KENYA MALARIA INDICATOR SURVEY WOMAN'S QUESTIONNAIRE
KENYA NATIONAL BUREAU OF STATISTICS
COUNTY
SUBLOCATION
NASSEP CLUSTER NUMBER
KMIS CLUSTER NUMBER
CLUSTER NAME
STRUCTURE NUMBER
HOUSEHOLD NUMBER
NAME OF HOUSEHOLD HEAD
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NO.
RESULT
NOT AT HOME 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
TOTAL NUMBER OF VISITS
LANGUAGE OF QUESTIONNAIRE: 01 ENGLISH
LANGUAGE OF INTERVIEW
KISWAHILI 02
BORANA 03
EMBU 04
KALENJIN 05
KAMBA 06
KIKUYU 07
KISII 08
LUHYA 09
MARAGOLI 10
LUO 11
MAASAI 12
MERU 13
MIJIKENDA 14
POKOT 15
SOMALI 16
TURKANA 17
OTHER 18
NO 2
NAME
NUMBER
ADMINISTER CONSENT
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
SECTION 1. RESPONDENT'S BACKGROUND
101. RECORD THE TIME.
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 (GO TO 108)
105. What is the highest level of school you attended: primary, secondary, or higher?
POST-PRIMARY/VOCATIONAL 2
SECONDARY/'A' LEVEL 3
COLLEGE (MIDDLE LEVEL) 4
UNIVERSITY 5
106. What is the highest (standard/form/year) you completed at that level? IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.
UNIVERSITY (GO 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 PART OF THE SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) 4
BLIND/VISUALLY IMPAIRED 5
PROTESTANT/OTHER CHRISTIAN 2
MUSLIM 3
NO RELIGION 4
OTHER (SPECIFY) 6
110. What is your ethnic group / tribe?
KALENJIN 02
KAMBA 03
KIKUYU 04
KISII 05
LUHYA 06
LUO 07
MAASAI 08
MERU 09
MIJIKENDA/ SWAHILI 10
SOMALI 11
TAITA/ TAVETA 12
BORANA 13
MARAGOLI 14
POKOT 15
TURKANA 16
OTHER (SPECIFY) 96
111. In the past six months, have you seen or heard any messages about malaria?
NO 2 (GO TO 201)
112. Have you seen or heard these messages:
On the radio?
NO 2
On the television?
NO 2
On a poster or billboard?
NO 2
From a community health worker?
YES 1
NO 2
At a community event?
NO 2
Anywhere else?
NO 2
201. Now I would like to ask about all the births you have had during your life. Have you ever given birth?
NO 2 (GO TO 206)
202. Do you have any sons or daughters to whom you have given birth who are now living with you?
NO 2 (GO 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 (GO 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'.
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, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?
NO 2 (GO 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'.
209. CHECK 208: 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)
NO BIRTHS (GO TO 225)
211. Now I'd like to ask you about your more recent births. How many births have you had in the last 5 years, that is since January 2010? RECORD ALL BIRTHS IN 2010-2015F NONE, RECORD '00'
NONE 00 (GO TO 225)
212. Now I'd like to record the names of all your births in the last 5 years, from January 2010 until today. I would like to list these births, whether still alive or not, starting with the most recent birth you have had. RECORD NAMES OF ALL THE BIRTHS IN 2010-2015 IN 213. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS. IF THERE ARE MORE THAN 5 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE STARTING WITH THE SECOND ROW.
213. What name was given to your (most recent/ previous) baby? RECORD NAME. BIRTH HISTORY NUMBER.
214. Is (NAME) a boy or a girl?
GIRL 2
215. Were any of these births twins?
MULTIPLE 2
216. On what day, month, and year was (NAME) born?
MONTH ___
YEAR ___
NO 2 (GO TO NEXT BIRTH)
218. IF ALIVE: How old was (NAME) at (NAME)'s last birthday? RECORD AGE IN COMPLETED YEARS.
219. IF ALIVE: Is (NAME) living with you?
NO 2
220. IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD. RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD.
221. Were there any other live births between (NAME) and (NAME OF PREVIOUS BIRTH), including any children who died after birth?
