Survey Text

Afghanistan 2015 Guinea 1999 Mozambique 2011 Tanzania 2004
Angola 2015 Guinea 2005 Myanmar 2015 Tanzania 2010
Benin 2001 Guinea 2012 Namibia 2000 Tanzania 2015
Benin 2006 Kenya 2003 Niger 2006 Uganda 2001
Benin 2011 Kenya 2008 Niger 2012 Uganda 2006
Burkina Faso 2003 Kenya 2014 Nigeria 2003 Uganda 2011
Burkina Faso 2010 Madagascar 2003 Nigeria 2008 Uganda 2016
Burundi 2016 Madagascar 2008 Nigeria 2013 Zambia 2001
Cameroon 2004 Malawi 2000 Nigeria 2018 Zambia 2007
Cameroon 2011 Malawi 2004 Rwanda 2000 Zambia 2013
Cote d'Ivoire 2011 Malawi 2010 Rwanda 2005 Zimbabwe 2005
Eswatini (Swaziland) 2006 Malawi 2016 Rwanda 2010 Zimbabwe 2010
Ethiopia 2005 Mali 2001 Rwanda 2014 Zimbabwe 2015
Ghana 2003 Mali 2006 Senegal 2005
Ghana 2008 Mali 2012 Senegal 2017
Ghana 2014 Mozambique 2003 Tanzania 1999
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Afghanistan 2015
Survey form view entire document:  text 
135. Who slept under this mosquito net last night?
RECORD THE PERSON'S NAME AND LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

NAME_______________
LINE NO.____

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Angola 2015
Survey form view entire document:  text 
137) Who slept under this mosquito net last night?
RECORD THE PERSON'S LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

NAME____
LINE NUMBER ___

138) GO BACK TO 129 FOR NEXT NET; OR, IF NO MORE NETS, GO TO 139


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Benin 2001
Survey form view entire document:  text 
494) Did you sleep under a bednet last night?

YES 1
NO 2

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Benin 2006
Survey form view entire document:  text 
136 Who slept under this mosquito net last night?

RECORD THE PERSON'S LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

NAME_____________
LINE NO. ____________

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Benin 2011
Survey form view entire document:  text 
324) Do you know of a place where you can obtain a method of family planning?

YES 1
NO 2 (GO TO 326)

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Burkina Faso 2003
Survey form view entire document:  text 
31. Who slept under this mosquito net last night?
RECORD THE LINE NUMBER ACCORDING TO THE LIST OF HOUSEHOLD MEMBERS. REPEAT FOR ALL WHO SLEPT UNDER NET.

LINE NUMBER ____

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Burkina Faso 2010
Survey form view entire document:  text 
306. What is the brand name of the condoms you are using?
IF DOESN'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

PRUDENCE 01 (GO TO 308A)
IPPF 02 (GO TO 308A)
KAMASSOUTRA 03 (GO TO 308A)
OTHER (SPECIFY) _____ 96 (GO TO 308A)
DOESN'T KNOW 98 (GO TO 308A)

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Burundi 2016
Survey form view entire document:  text 
137) Who slept under the mosquito net last night?

RECORD THE PERSON'S LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

NAME_________
LINE NUMBER___

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Cameroon 2004
Survey form view entire document:  text 
32D) Who slept under this mosquito net last night?

RECORD THE RESPECTIVE LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

NAME: ___
LINE NUMBER: ___
NAME: ___
LINE NUMBER: ___
NAME: ___
LINE NUMBER: ___
NAME: ___
LINE NUMBER: ___
NAME: ___
LINE NUMBER: ___

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Cameroon 2011
Survey form view entire document:  text 
135. (7) Who slept under this mosquito net last night?

RECORD THE PERSON'S NAME AND LINE NUMBER FROM THE HOUSEHOLD SCHEDULE. RECORD UP TO FOUR PEOPLE.

NAME ____
LINE NO. ____

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Cote d'Ivoire 2011
Survey form view entire document:  text 
135. (7) Who slept under this mosquito net last night?

