STUDY OF MALARIA INDICATORS
EIPMD 2011
WOMAN'S QUESTIONNAIRE
REPUBLIC OF MADAGASCAR
NATIONAL INSTITUTE OF STATISTICS
OFFICE OF DEMOGRAPHY AND SOCIAL STATISTICS
NAME OF HEAD OF HOUSEHOLD ______
CLUSTER NUMBER ______
HOUSEHOLD NUMBER ______
REGION ______
COMMUNE ______
CITY/RURAL (CITY = 1, RURAL = 2) _______
NAME AND LINE NUMBER OF WOMAN ______
INTERVIEWER VISITS
DATE ______
NAME OF INTERVIEWER ______
RESULT ______
TIME ______
MONTH ______
YEAR 2011
NAME ______
RESULT ______
2 NOT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) ______
DATE ______
SECTION 1. SOCIODEMOGRAPHIC BACKGROUND OF RESPONDENT
INTRODUCTION AND INFORMED CONSENT
INFORMED CONSENT
Hello. My name is ______ and I work for the National Institute of Statistics. We are conducting a survey on malaria throughout Madagascar. The information that we collect will help the country plan health services. Your household has been selected for the survey. I would like to ask you some questions. The survey usually takes between 10 and 20 minutes. All the information that you give us is strictly confidential and will not be shared with anyone other than members of the survey team.
You do not have to participate in this survey but we hope you will agree to answer questions because your opinion is very important. If you decide not to participate, there will be no changes in the services you can receive from health programs. If I happen to ask a question that you do not want to answer, tell me and I will move on to the next question; you can also stop the interview at any time.
If you would like more information about any aspect of the survey, you can contact the people whose names are on the card that was already given to your household.
Mr. Victor Rabeza, National Institute of Statistics (INSTAT). Tel: 0340755950
Dr. Hortense Rakotonirainy, National Program of the Fight Against Malaria (PNLP). Tel: 0331161498
Mr. Andry Rakotorahalay, National Program of the Fight Against Malaria (PNLP). Tel: 0331463102
Do you have any questions?
May I begin the interview now?
Date: ______
2 RESPONDENT DECLINES TO BE INTERVIEWED (Skip to END)
MINUTES ______
102. In what month and what year were you born?
98 DK MONTH
YEAR ______
9998 DK YEAR
103. How old were you on your last birthday?
104. Have you ever been to school?
2 NO (Skip to 108)
105. What is the highest level of education you have reached: primary, secondary 1, secondary 2, or higher?
2 SECONDARY 1
3 SECONDARY 2
4 HIGHER
106. What is the highest (year/grade) that you have successfully completed at this level?
PRIMARY GRADES
2 2ND GRADE
3 3RD GRADE
4 4TH GRADE
5 5TH GRADE
8 DK
2 7TH GRADE
3 8TH GRADE
4 9TH GRADE
8 DK
2 11TH GRADE
3 12TH GRADE
8 DK
2 2ND YEAR
3 3RD YEAR
4 4TH YEAR
5 5TH YEAR OR HIGHER
8 DK
SECONDARY OR HIGHER ______ (Skip to 109)
108. Now I would like you to read this sentence to me.
IF RESPONDENT CANNOT READ THE WHOLE SENTENCE, PROBE:
2 CAN ONLY READ PARTS OF THE SENTENCE
3 CAN READ ENTIRE SENTENCE
4 NO CARD IN RESPONDENT'S LANGUAGE
5 BLIND/VISUALLY IMPAIRED
02 PROTESTANT/MALAGASY LUTHERAN CHURCH
03 MUSLIM
04 TRADITIONAL/ANIMIST
05 NO RELIGION/NONE
06 SECT
96 OTHER (SPECIFY) ______
SECTION 2. REPRODUCTION
201. Now I would like to ask you some questions about all the births you have had in your lifetime. Have you ever given birth?
2 NO (Skip to 206)
202. Do you have any sons or daughters to whom you gave birth who are currently living with you?
2 NO (Skip to 204)
203. How many sons live with you?
How many daughters live with you?
DAUGHTERS AT HOME ______
204. Do you have any sons or daughters to whom you gave birth who are still living but do not live with you?
2 NO (Skip to 206)
205. How many sons are living but do not live with you?
How many daughters are living but do not live with you?
DAUGHTERS ELSEWHERE ______
206. Have you ever given birth to a boy or girl who was born alive but who later died?
2 NO (Skip to 208)
207. How many boys died?
How many girls died?
DECEASED GIRLS ______
208. TOTAL UP THE ANSWERS TO 203, 205, AND 207 AND RECORD THE TOTAL.
TOTAL BIRTHS ______
NO ______ PROBE AND CORRECT 201 - 208 AS NECESSARY
IF NONE, RECORD '00'.
TOTAL IN LAST SIX YEARS ______
211. Now I would like to record the names of all the births you have had in the last six years, whether they are still living or not, beginning with the most recent birth.
