2016 LIBERIA MALARIA INDICATOR SURVEY
WOMAN'S QUESTIONNAIRE
NATIONAL MALARIA CONTROM PROGRAM-MINISTRY OF HEALTH
LIBERIA INSTITUTE OF STATISTICS AND GEO-INFORMATION SERVICES
PLACE NAME
NAME OF HOUSEHOLD HEAD
LMIS CLUSTER NUMBER
HOUSEHOLD NUMBER
NAME AND LINE NUMBER OF WOMAN
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
TOTAL NUMBER OF VISITS
NAME
NUMBER
OFFICE EDITOR
NUMBER
KEYED BY
NUMBER
Hello. My name is __. I am working with the Ministry of Health. We are conducting a survey about malaria all over Liberia. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 30 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 DOES NOT AGREE TO BE INTERVIEWED (END) 2
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 (SKIP TO 108)
105. What is the highest level of school you attended: elementary, junior high, senior high, or higher?
JUNIOR HIGH (7-9) 2
SENIOR HIGH (10-12) 3
HIGHER 4 (SKIP TO 106A)
106. What is the highest grade you completed? IF COMPLETED NO GRADES, RECORD '00'.
106A. How many years of higher education did you complete? IF COMPLETED LESS THAN ONE YEAR OF HIGHER EDUCATION, RECORD '00'.
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 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
MUSLIM 02
TRADITIONAL RELIGION 03
NO RELIGION 04
OTHER (SPECIFY) 96
110A. What dialect do you speak well (besides English)? IF RESPONDENT CAN SPEAK SEVERAL DIALECTS, ASK WHICH ONE SHE SPEAKS THE MOST, OR WHICH IS HER FIRST LANGUAGE, OR MOTHER TONGUE
GBANDI 02
BELLE 03
DEY 04
GIO 05
GOLA 06
GREBO 07
KISSI 08
KPELLE 09
KRAHN 10
KRU 11
LORMA 12
MANDINGO 13
MANO 14
MENDE 15
SAPRO 16
VAI 17
NONE/ONLY ENGLISH 18
OTHER 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 (belly born) who are now living with you?
NO 2
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 (belly born) who are alive but do not live with you?
NO 2
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 belly 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)
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 (belly born) during your life. Is that correct?
NO (PROBE AND CORRECT 201-208 AS NECESSARY)
NO BIRTHS (SKIP TO 225)
211. Now I'd like to ask you about your more recent births. How many births have you had since January 2011? RECORD NUMBER OF LIVE BIRTHS FROM 2011-2016. IF NONE, CIRCLE '00'.
NONE 00 (SKIP TO 225)
212. Now I would like to record the names of all your births in 2011-2016, whether still alive or not, starting with the most recent one you had. RECORD IN 213 NAMES OF ALL THE BIRTHS IN 2011-2016. 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.
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 (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 (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)
224. CHECK 216: ENTER THE NUMBER OF BIRTHS IN 2011-2016.
NONE 0
NO 2 (SKIP TO 226A)
UNSURE 3 (SKIP TO 226A)
226. How many months pregnant are you? RECORD NUMBER OF COMPLETED MONTHS.
226A. Are you or your partner currently doing something or using any method to delay or avoid getting pregnant?
NO 2 (SKIP TO 226D)
226B. Which method are you using? RECORD ALL MENTIONED. IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.
MALE STERILIZATION B (SKIP TO 227)
IUD C
INJECTABLES/DEPO D
IMPLANTS E
PILL F
CONDOM G
FEMALE CONDOM H
EMERGENCY CONTRACEPTION I
CYCLEBEADS/STANDARD DAYS METHOD J (SKIP TO 227)
LACTAIONAL AMENORRHEA METHOD K (SKIP TO 227)
RHYTHM METHOD L (SKIP TO 227)
WITHDRAWAL M (SKIP TO 227)
OTHER MODERN METHOD X
OTHER TRADITIONAL METHOD Y (SKIP TO 227)
226C. Where did you obtain (CURRENT METHOD) the last time? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVERNMENT HEALTH CENTER 12 (SKIP TO 227)
HEALTH CLINIC 13 (SKIP TO 227)
MOBILE CLINIC 14 (SKIP TO 227)
COMMUNITY HEALTH WORKER/OUTREACH 15 (SKIP TO 227)
OTHER PUBLIC SECTOR (SPECIFY) 16 (SKIP TO 227)
PHARMACY/MED. STORE 22 (SKIP TO 227)
PRIVATE DOCTOR 23 (SKIP TO 227)
PLANNED PARENTHOOD ASSOCIATION OF LIBERIA 25 (SKIP TO 227)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 26 (SKIP TO 227)
CHURCH 32 (SKIP TO 227)
FRIEND/RELATIVE 33 (SKIP TO 227)
226D. Do you know of a place where you can obtain a method of family planning?