RECORD THE PERSON'S NAME AND LINE NUMBER FROM THE HOUSEHOLD SCHEDULE. RECORD UP TO FOUR PEOPLE.

NAME ____
LINE NO. ____

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Eswatini (Swaziland) 2006
Survey form view entire document:  text 
132) Who slept under this mosquito net last night?
RECORD THE RESPECTIVE LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

NAME_____
LINE NO._______

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Ethiopia 2005
Survey form view entire document:  text 
136 Who slept under this mosquito net last night?

RECORD THE PERSON'S LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

NAME_____________
LINE NO. ____________

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Ghana 2003
Survey form view entire document:  text 
32D. Who slept under this mosquito bed net last night? RECORD THE RESPECTIVE LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

NAME ____
LINE NO____

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Ghana 2008
Survey form view entire document:  text 
136 Who slept under this mosquito net last night?

RECORD THE PERSON'S LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

NAME_____________
LINE NO. ____________

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Ghana 2014
Survey form view entire document:  text 
135. (7) Who slept under this mosquito net last night?

RECORD THE PERSON'S NAME AND LINE NUMBER FROM THE HOUSEHOLD SCHEDULE. RECORD UP TO FOUR PEOPLE.

NAME ____
LINE NO. ____

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Guinea 1999
Survey form view entire document:  text 
1132A. Did you sleep under a mosquito net last night?

YES 1 (GO TO 1134)
NO 2

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Guinea 2005
Survey form view entire document:  text 
136 Who slept under this mosquito net last night?

RECORD THE PERSON'S LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

NAME_____________
LINE NO. ____________

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Guinea 2012
Survey form view entire document:  text 
135. (7) Who slept under this mosquito net last night?

RECORD THE PERSON'S NAME AND LINE NUMBER FROM THE HOUSEHOLD SCHEDULE. RECORD UP TO FOUR PEOPLE.

NAME ____
LINE NO. ____

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Kenya 2003
Survey form view entire document:  text 
34B. Who slept under this mosquito net last night? Anyone else?

WRITE THE LINE NUMBERS FROM THE HOUSEHOLD SCHEDULE.
IF NO ONE SLEPT UNDER THE NET, WRITE '00'.

LINE NO. __

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Kenya 2008
Survey form view entire document:  text 
136 Who slept under this mosquito net last night?

RECORD THE PERSON'S LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

NAME_____________
LINE NO. ____________

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Kenya 2014
Survey form view entire document:  text 
135. (7) Who slept under this mosquito net last night?

RECORD THE PERSON'S NAME AND LINE NUMBER FROM THE HOUSEHOLD SCHEDULE. RECORD UP TO FOUR PEOPLE.

NAME ____
LINE NO. ____

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Madagascar 2003
Survey form view entire document:  text 
31) Did (NAME) use a bednet last night?

YES 1 (GO TO 33)
NO 2 (GO TO 33)

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Madagascar 2008
Survey form view entire document:  text 
136 Who slept under this mosquito net last night?

RECORD THE PERSON'S LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

NAME_____________
LINE NO. ____________

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Malawi 2000
Survey form view entire document:  text 
494K. Did you sleep under a mosquito net last night?

YES 1
NO 2 (GO TO 501)

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Malawi 2004
Survey form view entire document:  text 
35E. Who slept under this mosquito net last night?
RECORD THE RESPECTIVE LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

NAME ____________
LINE NUMBER __

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Malawi 2010
Survey form view entire document:  text 
136 Who slept under this mosquito net last night?

RECORD THE PERSON'S LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

NAME_____________
LINE NO. ____________

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Malawi 2016
Survey form view entire document:  text 
137. (9) Who slept under this mosquito net last night?

RECORD THE PERSON'S NAME AND LINE NUMBER FROM HOUSEHOLD SCHEDULE.

NAME______________
LINE NO. __ __
NAME______________
LINE NO. __ __
NAME______________
LINE NO. __ __
NAME______________
LINE NO. __ __

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Mali 2001
Survey form view entire document:  text 
494. Did you sleep under a mosquito net last night?

