KENYA MALARIA INDICATOR SURVEY WOMAN'S QUESTIONNAIRE

MALARIA CONTROL UNIT

KENYA NATIONAL BUREAU OF STATISTICS

IDENTIFICATION

COUNTY

SUBLOCATION

NASSEP CLUSTER NUMBER

KMIS CLUSTER NUMBER

CLUSTER NAME

STRUCTURE NUMBER

HOUSEHOLD NUMBER

NAME OF HOUSEHOLD HEAD

INTERVIEWER VISITS

FIRST VISIT

DATE

INTERVIEWER'S NAME

RESULT

COMPLETED 1
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

COMPLETED 1
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

ENGLISH 01
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

TRANSLATOR USED

YES 1
NO 2

SUPERVISOR

NAME

NUMBER

INTRODUCTION AND CONSENT

ADMINISTER CONSENT

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

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME.

HOURS
MINUTES

102. In what month and year were you born?

MONTH ___
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.

AGE IN COMPLETED YEARS ___

104. Have you ever attended school?

YES 1
NO 2 (GO TO 108)

105. What is the highest level of school you attended: primary, secondary, or higher?

PRIMARY 1
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'.

STANDARD/FORM/YEAR ___

107. CHECK 105:

PRIMARY, POST-PRIMARY, SECONDARY/'A' LEVEL OR COLLEGE (MIDDLE LEVEL) (CONTINUE)
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?

CANNOT READ AT ALL 1
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

109. What is your religion?

ROMAN CATHOLIC 1
PROTESTANT/OTHER CHRISTIAN 2
MUSLIM 3
NO RELIGION 4
OTHER (SPECIFY) 6

110. What is your ethnic group / tribe?

EMBU 01
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?

YES 1
NO 2 (GO TO 201)

112. Have you seen or heard these messages:

On the radio?

YES 1
NO 2

On the television?

YES 1
NO 2

On a poster or billboard?

YES 1
NO 2

From a community health worker?

YES 1
NO 2

At a community event?

YES 1
NO 2

Anywhere else?

YES 1
NO 2

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 (GO 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 (GO 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 given birth who are alive but do not live with you?

YES 1
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'.

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, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?

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

210. CHECK 208:

ONE OR MORE BIRTHS (CONTINUE)
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'

TOTAL BIRTHS IN 2010-2015 ___
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?

BOY 1
GIRL 2

215. Were any of these births twins?

SINGLE 1
MULTIPLE 2

216. On what day, month, and year was (NAME) born?

DAY ___
MONTH ___
YEAR ___

217. Is (NAME) still alive?

YES 1
NO 2 (GO TO NEXT BIRTH)

218. IF ALIVE: How old was (NAME) at (NAME)'s 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.

HOUSEHOLD LINE NUMBER ___ (GO TO NEXT BIRTH)

221. 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 (GO TO NEXT BIRTH)

222. Since January 2010, have you had any more live births that have not already been listed?

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

223. COMPARE 211 WITH NUMBER OF BIRTHS IN BIRTH HISTORY

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

224. CHECK 216: ENTER THE NUMBER OF BIRTHS IN 2010-2015

NUMBER OF BIRTHS ___
NONE 0

225. Are you pregnant now?

YES 1
NO 2 (GO TO 227)
UNSURE 8 (GO TO 227)

226. How many months pregnant are you? RECORD NUMBER OF COMPLETED MONTHS.

MONTHS ___

227. CHECK 224:

ONE OR MORE BIRTHS IN 2010 OR LATER (GO TO 301)
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:

NAME ___
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?

YES 1
NO 2 (GO TO 304)

302A. How many times did you see someone for antenatal care for this pregnancy?

TIMES ___

303. Whom did you see? Anyone else? PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEALTH PERSONNEL

DOCTOR A
NURSE/MIDWIFE B

OTHER PERSON

TRADITIONAL BIRTH ATTENDANT C
COMMUNITY HEALTH WORKER D

OTHER (SPECIFY) X

304. During this pregnancy, did you take SP/Fansidar to keep you from getting malaria?

YES 1
NO 2 (GO TO 308)
DON'T KNOW 8 (GO TO 308)

305. How many times did you take SP/Fansidar during this pregnancy?

TIMES ___

306. CHECK 303: ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY

CODE 'A' OR 'B' CIRCLED (CONTINUE)
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.

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

308. CHECK 216 AND 217:

ONE OR MORE LIVING CHILDREN BORN IN 2010 OR LATER (GO TO 401)
NO LIVING CHILDREN BORN IN 2010 OR LATER (GO TO 427D)

SECTION 4. FEVER IN CHILDREN

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.

BIRTH HISTORY NUMBER ___

403. FROM 213 AND 217:

NAME ___
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?

YES 1
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?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
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)

PUBLIC SECTOR

GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT DISPENSARY C
OTHER PUBLIC (SPECIFY) D

PRIVATE MEDICAL SECTOR

MISSION HOSPITAL/CLINIC E
PHARMACY G
OTHER PRIVATE (SPECIFY) H
MOBILE CLINIC I
COMMUNITY HEALTH WORKER J

OTHER SOURCE

SHOP K
TRADITIONAL HEALER L
RELATIVE/FRIEND M
OTHER (SPECIFY) X

408. CHECK 407:

2 OR MORE CODES CIRCLED (CONTINUE)
OTHER (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 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.

ACT ANTIMALARIALS

AL A
ARTESUNATE/AMODIAQUINE B
DHAP C

NON-ACT ANTIMALARIAL

SP/FANSIDAR D
CHLOROQUINE E
AMODIAQUINE F
QUININE PILLS G
QUININE INJECTION/IV H
ARTESUNATE RECTAL I
ARTESUNATE INJECTION/IV J
OTHER ANTIMALARIAL (SPECIFY) K

ANTIBIOTIC DRUGS

PILL/SYRUP L
INJECTION M

OTHER DRUGS

ASPIRIN N
ACETAMINOPHEN/PARACETAMOL O
IBUPROFEN P
OTHER (SPECIFY) X
DON'T KNOW Z

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

YES 1
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' CIRCLED (CONTINUE)
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

YES 1
NO 2
DON'T KNOW 8

413A. CHECK 411: AL ('A') GIVEN

CODE 'A' CIRCLED (CONTINUE)
CODE 'A' NOT CIRCLED (SKIP TO 414A)

413B. How long after the fever started did (NAME) first take AL?