NO 2
NO BIRTHS IN 2011-2016 (SKIP TO 701)
Q.224 IS BLANK (SKIP TO 701)
SECTION 3. PREGNANCY AND INTERMITTENT PREVENTATIVE TREATMENT
301. RECORD BORTH HISTORY NUMBER FOR THE MOST RECENT BIRTH IN 2011-2016 FROM 213 IN BIRTH HISTORY.
301A. 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 (SKIP TO 303E)
303. Whom did you see? Anyone else? PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
NURSE/MIDWIFE B
PHYSICIAN ASSISTANT C
COMMUNITY HEALTH WORKER/OUTREACH E
303A. Where did you receive antenatal care for this pregnancy? Anywhere else? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
OTHER HOME B
GOVERNMENT HEALTH CENTER D
GOVERNMENT HEALTH CLINIC E
COMMUNITY HEALTH WORKER/OURTEACH F
OTHER PUBLIC MEDICAL SECTOR (SPECIFY) G
PRIVATE DOCTOR I
PLANNED PARENTHOOD ASSOCIATION OF LIBERIA J
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) K
303B. How many months pregnant were you when you first received antenatal care for this pregnancy?
DON?T KNOW/DON?T REMEMBER 98
303C. How many times did you receive antenatal care during this pregnancy?
DON?T KNOW/DON?T REMEMBER 98
303D. Did you get a mosquito net during any ANC visit?
NO 2
DON?T KNOW/DON?T REMEMBER 8
303E. Did you get a mosquito net during your delivery?
NO 2
DON?T KNOW/DON?T REMEMBER 8
303F. During this pregnancy, did anyone tell you that you were supposed to get two mosquito nets, one at an ANC visit, and one at delivery?
NO 2
DON?T KNOW/DON?T REMEMBER 8
303G. During this pregnancy, did anyone tell you that pregnant women need to take some kind of medicine to keep them from getting malaria? EMPHASIZE THE WORD 'KEEP'.
NO 2
DON?T KNOW/DON?T REMEMBER 8
304. During this pregnancy did you take any medicine to keep you from getting malaria? EMPHASIZE 'KEEP'. DO NOT CIRCLE '1' IF SHE WAS ONLY GIVEN DRUGS BECAUSE SHE HAD MALARIA.
NO 2 (SKIP TO 403)
DON?T KNOW 8 (SKIP TO 403)
304A. What medicine did you take to keep you from getting malaria? RECORD ALL MENTIONED. IF SHE DOES NOT KNOW THE TYPE OF DRUGS, SHOW HER TYPICAL ANTIMALARIAL DRUGS. TREATMENT WITH SP/FANSIDAR USUSALLY CONSISTS OF TAKING 3 BIG WHITE TABLETS AT THE HEALTH FACILITY.
CHLOROQUINE B
OTHER (SPECIFY) X
DON?T KNOW Z
304B. CHECK 304A: DRUGS TAKEN FOR MALARIA PREVENTION
BODE 'B' OR 'X' OR 'Z' CIRCLED BUT NOT 'A' (SKIP TO 403)
305. How many times did you take SP/Fansidar during this pregnancy?
306. 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
SECTION 4. PREGNANCY AND POSTNATAL CARE
403. RECORD BIRTH HISTORY NUMBER FOR THE MOST RECENT BIRTH FROM 213 IN BIRTH HISTORY
LIVING (CONTINUE)
DEAD (CONTINUE)
405. Where did you give birth to (NAME)? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
OTHER HOME 12
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH CLINIC 23
OTHER PUBLIC SECTOR (SPECIFY) 26
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36
405A. CHECK 405: PLACE OF DELIVERY
OTHER (CONTINUE)
406. I would like to talk to you about checks on you health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health while you were still in the facility?
