FORMATTING DATE: 15 Oct 2020
ENGLISH LANGUAGE: 15 Oct 2020
KENYA MALARIA INDICATOR SURVEY
WOMAN'S QUESTIONNAIRE
Division of National Malaria Programme
Kenya National Bureau of Statistics
NAME OF HOUSEHOLD HEAD _______________________
CLUSTER NUMBER ________________
HOUSEHOLD NUMBER ____________________
NAME AND LINE NUMBER OF WOMAN __________________
VISITS 1, 2, 3
INTERVIEWER'S NAME ___________
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER __________________(SPECIFY) 7
NEXT VISIT:
TIME _____________
FINAL VISIT
MONTH _________________
YEAR _________________
INTERVIEWER NUMBER ____________________
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER __________________(SPECIFY) 7
TOTAL NUMBER OF VISITS _____________________
LANGUAGE OF QUESTIONNAIRE: ENGLISH 01
LANGUAGE OF INTERVIEW
KISWAHILI 02
BORANA 03
EMBU 04
KALENJIN 05
KAMBA 06
KIKUYU 07
KISII 08
LUHYA 09
MARAGOL 10
LUO 11
MAASAI 12
MERU 13
MIJIKENDA 14
POKOT 15
SOMALI 16
TURKANA 17
OTHER ___________________(SPECIFY) 96
NUMBER ______________
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?
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 (SKIP TO 108)
105. What is the highest level of school you attended: primary, post-primary/vocational, secondary/'A' Level, College, or University?
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'.
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?
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
CODE '1' OR '5' CIRCLED (SKIP TO 111)
110. Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
111. Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
112. Do you watch television almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
113. Do you own a mobile phone?
NO 2 (SKIP TO 115)
114. Is your mobile phone a smart phone?
NO 2
115. Have you ever used the internet from any location on any device?
NO 2 (SKIP TO 118)
116. In the last 12 months, have you used the internet?
IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.
NO 2 (SKIP TO 118)
117. During the last one month, how often did you use the internet: almost every day, at least once a week, less than once a week, or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
PROTESTANT/OTHER CHRISTIAN 2
MUSLIM 3
NO RELIGION 4
OTHER __________________(SPECIFY) 96
201. Now I would like to ask about all the births you have had during your life. Have you ever given birth?
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?
NO 2 (SKIP TO 204)
203a. How many sons live with you?
IF NONE, RECORD '00'.
b. And how many daughters live with you?
IF NONE, RECORD '00'.
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 (SKIP TO 206)
205a. How many sons are alive but do not live with you?
IF NONE, RECORD '00'.
b. How many daughters are alive but do not live with you?
IF NONE, RECORD '00'.
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 (SKIP TO 208)
207a. How many boys have died?
IF NONE, RECORD '00'.
b. How many girls have died?
IF NONE, RECORD '00'.
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 (SKIP TO 224)
211. Now I'd like to ask you about your more recent births. How many births have you had in 2015-2020?
RECORD NUMBER OF LIVE BIRTHS IN 2015-2020.
NONE 00 (SKIP TO 224)
212. Now I would like to record the names of all your births in 2015-2020, whether still alive or not, starting with the most recent one you had.
RECORD IN 213 THE NAMES OF ALL THE BIRTHS BORN IN 2015-2020. 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/prvious) baby?
RECORD NAME.
______________________________
214. Is (NAME) a boy or a girl?
GIRL 2
215. Was that a single or multiple pregnancy?
MULTIPLE 2
216. On what day, month, and year was (NAME) born?
MONTH ____________
YEAR ___________
NO 2 (NEXT BIRTH)
218. IF ALIVE: How old was (NAME) at (NAME)'s last birthday?
RECORD AGE IN COMPLETED
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 (NEXT BIRTH)
222. Have you had any live births since the birth of (NAME OF MOST RECENT BIRTH)?
NO 2
223. COMPARE 211 WITH NUMBER OF BIRTHS IN BIRTH HISTORY
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)
NO 2 (SKIP TO 301)
UNSURE 8 (SKIP TO 301)
225. How many weeks or months pregnant are you?
RECORD NUMBER OF COMPLETED WEEKS OR MONTHS.
MONTHS _____________2
SECTION 3. PREGNANCY AND INTERMITTENT PREVENTIVE TREATMENT
301.
NO BIRTHS 0-35 MONTHS BEFORE THE SURVEY (SKIP TO 401)
302. RECORD THE NAME OF THE MOST RECENT BIRTH FROM 213, LINE 01:
303. Now I would like to ask you some questions about your last pregnancy that resulted in a live birth.
While you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?
NO 2 (SKIP TO 308)
304. Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
COMMUNITY HEALTH WORKER D
305. Where did you receive antenatal care for this pregnancy? Anywhere else?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC, PRIVATE, OR NGO SECTOR, RE ORD 'X' AND WRITE THE NAME OF THE PLACE(S).
OTHER HOME B
GOVERNMENT HEALTH CENTER D
GOVERNMENT DISPENSARY E
OTHER PUBLIC SECTOR ____________________(SPECIFY) F
PRIVATE CLINIC H
FAITH-BASED, CHURCH, HOSPITAL/CLINIC I
OTHER PRIVATE MEDICAL SECTOR ________________(SPECIFY) J
306. How many weeks or months pregnant were you when you first received antenatal care for this pregnancy?
MONTHS _______________ 2
DON'T KNOW 998
307. How many times did you receive antenatal care during this pregnancy?
DON'T KNOW 98
307A. During this pregnancy who usually made the final decision about whether you went for antenatal care - you, your spouse, you and your spouse, or someone else?