NO 2 (GO TO NEXT BIRTH)
222. Since January 2010, have you had any more live births that have not already been listed?
NO 2
223. COMPARE 211 WITH NUMBER OF BIRTHS IN BIRTH HISTORY
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)
224. CHECK 216: ENTER THE NUMBER OF BIRTHS IN 2010-2015
NONE 0
NO 2 (GO TO 227)
UNSURE 8 (GO TO 227)
226. How many months pregnant are you? RECORD NUMBER OF COMPLETED MONTHS.
NO BIRTHS IN 2010 OR LATER (GO TO 427D)
Q. 224 IS BLANK (GO TO 427D)
SECTION 3. PREGNANCY AND INTERMITTENT PREVENTIVE TREATMENT
301. RECORD THE NAME AND SURVIVAL STATUS OF THE MOST RECENT BIRTH FROM 213 AND 217, LINE 01:
LIVING (CONTINUE)
DEAD (CONTINUE)
302. Now I would like to ask you some questions about your last pregnancy that resulted in a live birth. When you got pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?
NO 2 (GO TO 304)
302A. How many times did you see someone for antenatal care for this pregnancy?
303. Whom did you see? Anyone else? PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
NURSE/MIDWIFE B
COMMUNITY HEALTH WORKER D
304. During this pregnancy, did you take SP/Fansidar to keep you from getting malaria?
NO 2 (GO TO 308)
DON'T KNOW 8 (GO TO 308)
305. How many times did you take SP/Fansidar during this pregnancy?
306. CHECK 303: ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY
OTHER (GO TO 308)
307. Did you get the SP/Fansidar during any antenatal care visit, during any other visit to a health facility or from another source? IF MORE THAN ONE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST.
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6
NO LIVING CHILDREN BORN IN 2010 OR LATER (GO TO 427D)
401. CHECK 213: RECORD THE BIRTH HISTORY NUMBER IN 402 AND THE NAME AND SURVIVAL STATUS IN 403 FOR EACH BIRTH IN 2010-2015. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL QUESTIONNAIRE(S). Now I would like to ask some questions about the health of your children born since January 2010. (We will talk about each separately.)
402. BIRTH HISTORY NUMBER FROM 213 IN BIRTH HISTORY.
LIVING (CONTINUE)
DEAD (GO TO 403 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 427A)
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 427A)
DON'T KNOW 8 (GO TO 403 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 427A)
405. At any time during the illness, did (NAME) have blood taken from (NAME)'s finger or heel for testing?
NO 2
DON'T KNOW 8
406. Did you seek advice or treatment for the illness from any source?
NO 2 (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)
GOVERNMENT HEALTH CENTER B
GOVERNMENT DISPENSARY C
OTHER PUBLIC (SPECIFY) D
PHARMACY G
OTHER PRIVATE (SPECIFY) H
MOBILE CLINIC I
COMMUNITY HEALTH WORKER J
TRADITIONAL HEALER L
RELATIVE/FRIEND M
OTHER (SPECIFY) X
OTHER (SKIP TO 410)
409. Where did you first seek advice or treatment? USE LETTER CODE FROM 407.
410. At any time during the illness, did (NAME) take any drugs for the illness?
NO 2 (GO TO 403 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 427A)
DON'T KNOW 8 (GO TO 403 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 427A)
411. What drugs did (NAME) take? Any other drugs? RECORD ALL MENTIONED.
ARTESUNATE/AMODIAQUINE B
DHAP C
CHLOROQUINE E
AMODIAQUINE F
QUININE PILLS G
QUININE INJECTION/IV H
ARTESUNATE RECTAL I
ARTESUNATE INJECTION/IV J
OTHER ANTIMALARIAL (SPECIFY) K
INJECTION M
ACETAMINOPHEN/PARACETAMOL O
IBUPROFEN P
OTHER (SPECIFY) X
DON'T KNOW Z
412. CHECK 411: ANY CODE A-K CIRCLED?
NO 2 (GO TO 403 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 427A)
412A. CHECK 411: CODE 'A' OR 'B' CIRCLED?