NO 2 (SKIP TO 409)
407. How long after delivery did the first check take place? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS__ 2
WEEKS__ 3
DON?T KNOW 998
408. Who checked on your health at that time? PROBE FOR MOST QUALIFIED PERSON
NURSE/MIDWIFE 12
PHYSICIAN ASSISTANT 13
COMMUNITY HEALTH WORKER/OUTREACH 22
409. Now I would like to talk to you about checks on (NAME)'s health after delivery-for example, someone examining (NAME), checking the cord, or seeing if (NAME) is OK. Did anyone check on (NAME)'s health while you were still in the facility?
NO 2 (SKIP TO 412)
DON?T KNOW 8 (SKIP TO 412)
410. How long after delivery was (NAME)'s health first checked? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS__ 2
WEEKS__ 3
DON?T KNOW 998
411. Who checked on (NAME)'s health at that time? PROBE FOR MOST QUALIFIED PERSON.
NURSE/MIDWIFE 12
PHYSICIAN ASSISTANT 13
COMMUNITY HEALTH WORKER/OUTREACH 22
412. Now I want to talk to you about what happened after you left the facility. Did anyone check on your health after you left the facility?
NO 2 (SKIP TO 416)
413. How long after delivery did that check take place? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS__ 2
WEEKS__ 3
DON?T KNOW 998
414. Who checked on your health at that time? PROBE FOR MOST QUALIFIED PERSON
NURSE/MIDWIFE 12
PHYSICIAN ASSISTANT 13
COMMUNITY HEALTH WORKER/OUTREACH 22
415. Where did the check take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
OTHER HOME 12
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH CLINIC 23
OTHER PUBLIC SECTOR (SPECIFY) 26
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36
416. I would like to talk to you about checks on (NAME)'s health after you left (FACILITY IN 405). Did any health care provider or a traditional birth attendant check on (NAME)'s health in the two months after you left (FACILITY IN 405)?
NO 2 (SKIP TO 501)
DON?T KNOW 8 (SKIP TO 501)
417. How many hours, days, or weeks after the birth of (NAME) did that check take place? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS__ 2
WEEKS__ 3
DON?T KNOW 998
418. Who checked on (NAME)'s health at that time? PROBE FOR MOST QUALIFIED PERSON.
NURSE/MIDWIFE 12
PHYSICIAN ASSISTANT 13
COMMUNITY HEALTH WORKER/OUTREACH 22
419. Where did this check of (NAME) take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
OTHER HOME 12 (SKIP TO 501)
GOVERNMENT HEALTH CENTER 22 (SKIP TO 501)
GOVERNMENT HEALTH CLINIC 23 (SKIP TO 501)
OTHER PUBLIC SECTOR (SPECIFY) 26 (SKIP TO 501)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36 (SKIP TO 501)
420. I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health after you gave birth to (NAME)?
NO 2 (SKIP TO 424)
421. How long after the delivery did the first check take place? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS__ 2
WEEKS__ 3
DON?T KNOW 998
422. Who checked on your health at that time? PROBE FOR MOST QUALIFIED PERSON.
NURSE/MIDWIFE 12
PHYSICIAN ASSISTANT 13
COMMUNITY HEALTH WORKER/OUTREACH 22
423. Where did this check first take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETEMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
OTHER HOME 12
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH CLINIC 23
OTHER PUBLIC SECTOR (SPECIFY) 26
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36
424. I would like to talk to you about checks on (NAME)'s health after delivery-for example, someone examining (NAME), checking the cord, or seeing if (NAME) is OK. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on (NAME)'s health?
NO 2 (SKIP TO 501)
DON?T KNOW 8 (SKIP TO 501)
425. How many hours, days, or weeks after the birth of (NAME) did the first check take place? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS AFTER BIRTH__ 2
WEEKS AFTER BIRTH__ 3
DON?T KNOW 998
426. Who checked on (NAME)'s health at that time? PROBE FOR MOST QUALIFIED PERSON.
NURSE/MIDWIFE 12
PHYSICIAN ASSISTANT 13
COMMUNITY HEALTH WORKER/OUTREACH 22
427. Where did this first check of (NAME) take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
OTHER HOME 12
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH CLINIC 23
OTHER PUBLIC SECTOR (SPECIFY) 26
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36
501. CHECK 213: RECORD THE BIRTH HISTORY NUMBER IN 502 AND THE NAME AND SURVIVAL STATUS IN 503 FOR EACH BIRTH IN 2011-2016. ASK QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE MOST RECENT BIRTH. IF THERE WERE MORE THAN 2 BIRTHS, USE ADDITIONAL QUESTIONNAIRES. Now I would like to ask questions about the health of your children born in 2011-2016. (We will talk about each separately.)