SPOUSE 2
JOINT DECISION WITH SPOUSE 3
SOMEONE ELSE 4
DON'T KNOW 8
308. During this pregnancy, did you take SP/Fansidar to keep you from getting malaria?
NO 2 (SKIP TO 401)
DON'T KNOW 8 (SKIP TO 401)
309. How many times did you take SP/Fansidar during this pregnancy?
DON'T KNOW 98
309A. CHECK 309: TOOK SP ONLY 1 OR 2 TIMES DURING THIS PREGNANCY
OTHER (SKIP TO 310)
309B. Why did you take SP/Fansidar only one or two times during this pregnancy?
RECORD ALL MENTIONED.
HAD NO MONEY B
SIDE EFFECTS C
NOT AWARE HAD TO TAKE MORE D
DID NOT WANT TO TAKE E
NOT GIVEN F
NOT AVAILABLE G
OTHER ________________(SPECIFY) X
DON'T KNOW Z
310. Did you get the SP/Fansidar during any antenatal care visit, during another 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
401.
NO SURVIVING CHILDREN BORN 0-59 MONTHS BEFORE THE SURVEY (SKIP TO 501)
402. RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 213 OF THE SURVIVING CHILDREN BORN 0-59 MONTHS BEFORE THE SURVEY, STARTING WITH THE LAST ONE.
BIRTH HISTORY NUMBER _______________
403. RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 213 OF THE SURVIVING CHILDREN BORN 0-59 MONTHS BEFORE THE SURVEY, STARTING WITH THE LAST ONE.
BIRTH HISTORY NUMBER ___________________
404. Has (NAME) been ill with a fever at any time in the last 2 weeks?
NO 2 (SKIP TO 416)
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. Were you told by a healthcare provider that (NAME) had malaria?
NO 2
DON'T KNOW 8
407. Did you seek advice or treatment for the illness from any source?
NO 2 (SKIP TO 412)
408. Where did you seek advice or treatment? Anywhere else?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC, PRIVATE, OR NGO SECTOR, RECORD 'X' AND WRITE THE NAME OF THE PLACE(S).
GOVERNMENT HEALTH CENTER B
GOVERNEMNT DISPENSARY C
MOBILE CLINIC D
COMMUNITY HEALTH WORKER/FIELDWORKER E
OTHER PUBLIC SECTOR ____________________(SPECIFY) F
PRIVATE CLINIC H
PHARMACY I
PRIVATE DOCTOR J
MOBILE CLINIC K
COMMUNITY HEALTH WORKER L
OTHER PRIVATE MEDICAL SECTOR ___________________(SPECIFY) M
TRADITIONAL PRACTITIONER R
MARKET S
ITINERANT DRUG SELLER T
ONLY ONE CODE CIRCLED (SKIP TO 411)
410. Where did you first seek advice or treatment?
FIRST PLACE _____________
GOVERNMENT HEALTH CENTER B
GOVERNEMNT DISPENSARY C
MOBILE CLINIC D
COMMUNITY HEALTH WORKER/FIELDWORKER E
OTHER PUBLIC SECTOR ____________________(SPECIFY) F
PRIVATE CLINIC H
PHARMACY I
PRIVATE DOCTOR J
MOBILE CLINIC K
COMMUNITY HEALTH WORKER L
OTHER PRIVATE MEDICAL SECTOR ___________________(SPECIFY) M
TRADITIONAL PRACTITIONER R
MARKET S
ITINERANT DRUG SELLER T
411. How many days after the illness began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY RECORD '00'.
412. At any time during the illness, did (NAME) take any medicine for the illness?
NO 2 (SKIP TO 416)
DON'T KNOW (SKIP TO 416)
413. What medicine did (NAME) take? Any other medicine?
RECORD ALL MENTIONED.
IF MEDICINE NOT KNOWN, ASK TO SEE THE PACKAGE OR PRESCRIPTION.
DHAP B
OTHER ACT (NOT AL OR DHAP) C
CHLOROQUINE E
AMODIAQUINE F
QUININE
INJECTION/IV H
INJECTION/IV J
COTRIMOXAZOLE M
OTHER PILL/SYRUP N
OTHER INJECTION/IV O
PARACETAMOL/PANADOL/ACETAMINOPHEN Q
IBUPROFEN R
DON'T KNOW Z
414. CHECK 413: ARTEMISININ-BASED COMBINATION THERAPY ('A', 'B', OR 'C') GIVEN
CODE 'A', 'B' AND/OR 'C' NOT CIRCLED (SKIP TO 416)
415. How long after the fever started did (NAME) first take an artemisinin-based combination therapy?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
416. CHECK 216 AND 217 IN BIRTH HISTORY: ANY MORE SURVIVING CHILDREN BORN 0-59 MONTHS BEFORE THE SURVEY?
MORE SURVIVING CHILDREN BORN 0-59 MONTHS BEFORE THE SURVEY (SKIP TO 403)