YES 1
NO 2

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Mali 2006
Survey form view entire document:  text 
136 Who slept under this mosquito net last night?

RECORD THE PERSON'S LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

NAME_____________
LINE NO. ____________

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Mali 2012
Survey form view entire document:  text 
135) Who slept under the mosquito net last night?
RECORD THE PERSONS' LINE NUMBER FROM THE HOUSEHOLD SCHEDULE

NAME________
LINE NUMBER_______

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Mozambique 2003
Survey form view entire document:  text 
495. Did you sleep under a hammock/bed net last night?

YES 1
NO 2

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Mozambique 2011
Survey form view entire document:  text 
135. (7) Who slept under this mosquito net last night?

RECORD THE PERSON'S NAME AND LINE NUMBER FROM THE HOUSEHOLD SCHEDULE. RECORD UP TO FOUR PEOPLE.

NAME ____
LINE NO. ____

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Myanmar 2015
Survey form view entire document:  text 
135. Who slept under this mosquito net last night?
RECORD THE PERSON'S NAME AND LINE NUMBER FROM HOUSEHOLD SCHEDULE.

NAME _______
LINE NO. ____

NAME _______
LINE NO. ____

NAME _______
LINE NO. ____

NAME _______
LINE NO. ____

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Namibia 2000

No questionnaire text is available for this sample.


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Niger 2006
Survey form view entire document:  text 
136 Who slept under this mosquito net last night?

RECORD THE PERSON'S LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

NAME_____________
LINE NO. ____________

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Niger 2012
Survey form view entire document:  text 
135. (7) Who slept under this mosquito net last night?

RECORD THE PERSON'S NAME AND LINE NUMBER FROM THE HOUSEHOLD SCHEDULE. RECORD UP TO FOUR PEOPLE.

NAME ____
LINE NO. ____

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Nigeria 2003
Survey form view entire document:  text 
494) Did you sleep under a bednet last night?

YES 1
NO 2

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Nigeria 2008
Survey form view entire document:  text 
136 Who slept under this mosquito net last night?

RECORD THE PERSON'S LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

NAME_____________
LINE NO. ____________

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Nigeria 2013
Survey form view entire document:  text 
135. (7) Who slept under this mosquito net last night?

RECORD THE PERSON'S NAME AND LINE NUMBER FROM THE HOUSEHOLD SCHEDULE. RECORD UP TO FOUR PEOPLE.

NAME ____
LINE NO. ____

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Nigeria 2018
Survey form view entire document:  text 
137. Who slept in this mosquito net last night?

RECORD THE PERSON'S NAME AND LINE NUMBER FROM HOUSEHOLD SCHEDULE.
NAME_____
LINE NUMBER_____

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Rwanda 2000
Survey form view entire document:  text 
31) Did (NAME) use a bednet last night?

YES 1 (GO TO 33)
NO 2 (GO TO 33)

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Rwanda 2005
Survey form view entire document:  text 
136 Who slept under this mosquito net last night?

RECORD THE PERSON'S LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

NAME_____________
LINE NO. ____________

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Rwanda 2010
Survey form view entire document:  text 
135. (7) Who slept under this mosquito net last night?

RECORD THE PERSON'S NAME AND LINE NUMBER FROM THE HOUSEHOLD SCHEDULE. RECORD UP TO FOUR PEOPLE.

NAME ____
LINE NO. ____

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Rwanda 2014
Survey form view entire document:  text 
137. (9) Who slept under this mosquito net last night?

RECORD THE PERSON'S NAME AND LINE NUMBER FROM HOUSEHOLD SCHEDULE.

NAME______________
LINE NO. __ __
NAME______________
LINE NO. __ __
NAME______________
LINE NO. __ __
NAME______________
LINE NO. __ __

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Senegal 2005
Survey form view entire document:  text 
32E. Who slept under this net last night?
RECORD THE LINE NUMBER FROM THE HOUSEHOLD TABLE.
RECORD UP TO FIVE PEOPLE PER NET.

