = 3)
LANGUAGE OF QUESTIONNAIRE ENGLISH

LANGUAGE USED:

ATESO-KARAMOJONG 1
LUGANDA 2
LUGBARA 3
LUO 4
RUNYANKORE-RUKIGA 5
RINYORO-RUTORO 6
ENGLISH 7
OTHER 8 (SPECIFY)

SUPERVISOR
NAME ___

OFFICE EDITOR ___

KEYED BY ___

SECTION 1: RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT
Hello. My name is ____________________. I am working with MOH. We are conducting a survey about malaria all over UGANDA 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 INTERVIEWER: _________________________ DATE: ________________

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

101. RECORD THE TIME.

HOURS ___
MINUTES ___

102. In what month and year were you born?

MONTH ___
DIDN'T KNOW MONTH 98
YEAR ___
DON'T KNOW YEAR 0008

103. How old were you at your last birthday?

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 108)

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

PRIMARY 1
'O' LEVEL 2
'A' LEVEL 3
UNIVERSITY/TERITARY 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. CHECK 105:

PRIMARY (CONTINUE)
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 SETNENCE, PROBE: Can you read any part of the sentence to me?

CANNOT REAT AT ALL 1
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGAUGE 4 (SPECIFY LANGUAGE)
BLIND/VISUALLY IMPAIRED 5

109. What is your religion?

CATHOLIC 01
ANGLICAN/PROTESTANT 02
SDA 03
ORTHODOX 04
PENTECOSTAL 05
OTHER CHRISTIAN 06
MOSELM 07
BAHAI 08
TRADITIONAL 09
HINDU 10
NONE 11
OTHER 99 (SPECIFY)

110. 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
ALURI/JOPADHOLA 11
BANYORO 12
BATORO 13
OTHER 14 (SPECIFY)

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

YES 1
NO 2 (SKIP TO 201)

112. Have you seen or heard these messages:

a) On the radio?
b) On the television?
c) On a poster or billboard?
d) From a community health worker?
e) At a community event?
f) Anywhere else?
a) RADIO
YES 1
NO 2
b) TELEVISON
YES 1
NO 2
c) POSTER OR BILLBOARD
YES 1
NO 2
d) COMMUNITY HEALTH WORKER
YES 1
NO 2
e) COMMUNITY EVENT
YES 1
NO 2
f) ANYWHERE ELSE
YES 1
NO 2

SECTION 2. REPRODUCTION

201. Now I would like to ask you 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.

a) How many sons live with you?
b) And how many daughters live with you?
IF NONE, RECORD '00'.
a) SONS AT HOME ___
b) 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?

YES 1
NO 2 (SKIP TO 206)

205.

a) How many sons are alive but do not live with you?
b) And how many daughters are alive but do not live with you?
IF NONE, RECORD '00.'
a) SONS ELSEWHERE ___
b) DAUGHTERS ELSEWHERE ___

206. Have you ever given birth to a boy or a 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.

a) How many boys died?
b) And how many girls have died?
IF NONE, RECORD '00'.
a) BOYS DEAD ___
b) GIRLS ___

208. SUM, ANSWERS TO 20, 203, AND 207, AND ENTER TOTAL. IF NON, RECORD '00'.

TOTAL BIRTHS ___

209. CHECK 208:

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

YES 1 (CONTINUE)
NO 2 (PROBE AND CORRECT 201-208 AS NECESSARY.)

210. Now I'd like to ask you about your more recent births. How many births have you gad in the last 6 years?

IF NONE, CIRCLE '00'.

TOTAL IN THE LAST 6 YEARS ___
NONE 00 (SKIP TO 224)

211. Now I would like to record the name 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?

BOY 1
GIRL 2

214. Where any of these births twins?

SING 1
MULT 2

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

PROBE: When is his/her birthday?

MONTH ___
YEAR ___

216. Is (NAME) still alive?

YES 1
NO 2 (NEXT BIRTH) (CONTINUE TO 220)

217. IF ALIVE:

How old was (NAME) at his/her last birthday?