(Repeat 212 - 220 for up to 7 births)
212. What name was given to your (last/preceding) child?
01 ______
213. Is (NAME) a single or a multiple birth?
2 MULTIPLE
214. Is (NAME) a boy or a girl?
2 GIRL
215. In what month and what year was (NAME) born?
YEAR ______
2 NO (Go to NEXT BIRTH)
217. IF ALIVE:
How old was (NAME) on his/her last birthday?
2 NO
NOTE THE LINE NUMBER OF CHILD FROM HOUSEHOLD SCHEDULE
220. Were there any other live births between (NAME) and (NAME OF BIRTH FROM PRECEDING LINE)?
2 NO
221. Have you had any other live births since (NAME OF LAST BIRTH)?
IF YES, RECORD THE BIRTH(S) IN BIRTH TABLE.
2 NO
222. COMPARE 210 TO THE NUMBER OF RECORDED BIRTHS IN TABLE BELOW AND MAKE A CHECK MARK:
NUMBERS ARE DIFFERENT ______ (PROBE AND CORRECT)
223. CHECK 215 AND RECORD THE NUMBER OF BIRTHS IN 2006 OR LATER.
IF NONE, RECORD '0'.
224. Are you currently pregnant?
2 NO (Skip to 226)
8 NOT SURE (Skip to 226)
225. How many months pregnant are you?
RECORD THE NUMBER OF COMPLETED MONTHS.
NO BIRTHS IN 2006 OR LATER ______ (Skip to 401)
SECTION 3A. PREGNANCY AND INTERMITTENT PREVENTIVE TREATMENT
301. NOTE THE NAME AND SURVIVAL STATUS OF THE LAST BIRTH IN 302.
Now I would like to ask you some questions about your last pregnancy in the last six years.
302. ACCORDING TO Q. 212 AND Q. 216 (LINE 01)
LIVING ______ (Continue to 303)
DECEASED ______ (Continue to 303)
303. When you were pregnant with (NAME), did you see anyone for antenatal care?
2 NO (Skip to 305)
Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
B NURSE/MIDWIFE/MEDICAL ASSISTANT
D UNTRAINED TRADITIONAL BIRTH ATTENDANT
X OTHER (SPECIFY) ______
Y NO ONE
305. During this pregnancy, did you take any medication to prevent malaria?
2 NO (Skip to 315)
8 DK (Skip to 315)
306. What medication did you take to prevent malaria?
IF TYPE OF MEDICATION IS NOT DETERMINED, SHOW COMMON ANTIMALARIALS TO RESPONDENT.
B CHLOROQUINE
C QUININE
X OTHER (SPECIFY) ______
Z DK
INTERMITTENT PREVENTIVE TREATMENT (SP/FANSIDAR) TAKEN FOR MALARIA
CODE 'A' NOT CIRCLED ______ (Skip to 312)
308. How many times did you take the intermittent preventive treatment (SP/Fansidar) during this pregnancy?
8 DON'T REMEMBER
309. How many tablets did you take each time?
8 DON'T REMEMBER
OTHER ______ (Skip to 315)
311. Did you receive the intermittent preventive treatment (SP/Fansidar) during an antenatal visit, during a different visit to a health facility, or from another source?
1 ANTENATAL VISIT
2 OTHER VISIT TO HEALTH FACILITY
3 OUTREACH STRATEGIES /MOTHER AND CHILD HEALTH WEEK
6 OTHER SOURCE (SPECIFY) ______
OTHER CASE ______ (Skip to 315)
313. How many times did you take the medicine to prevent malaria during this pregnancy?
98 DON'T REMEMBER
314. How many tablets did you take each time?
8 DON'T REMEMBER
NO LIVING CHILDREN BORN IN 2006 OR LATER ______ (Skip to 401)
IN CHILDREN
316. NOTE THE LINE NUMBER AND NAME IN THE TABLE OF EACH LIVING CHILD
Now I would like to ask you some questions about the health of all your children who are under the age of 5. (We will talk about one child at a time).
317. NAME AND LINE NUMBER ACCORDING TO Q. 212
NAME ______
319. Has (NAME) had a fever at any time in the last two weeks?
2 NO (GO TO NEXT COLUMN OF 317 OR, IF NO MORE CHILDREN, SKIP TO 394)
8 DK (GO TO NEXT COLUMN OF 317 OR, IF NO MORE CHILDREN, SKIP TO 394)
320. How many days ago did the fever begin?
98 DK
321. Have you sought out any advice or treatment of any kind for the fever?
2 NO (SKIP TO 324)
322. Where did you go for advice or treatment?
Anywhere else?
RECORD ALL SOURCES MENTIONED.