502. BIRTH HISTORY NUMBER FROM 213 IN BIRTH HISTORY.
LIVING (CONTINUE)
DEAD (SKIP TO 528)
504. Has (NAME) been ill with a fever at any time in the last 2 weeks?
NO 2 (SKIP TO 528)
DON?T KNOW 8 (SKIP TO 528)
506. Did you seek advice or treatment for the illness from any source?
NO 2 (SKIP TO 511)
507. Where did you seek advice or treatment? Anywhere else? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAMES OF THE PLACE(S).
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH CLINIC C
MOBILE CLINIC D
COMMUNITY HEALTH WORKER/OUTREACH E
OTHER PUBLIC SECTOR (SPECIFY) F
PHARMACY/MEDICINE STORE H
PRIVATE DOCTOR I
PLANNED PARENTHOOD ASSOCIATION OF LIBERIA J
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) K
MARKET M
BLACK BAGGER/DRUG PEDDLER N
ONLY ONE CODE CIRCLED (SKIP TO 510)
509. Where did you first seek advice or treatment? USE LETTER CODE FROM 507.
510. How many days after the illness began did you first seek advice or treatment for (NAME)? IF THE SAME DAY RECORD '00'.
510A. At any time during the illness, did (NAME) have blood taken from (NAME)'s finger or heel for testing?
NO 2 (SKIP TO 511)
DON?T KNOW 8 (SKIP TO 511)
510B. Were you given malaria medicine for (NAME) after this test?
NO 2
DON?T KNOW 8
511. At any time during the illness, did (NAME) take any drugs for the illness?
NO 2 (SKIP TO 528)
DON?T KNOW 8 (SKIP TO 528)
512. What drugs did (NAME) take? Any other drugs? RECORD ALL MENTIONED. PROBE: IF AMODIAQUINE IS NAMED CLARIFY TO VERIFY IF IT IS ACT.
SP/FANSIDAR B
CHLOROQUINE C
AMODIAQUINE D
QUININE:
INJECTION/IV F
INJECTION/IV H
INJECTION/IV K
PARACETAMOL M
IBUPROFEN N
DON?T KNOW Z
513. CHECK 512: ANY CODE A-I CIRCLED?
NO (SKIP TO 528)
514. CHECK 512: ARTEMISININ COMBINATION THERAPY ('A') GIVEN
CODE 'A' NOT CIRCLED (SKIP TO 516)
515. How long after the fever started did (NAME) first take an artemisinin combination therapy?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON?T KNOW 8
516. CHECK 512: SP/FANSIDAR ('B') GIVEN
CODE 'B' NOT CIRCLED (SKIP TO 518)
517. 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
518. CHECK 512: CHLOROQUINE ('C') GIVEN
CODE 'C' NOT CIRCLED (SKIP TO 520)
519. 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
520. CHECK 512: AMODIAQUINE ('D') GIVEN
CODE 'D' NOT CIRCLED (SKIP TO 522)
521. 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
522. CHECK 512: QUININE ('E' OR 'F') GIVEN
CODE 'E' OR 'F' NOT CIRCLED (SKIP TO 524)
523. 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
524. CHECK 512: ARTESUNATE ('G' OR 'H') GIVEN
CODE 'G' OR 'H' NOT CIRCLED (SKIP TO 528)
525. 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
526. CHECK 512: OTHER ANTIMALARIAL ('I') GIVEN
CODE 'I' NOT CIRCLED (SKIP TO 528)
527. 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
528. GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 601A.
SECTION 6A. CHILD IMMUNIZATION (MOST RECENT BIRTH)
601A. CHECK 216 IN THE BIRTH HISTORY: ANY BIRTHS IN 2013-2016?
NO BIRTHS IN 2013-2016 (SKIP TO 701)
602A. RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 213 OF THE LAST CHILD BORN IN 2013-2016.
BIRTH HISTORY NUMBER__
DEAD (SKIP TO 601B)
604A. Do you have a card or other document where (NAME)'s vaccinations are written down?
YES, HAS ONLY AN OTHER DOCUMENT 2
YES, HAS CARD AND OTHER DOCUMENT 3 (SKIP TO 607A)
NO, NO CARD AND NO OTHER DOCUMENT 4
605A. Did you ever have a vaccination card for (NAME)?