RECORD AGE IN COMPLETED YEARS.

AGE IN YEARS ___

218. IF ALIVE:

If (NAME) living with you?

YES 1
NO 2

219. IF ALIVE: RECORD HOUSE-HOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSE-HOLD).

HOUSEHOLD LINE NUMBER ___ (CONTINUE TO NEXT BIRTH)

220. Were there any other live births between (NAME) and (NAME OF PREVIOUS BIRTH), including any children who died after birth?

YES 1 (ADD BIRTH)
NO 2 (NEXT BIRTH)

221. Have you had any live births since the birth of (NAME OF MOST RECENT BIRTH)?

YES 1 (RECORD BIRTH(S) IN TABLE)
NO 2

222. COMPARE 210 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:

NUMBERS ARE SAME ___ (CONTINUE)
NUMBERS ARE DIFFERENT ___ (PROBE AND RECONCILE)

223. CHECK 215:

ENTER THE NUMBER OF BIRTHS IN 2008 OR LATER

NUMBER OF BIRTHS ___
NONE 0

224. Are you pregnant now?

YES 1
NO 2 (SKIP TO 226)
UNSURE (SKIP TO 226)

225. How many months pregnant are you?

RECORD NUMBER OF COMPLETED MONTHS.

MONTHS ___

226. CHECK 223

ONE OR MORE BIRTHS IN 2008 OR LATER ___
NO BIRTHS IN 2008 OR LATER (SKIP TO 426)
Q. 223 IS BLANK (SKIP TO 426)

SECTION 3. PREGNANCY AND INTERMITTENT PREVENTATIVE TREATMENT

301. CHECK 215: ENTER IN THE TABLE THE NAME AND 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.

301A. FROM 212 AND 216 IN BIRTH HISTORY NUMBER 01:

MOST RECENT BIRTH

NAME ___
LIVING ___
DEAD ___

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

YES 1
NO 2 (SKIP TO 303A)

303. Whom did you see?
Anyone else?

PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED

HEALTH PERSONNEL DOCTOR A (SKIP TO 304)
NURSE/MIDWIFE B (SKIP TO 304)
MEDICAL ASSISTANT/CLINCAL OFFICER C (SKIP TO 304)
NURSING AIDE D (SKIP TO 304)
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT E (SKIP TO 304)
OTHER (SPECIFY) X (SKIP TO 301)

303A. 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
DIDN'T KNOW 8

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

YES 1 (SKIP TO 305)
NO 2
DIDN'T KNOW 8 (SKIP TO 310)

304A. What was the main reason why you did not take any drugs to keep you from getting malaria during this pregnancy?

CLINIC TOO FAR 1 (SKIP TO 310)
HAD NO MONEY 2 (SKIP TO 310)
SIDE EFFECTS 3 (SKIP TO 310)
NOT AWARE HAD TO TAKE ANY 4 (SKIP TO 310)
DID NOT WANT TO TAKE 5 (SKIP TO 310)
OTHER (SPECIFY) 6 (SKIP TO 310)
DIDN'T KNOW 8 (SKIP TO 310)

305. What drugs did you take?

RECORD ALL MENTIONED.

IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.

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

306. CHECK 305:

SP/FANSIDAR TAKEN FOR MALARIA PREVENTION

CODE 'A' CIRCLED
CODE 'A' NOT CIRCLED (SKIP TO 301)

307. How many times did you take (SP/Fansidar) during this pregnancy?

TIMES ___

307A. CHECK 307

TOOK SP ONLY 1 TIME DURING THIS PREGNANCY

CODE '01' TIMES ENTERED ___
OTHER ___ (SKIP TO 308)

307B. Why did you take (SP/Fansidar) only one time during this pregnancy?