NAME _____
LINE NO. _____

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Senegal 2017
Survey form view entire document:  text 
310) CHECK 308 AND 309, 215, AND 231:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308 OR 309.

NO (GO TO 311)
YES (GO BACK TO 308 AND 309, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION))

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Tanzania 1999
Survey form view entire document:  text 
229. Did you sleep under a bednet last night?
IF YES: Was the bednet ever treated with a chemical to avoid mosquitos?

YES, TREATED BEDNET 1
YES, UNTREATED BEDNET 2
NO 3

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Tanzania 2004
Survey form view entire document:  text 
32E. Who slept under this mosquito net last night?
RECORD THE RESPECTIVE LINE NUMBER FROM THEHOUSEHOLD SCHEDULE.

NAME _______
LINE NO. _______

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Tanzania 2010
Survey form view entire document:  text 
135. (7) Who slept under this mosquito net last night?

RECORD THE PERSON'S NAME AND LINE NUMBER FROM THE HOUSEHOLD SCHEDULE. RECORD UP TO FOUR PEOPLE.

NAME ____
LINE NO. ____

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Tanzania 2015
Survey form view entire document:  text 
137. (9) Who slept under this mosquito net last night?

RECORD THE PERSON'S NAME AND LINE NUMBER FROM HOUSEHOLD SCHEDULE.

NAME______________
LINE NO. __ __
NAME______________
LINE NO. __ __
NAME______________
LINE NO. __ __
NAME______________
LINE NO. __ __

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Uganda 2001
Survey form view entire document:  text 
31) Did (NAME) use a bednet last night?

YES 1 (GO TO 33)
NO 2 (GO TO 33)

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Uganda 2006
Survey form view entire document:  text 
136 Who slept under this mosquito net last night?

RECORD THE PERSON'S LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

NAME_____________
LINE NO. ____________

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Uganda 2011
Survey form view entire document:  text 
135. (7) Who slept under this mosquito net last night?

RECORD THE PERSON'S NAME AND LINE NUMBER FROM THE HOUSEHOLD SCHEDULE. RECORD UP TO FOUR PEOPLE.

NAME ____
LINE NO. ____

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Uganda 2016
Survey form view entire document:  text 
137) Who slept under this mosquito net last night?

RECORD THE PERSON'S NAME AND LINE NUMBER FROM HOUSEHOLD SCHEDULE.

NET #1
NAME _____
LINE NO. ___
NET #2
NAME _____
LINE NO. ___
NET #3
NAME _____
LINE NO. ___

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Zambia 2001
Survey form view entire document:  text 
40. Who slept under this mosquito net last night?
RECORD RESPECTIVE LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

LINE NO. __

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Zambia 2007
Survey form view entire document:  text 
136 Who slept under this mosquito net last night?

RECORD THE PERSON'S LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

NAME_____________
LINE NO. ____________

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Zambia 2013
Survey form view entire document:  text 
135. (7) Who slept under this mosquito net last night?

RECORD THE PERSON'S NAME AND LINE NUMBER FROM THE HOUSEHOLD SCHEDULE. RECORD UP TO FOUR PEOPLE.

NAME ____
LINE NO. ____

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Zimbabwe 2005
Survey form view entire document:  text 
136 Who slept under this mosquito net last night?

RECORD THE PERSON'S LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

NAME_____________
LINE NO. ____________

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Zimbabwe 2010
Survey form view entire document:  text 
135. (7) Who slept under this mosquito net last night?

RECORD THE PERSON'S NAME AND LINE NUMBER FROM THE HOUSEHOLD SCHEDULE. RECORD UP TO FOUR PEOPLE.

NAME ____
LINE NO. ____

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Zimbabwe 2015
Survey form view entire document:  text 
134. (9) (10) Did you get the net through a [LOCAL NAME OF MASS DISTRIBUTION CAMPAIGN], during an antenatal care visit, or during an immunization visit?

YES, [NAME OF MASS DIST. CAMPAIGN] 1 (GO TO 136)
YES, ANC 2 (GO TO 136)
YES, IMMUNIZATION VISIT 3 (GO TO 136)
NO 4