CODE 'A' OR 'B' NOT CIRCLED (SKIP TO 414C)
412B. When you gave (AL/Aretesunate/Amodiaquine) to (NAME) did it have a logo that looks like this? SHOW LOGO TO RESPONDENT
NO 2
DON'T KNOW 8
413A. CHECK 411: AL ('A') GIVEN
CODE 'A' NOT CIRCLED (SKIP TO 414A)
413B. How long after the fever started did (NAME) first take AL?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
414A. CHECK 411: ARTESUNATE/AMODIAQUINE ('B') GIVEN
CODE 'B' NOT CIRCLED (SKIP TO 414C)
414B. How long after the fever started did (NAME) first take Artesunate/Amodiaquine?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
414C. CHECK 411: DHAP ('C') GIVEN
CODE 'C' NOT CIRCLED (SKIP TO 415)
414D. How long after the fever started did (NAME) first take DHAP?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
415. CHECK 411: SP/FANSIDAR ('D') GIVEN
CODE 'D' NOT CIRCLED (SKIP TO 417)
416. How long after the fever started did (NAME) first take SP/Fansidar?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
417. CHECK 411: CHLOROQUINE ('E') GIVEN
CODE 'E' NOT CIRCLED (SKIP TO 419)
418. 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
419. CHECK 411: AMODIAQUINE ('F') GIVEN
CODE 'E' NOT CIRCLED (SKIP TO 421)
420. 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
421. CHECK 411: QUININE ('G' OR 'H') GIVEN
CODE 'G' OR 'H' NOT CIRCLED (SKIP TO 423)
422. How long after the fever started did (NAME) first take quinine?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
423. CHECK 411: ARTESUNATE ('I' OR 'J') GIVEN
CODE 'I' OR 'J' 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 OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
425. CHECK 411: OTHER ANTIMALARIAL ('K') GIVEN
CODE 'K' NOT CIRCLED (SKIP TO 427)
426. 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
427. GO BACK TO 403 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 427A.
SECTION 4A. KNOWLEDGE AND ATTITUDES
427A. CHECK 224:
NO BIRTHS IN 2010 OR LATER (GO TO 427D)
Q. 224 IS BLANK (GO TO 427D)
427B. When your child/children has a fever, how important or unimportant is it to seek antimalarial treatment immediately? Is it extremely important, very important, a little important, or not at all important?
VERY IMPORTANT 2
A LITTLE IMPORTANT 3
NOT AT ALL IMPORTANT 4
427C. When your child/children had a fever, how affordable or unaffordable was treatment? Was it very affordable, affordable, unaffordable, or very unaffordable?
AFFORDABLE 2
UNAFFORDABLE 3
VERY UNAFFORDABLE 4
427D. What is the recommended treatment for malaria?
SP/FANSIDAR 2
CHLOROQUINE 3
AMODIAQUINE 4
OTHER 6
DON'T KNOW 8
427E. Have you seen or heard any information about ACT or AL?
NO 2 (GO TO 428)
427F. Where did you see or hear about ACT or AL? Any other place or person? RECORD ALL MENTIONED
RADIO B
NEWSPAPER C
BARAZA D
RELATIVE/FRIEND E
COMMUNITY LEADER/ELDER F
COMMUNITY HEALTH WORKER G
ROAD SHOW H
OTHER X
MINUTES
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT INTERVIEW
COMMENTS ON SPECIFIC QUESTIONS
ANY OTHER COMMENTS
SUPERVISOR'S OBSERVATIONS