NO 2
CODE '4' CIRCLED (SKIP TO 611A)
607A. May I see the card or other document where (NAME)'s vaccinations are written down?
YES, ONLY OTHER DOCUMENT SEEN 2
YES, CARD AND OTHER DOCUMENT SEEN 3
NO CARD AND NO OTHER DOCUMENT SEEN 4 (SKIP TO 611A)
CHILD HEALTH CARD PREVIOUS VERSIONS (SKIP TO 608A2)
608A1. COPY DATES FROM THE CARD OR OTHER DOCUMENT. WRITE '44' IN 'DAY' COLUMN IF CARD OR OTHER DOCUMENT SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.
FROM THE CHILD HEALTH CARD NEW VERSION
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
609A1. CHECK 608A1: 'BCG' TO 'YELLOW FEVER' ALL RECORDED?
YES (SKIP TO 626A)
608A2. COPY DATES FROM THE CARD OR OTHER DOCUMENT. WRITE '44' IN 'DAY' COLUMN IF CARD OR OTHER DOCUMENT SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.
FROM THE CHILD HEALTH CARD PREVIOUS VERSIONS
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
609A2. CHECK 608A2: 'BCG' OT 'PNEUMO-3' ALL RECORDED?
YES (SKIP TO 626A)
610A. In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days? RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 608A1 OR 609A2 THAT ARE NOT RECORDED AS HAVING BEEN GIVEN
NO 2 (WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN) (THEN SKIP TO 626A)
DON?T KNOW 8 (WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN) (THEN SKIP TO 626A)
611A. Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in campaigns or immunization days or child health days?
NO 2 (SKIP TO 626A)
DON?T KNOW 8 (SKIP TO 626A)
612A. Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the upper right arm that usually causes a scar?
NO 2
DON?T KNOW 8
614A. Has (NAME) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?
NO 2 (SKIP TO 617A)
DON?T KNOW 3 (SKIP TO 617A)
615A. Did (NAME) receive the first oral polio vaccine in the first two weeks after birth or later?
LATER 2
616A. How many times did (NAME) receive the oral polio vaccine?
617A. Has (NAME) ever received a pentavalent vaccination, that is, an injection in the upper left thigh sometimes at the same time as polio drops?
NO 2 (SKIP TO 619A)
DON?T KNOW 3 (SKIP TO 619A)
618A. How many times did (NAME) receive the pentavalent vaccine?
619A. Has (NAME) ever received a pneumococcal vaccination, that is, an injection in the upper right thigh to prevent pneumonia?
NO 2 (SKIP TO 621A)
DON?T KNOW 8 (SKIP TO 621A)
620A. How many times did (NAME) receive the pneumococcal vaccine?
621A. Has (NAME) ever received a rotavirus vaccination, that is, liquid in the mouth to prevent diarrhea?
NO 2 (SKIP TO 623A)
DON?T KNOW 8 (SKIP TO 623A)
622A. How many times did (NAME) receive the rotavirus vaccine?
623A. Has (NAME) ever received a measles vaccination, that is, an injection in the upper left arm to prevent measles?
NO 2
DON?T KNOW 8
625A. Has (NAME) ever received a yellow fever vaccination, that is, an injection in the upper right arm to prevent yellow fever?
NO 2
DON?T KNOW 8
626A. Did you ever have a certificate for outstanding parent for (NAME)?
NO 2 (SKIP TO 628A)
627A. May I see the certificate for outstanding parent for (NAME)?
YES, NOT SEEN 2
SECTION 6B. CHILD IMMUNIZATION (NEXT MOST RECENT BIRTH)
601B. CHECK 216 IN THE BIRTH HISTORY: ANY MORE BIRTHS IN 2013-2016?
NO BIRTHS IN 2013-2016 (SKIP TO 701)
602B. RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 213 OF NEXT-TO-MOST RECENT CHILD BORN IN 2013-2016.
BIRTH HISTORY NUMBER__
DEAD (SKIP TO 628B)
604B. Do you have a card or other document where (NAME)'s vaccinations are written down?
YES, HAS ONLY AN OTHER DOCUMENT 2
YES, HAS CARD AND OTHER DOCUMENT 3 (SKIP TO 607B)
NO, NO CARD AND NO OTHER DOCUMENT 4
605B. Did you ever have a vaccination card for (NAME)?
NO 2
CODE '4' CIRCLED (SKIP TO 611B)
607B. May I see the card or other document where (NAME)'s vaccinations are written down?