CLINIC TOO FAR 1
HAD NO MONEY 2
SIDE EFFECTS 3
NOT AWARE HAD TO TAKE MORE 4
DID NOT WANT TO TAKE 5
OTHER (SPECIFY) 6
DIDN'T KNOW 8

308. CHECK 303:

ANTENATAL CARE FROM HELATH PERSONNEL DURING THIS PREGNANCY

CODE 'A', 'B', 'C', OR 'D' CIRCLED ___
OTHER ___ (SKIP TO 301)

309. Did you get the (SP/Fansidar) during any antenatal care visit, during another visit to a health facility or from another source?

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

310. CHECK 215 AND 216:

ONE OR MORE LIVING CHILDREN BORN IN 2008 OR LATER ___ (GO TO 401)
NO LIVING CHILDREN BORN IN 2008 OR LATER ___ (SKIP TO 426)

SECTION 4. FEVER IN CHILDREN

401. CHECK 215: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2008 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE MOST RECENT BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE)

Now I would like to ask some questions about the health of your children born since January 2008. (We will talk about each separately.)

402. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

MOST RECENT BIRTH

BIRTH HISTORY NUMBER ___

403. FROM 212 AND 216

NAME ___
LIVING ___
DEAD ___ (GO TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 426)

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

YES 1
NO 2 (GO TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 426)
DON'T KNOW 8 (GO TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 426)

405. 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

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

YES 1 (SKIP TO 407)
NO 2

406A. Why have you not sought advice or treatment from any source?

CHILD JUST FEEL ILL A (SKIP TO 410)
CHILD NOT VERY ILL B (SKIP TO 410)
CLINC TOO FAR C (SKIP TO 410)
HAVE NO MONEY D (SKIP TO 410)
WAITING FOR CHILD'S FATHER E (SKIP TO 410)
DIDN'T KNOW WHAT TO DO F (SKIP TO 410)
ALREADY HAD MEDICINE AT HOME G (SKIP TO 410)
OTHER X (SPECIFY) (SKIP TO 410)

407. 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))

PUBLIC SECTOR (GOVERNMENT)
GOVT HOSPITAL A
GOVT HEALTH CENTER B
GOVT HEALTH POST C
MOBILE CLINIC D
COMMUNITY HEALTH WORKER (VHT) E
OTHER PUBLIC SECTOR F (SPECIFY)
PUBLIC SECTOR (PNFP)
HOSPITAL G
HEALTH CENTER H
PRIVATE MEDICAL SECTOR
PVT HOSPITAL/CLINIC I
PHARMACY J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MED. SECTOR M (SPECIFY)
OTHER SOURCE
SHOP N
TRADITIONAL PRACTITIONER O
MARKET P
OTHER X (SPECIFY)

408. CHECK 407:

TWO OR MORE CODES CIRCLED ____
ONLY ONE CODE CIRCLED ____ (SKIP TO 410)

409. Where did you first seek advice or treatment?

USE LETTER CODE FROM 407.

FIRST PLACE ____

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

YES 1
NO 2 (GO TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 426)
DON'T KNOW 8 (GO TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 426)

411. What drugs did (NAME) take?
Any other drugs?

RECORD ALL MENTIONED.

ANTIMALARIAL DRUGS
SP/FANSIDAR A
CHLOROQUINE B
AMODIAQUINE C
QUININE D
COARTEM/ACT E
OTHER ANTI-MALARIAL F (SPECIFY)
OTHER DRUGS
ASPIRIN I
PANADOL J
IBUPROFEN K
OTHER X (SPECIFY)
DON'T KNOW Z

412. CHECK 411:
ANY CODE A-F CIRCLED?

YES ______
NO _____ (GO TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 426)

413. CHECK 411

SP/FANSIDAR ('A') GIVEN

CODE 'A' CIRCLED ___ (CONTINUE)
CODE 'A' NOT CIRCLED ___ (SKIP TO 415)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8