YES, ONLY OTHER DOCUMENT SEEN 2
YES, CARD AND OTHER DOCUMENT SEEN 3
NO CARD AND NO OTHER DOCUMENT SEEN 4 (SKIP TO 611B)
CHILD HEALTH CARD PREVIOUS VERSIONS (SKIP TO 608B2)
608A1. COPY DATES FROM THE CARD OR OTHER DOCUMENT. WRITE '44' IN 'DAY' COLUMN IF CARD OR OTHER DOCUMENT SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.
FROM THE CHILD HEALTH CARD NEW VERSION
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
609B1. CHECK 608B1: 'BCG' TO 'YELLOW FEVER' ALL RECORDED?
YES (SKIP TO 626B)
608B2. COPY DATES FROM THE CARD OR OTHER DOCUMENT. WRITE '44' IN 'DAY' COLUMN IF CARD OR OTHER DOCUMENT SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.
FROM THE CHILD HEALTH CARD PREVIOUS VERSIONS
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
MONTH__
YEAR__
609B2. CHECK 608B2: 'BCG' OT 'PNEUMO-3' ALL RECORDED?
YES (SKIP TO 626B)
610B. In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days? RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 608B1 OR 608B2 THAT ARE NOT RECORDED AS HAVING BEEN GIVEN
NO 2 (WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN) (THEN SKIP TO 626B)
DON?T KNOW 8 (WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN) (THEN SKIP TO 626B)
611B. Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in campaigns or immunization days or child health days?
NO 2 (SKIP TO 626B)
DON?T KNOW 8 (SKIP TO 626B)
612B. Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the upper right arm that usually causes a scar?
NO 2
DON?T KNOW 8
614B. Has (NAME) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?
NO 2 (SKIP TO 617B)
DON?T KNOW 3 (SKIP TO 617B)
615B. Did (NAME) receive the first oral polio vaccine in the first two weeks after birth or later?
LATER 2
616B. How many times did (NAME) receive the oral polio vaccine?
617B. Has (NAME) ever received a pentavalent vaccination, that is, an injection in the upper left thigh sometimes at the same time as polio drops?
NO 2 (SKIP TO 619B)
DON?T KNOW 3 (SKIP TO 619B)
618B. How many times did (NAME) receive the pentavalent vaccine?
619B. Has (NAME) ever received a pneumococcal vaccination, that is, an injection in the upper right thigh to prevent pneumonia?
NO 2 (SKIP TO 621B)
DON?T KNOW 8 (SKIP TO 621B)
620B. How many times did (NAME) receive the pneumococcal vaccine?
621B. Has (NAME) ever received a rotavirus vaccination, that is, liquid in the mouth to prevent diarrhea?
NO 2 (SKIP TO 623B)
DON?T KNOW 8 (SKIP TO 623B)
622B. How many times did (NAME) receive the rotavirus vaccine?
623B. Has (NAME) ever received a measles vaccination, that is, an injection in the upper left arm to prevent measles?
NO 2
DON?T KNOW 8
625B. Has (NAME) ever received a yellow fever vaccination, that is, an injection in the upper right arm to prevent yellow fever?
NO 2
DON?T KNOW 8
626B. Did you ever have a certificate for outstanding parent for (NAME)?
NO 2 (SKIP TO 628B)
627B. May I see the certificate for outstanding parent for (NAME)?
YES, NOT SEEN 2
628B. CHECK 216 IN BIRTH HISTORY: ANY MORE BIRTHS IN 2013-2016?
NO MORE BIRTHS IN 2013-2016 (SKIP TO 701)
SECTION 7. KNOWLEDGE OF MALARIA
701. Now I would like to talk about something else. Before this interview, had you ever heard of a sickness called malaria?
NO 2 (SKIP TO 717)
702. What are the things that can happen to you when you have malaria? Anything else? CIRCLE ALL MENTIONED.
CHILLS B
HEADACHE C
JOINT PAIN D
POOR APETITE E
BODY PAIN F
VOMITING G
WEAKNESS H
DEATH J
OTHER (SPECIFY) X
DOES NOT KNOW ANY Z
703. Who do you think can get sick from malaria more often? Who else? CIRCLE ALL MENTIONED.
PREGNANT WOMEN B
ADULTS C
ELDERLY D
EVERYONE E
DOES NOT KNOW F
704. In your opinion, what causes malaria? Anything else? CIRCLE ALL MENTIONED.
DIRTY WATER B
DIRTY SURROUNDINGS C
BEER D
CERTAIN FOODS E
PLASMODIUM PARASITE F
OTHER (SPECIFY) X
DOES NOT KNOW ANY Z
705. Are there things people can do to stop them from getting malaria?
NO 2 (SKIP TO 718)
706. What are some of these things that you think people can do to stop them from getting malaria? What else? CIRCLE ALL MENTIONED.
USE MOSQUITO COILS B
USE INSECTICIDE SPRAY C
KEEP DOORS AND WINDOWS CLOSED D
USE INSECT REPELLENT E
KEEP SURROUNDINGS CLEAN F
CUT THE GRASS G
PREGNANT WOMEN TAKE MEDICINE H
OTHER (SPECIFY) X
707. Why do you think people are not doing these things to stop them from getting malaria? Anything else? CIRCLE ALL MENTIONED.
COSTS TOO MUCH B
DON?T KNOW WHAT TO DO C
DON?T THINK THESE WILL WORK D
OTHER (SPECIFY) X
DON?T KNOW Z
NO 2 (SKIP TO 714)
DON?T KNOW 8 (SKIP TO 714)
709. Why do you think people do not go for treatment as soon as they feel they have got malaria? Anything else? CIRCLE ALL MENTIONED.
COSTS TOO MUCH B
DIDN?T KNOW WHERE TO GO C
THINK THEY CAN TREAT AT HOME D
NO DRUGS AT HEALTH CENTER E
NEGATIVE BEHAVIOR OF PROVIDER F
GO TO TRADITIONAL HEALER G
WENT TO DRUG STORE H
ILLNESS NOT SERIOUS I
WEAKNESS/TOO SICK TO GO J
OTHER (SPECIFY) X
DON?T KNOW Z
710. What medicines are mainly used to treat malaria? Anything else? CIRCLE ALL MENTIONED. PROBE: IF AMODIAQUINE IS NAMED CLARIFY TO VERIFY IF IT IS ACT.
CHLOROQUINE B
QUININE C
ACT/AS-AQ D
AMADIOQUINE E
ASPIRIN, PANADOL, PARACETEMOL F
OTHER (SPECIFY) X
DOES NOT KNOW ANY Z
710A. Have you heard of a medicine called SP/Fansidar?
NO 2 (SKIP TO 714)
710B. What is SP/Fansidar used for? Anything else? CIRCLE ALL MENTIONED.
MALARIA TREATMENT B
OTHER (SPECIFY) X
DON?T KNOW Z
710C. CHECK 710B: CODE 'A' PREVENTION OF MALARIA DURING PREGNANCY CIRCLED?
OTHER (SKIP TO 714)
711. Why do you think pregnant women don?t take any or enough SP/Fansidar during pregnancy? Anything else? CIRCLE ALL MENTIONED.
COSTS TOO MUCH B
DON?T THINK/KNOW THEY NEED TO C
DON?T THINK IT WORKD D
WORRIED ABOUT SIDE EFFECTS E
DON?T KNOW WHERE TO GET IT F
NOT AVAILABLE/STOCK-OUTS G
PROVIDER DIDN'T EXPLAIN/NO INFO H
NEGATIVE PROVIDER INTERACTION I
EMPTY STOMACH J
NO WATER TO TAKE MEDICINE K
HUSBAND WOULDN?T LET HER GO L
OTHER (SPECIFY) X
DOES NOT KNOW ANY Z
714. In the past few months, have you seen or heard any messages about malaria?
NO 2 (SKIP TO 717)
715. In the past few months, have you heard or seen any of the following malaria messages?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
715A. CHECK 715: ANY MALARIA MESSAGES HEARD OR SEEN
OTHER (SKIP TO 717)
716. Where did you hear or see the messages? Anywhere else? CIRCLE ALL METNIONED.
BILLBOARD B
POSTER C
T-SHIRT D
LEAFLET/FACT SHEET/BROCHURE E
TELEVISION F
VIDEO CLUB G
SCHOOL H
COMMUNITY HEALTH WORKERS TTM, TBA, HEALTH PROMOTERS I
PEER EDUCATORS J
OTHER (SPECIFY) X
MINUTES__
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT INTERVIEW
COMMENTS ON SPECIFIC QUESTIONS
ANY OTHER COMMENTS
SUPERVISOR'S OBSERVATIONS
EDITOR'S OBSERVATIONS