415. CHECK 411:

CHOLOROQUINE ('B') GIVEN

CODE 'B' CIRCLED ___ (CONTINUE)
CODE 'B' NOT CIRCLED ___ (SKIP TO 417)

416. How long after the fever started did (NAME) first take chloroquine?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8

417: CHECK 411:

AMODIAQUINE ('C') GIVEN

CODE 'C' CIRCLED ___ (CONTINUE)
CODE 'C' NOT CIRCLED ___ (SKIP TO 419)

418. How long after the fever started did (NAME) first take amodiaquine?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8

419. CHECK 411:

QUININE ('D') GIVEN

CODE 'D' CIRCLED ___ (CONTINUE)
CODE 'D' NOT CIRCLED ____ (SKIP TO 421)

420. How long after the fever stated did (NAME) first take quinine?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8

421. CHECK 411:

COMBINATION WITH COARTEM/ACT ('E') GIVEN

CODE 'E' CIRCLED ___ (CONTINUE)
CODE 'E' NOT CIRCLED ___ (SKIP TO 423)

422. How long after the fever started did (NAME) first take COARTEM/ACT?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8

422A. For how many day did (NAME) take COATREM/ACT?

DAYS ___
STILL TAKING 95
DON'T NOW 98

423. CHECK 411:

OTHER ANTIMALARIAL ('F') GIVEN

CODE 'F' CIRCLED ___ (CONTINUE)
CODE 'F' NOT CIRCLED ___ (GO TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 426)

424. How long after the fever started did (NAME) first take (OTHER ANTIMALARIAL)?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8

425.

GO TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 426
426. I would like to ask you a few questions about fever in children.

When a child is sick with fever, how long after the fever begins should the child be taken for treatment?

SAME DAY 01
NEXT DAY 02
TWO DAYS AFTER ONSET OF FEVER 03
THREE OR MORE DAYS AFTER ONSET OF FEVER 04
FEVER IS NORMAL IN CHILDREN, NO TREATMENT NECESSARY 05
DEPENDS ON HOW SERIOUS THE FEVER IS 06
OTHER 96 (SPECIFY)
DON'T KNOW 98

427. In your opinion, what causes malaria?

PROBE: Anything else?

RECORD ALL MENTIONED

MOSQUITO BITES A
PARASITE B
EATING MAIZE C
EATING MANGOES D
EATING DIRTY FOOD E
RECORD ALL MENTIONED DRINKING UNBOILED WATER F
GETTING SOAKED WITH RAIN G
COLD/CHANGING WEATHER H
WITCHCRAFT I
CONTACT WITH INFECTED PERSON J
GERM K
OTHER X (SPECIFY)
DON'T KNOW Z

428. Are there ways to avoid getting malaria?

YES 1
NO 2 (SKIP TO 431)

429. What are the ways to avoid getting malaria?

PROBE: Anything else?

RECORD ALL MENTIONED

SLEEP UNDER MOSQUITO NET A
SLEEP UNDER AN INSECTICIDE TREATED NET B
TAKING PREVENTIVE MEDICATION C
USE MOSQUITO REPELLANT D
SPRAYING HOUSE WITH INSECTICIDE E
USING MOSQUITO COILS F
DESTROY MOSQUITO BREEDING SITES G
OTHER X (SPECIFY)
DON'T KNOW Z

431. CHECK 430 SP/FANSIDAR MENTIONED

CODE 'A'CIRCLED ___ (CONTINUE)
CODE 'A' NOT CIRCLED ____ (SKIP TO 433)

432. How many times does a woman need to take SP/FANSIDAR during her pregnancy to avoid getting malaria?

NUMBER OF TIMES ___
DON'T KNOW 98

433. RECORD THE TIME.

HOUR ___
MINUTES ___

INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT REPONSDENT: _____

COMMENTS ON SPECIFC QUESTIONS: ____

ANY OTHER COMMENTS: ______

SUPERVISOR'S OBSERVATIONS

NAME OF SUPERVISOR: _____ DATE: _______