B HOSPITAL CENTRE 1
C BASIC HEALTH CENTRE II
D BASIC HEALTH CENTRE I
E OTHER PUBLIC (SPECIFY) ______
[###translator's note: Basic Health Centre I (CSB1) offers vaccinations and is first point of contact when seeking care. Basic Health Centre II (CSBII) offers essential obstetrical care under supervision of a doctor. Hospital Centres I and II provide increasing levels of care and serve huge health districts]
G PRIVATE HEALTH CENTRE
H PHARMACY/DRUG DEPOT
I PRIVATE DOCTOR
J FAMILY PLANNING CENTRE/NON PROFIT FAMILY HEALTH ORGANIZATION "FISA"
K ADOLESCENT REPRODUCTIVE HEALTH CLINIC "TOP"
L OTHER PRIVATE MEDICAL (SPECIFY) ______
N SHOP
O KIOSK
P TRADITIONAL HEALER
Q FRIEND/FAMILY MEMBER
R MARKET
X OTHER (SPECIFY) ______
323. How many days after the onset of fever did you start seeking treatment for (NAME)?
IF SAME DAY, RECORD '00'.
324. Was blood taken from (NAME)'s finger or heel at any time during the illness?
2 NO
8 DK
325. Did (NAME) take medicine for the fever at any time during the illness?
2 NO (Skip to 389)
8 DK (Skip to 389)
326. What medicines did (NAME) take?
Any other medicine?
RECORD ALL MENTIONED.
ASK TO SEE THE MEDICINE(S) IF TYPE OF MEDICINE IS NOT KNOWN. IF TYPE OF MEDICINE CAN NOT BE IDENTIFIED, SHOW COMMON ANTIMALARIALS TO RESPONDENT.
B CHLOROQUINE
C AMODIAQUINE
D QUININE
E ACTIPAL (ACT)
F LARIMAL (ACT)
G ARTEMODI (ACT)
H ARSUMOON (ACT)
I FALCIMON (ACT)
J OTHER UNDETERMINED COMBINATION WITH ARTEMISININ (ACT/ACTm)
K OTHER ANTIMALARIAL (SPECIFY) ______
M INJECTION
O ACETAMINOPHEN
P IBUPROFEN
Q PARACETAMOL
X OTHER (SPECIFY) ______
Z DK
327. In all, how much did you pay for medication and consultations for (NAME)'s fever?
99995 FREE
99998 DK
328. CHECK 326:
ANY CODE 'A' TO 'K' CIRCLED?
NO ______ (Skip to 385)
CODE 'A' NOT CIRCLED ______ (Skip to 334)
330. IF YOU CAN SEE THE SP/FANSIDAR, CHECK IF THE EXPIRATION DATE HAS PASSED.
2 EXPIRATION DATE PASSED
8 DK
331. How soon after the onset of fever did (NAME) start taking SP/Fansidar?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE OR MORE DAYS AFTER FEVER
4 FOUR OR MORE DAYS AFTER FEVER
8 DK
332. How many days did (NAME) take the SP/Fansidar?
8 DK
333. How many tablets of SP/Fansidar did (NAME) take per day?
CODE 'B' NOT CIRCLED ______ (Skip to 339)
335. IF YOU CAN SEE THE CHLOROQUINE, CHECK IF THE EXPIRATION DATE HAS PASSED.
2 EXPIRATION DATE PASSED
8 DK
336. How soon after the onset of fever did (NAME) start taking chloroquine?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE OR MORE DAYS AFTER FEVER
4 FOUR OR MORE DAYS AFTER FEVER
8 DK
337. How many days did (NAME) take chloroquine?
8 DK
338. How many chloroquine tablets did (NAME) take per day?
CODE 'C' NOT CIRCLED ______ (Skip to 344)
340. IF YOU CAN SEE THE AMODIAQUINE, CHECK IF THE EXPIRATION DATE HAS PASSED.
2 EXPIRATION DATE PASSED
8 DK
341. How soon after the onset of the fever did (NAME) start taking amodiaquine?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE OR MORE DAYS AFTER FEVER
4 FOUR OR MORE DAYS AFTER FEVER
8 DK
342. How many days did (NAME) take amodiaquine?
8 DK
343. How many amodiaquine tablets did (NAME) take per day?
CODED 'D' NOT CIRCLED ______ (Skip to 349)
345. IF YOU CAN SEE THE QUININE, CHECK IF THE EXPIRATION DATE HAS PASSED.
2 EXPIRATION DATE PASSED
8 DK
346. How soon after the onset of the fever did (NAME) start taking quinine?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE OR MORE DAYS AFTER FEVER
4 FOUR OR MORE DAYS AFTER FEVER
8 DK
347. How many days did (NAME) take quinine?
8 DK
348. How many quinine tablets or ampoules did (NAME) take per day?
CODE 'E' NOT CIRCLED ______ (Skip to 354)
350. IF YOU CAN SEE THE ACTIPAL, CHECK IF THE EXPIRATION DATE HAS PASSED.
2 EXPIRATION DATE PASSED
8 DK
351. How soon after the onset of the fever did (NAME) start taking actipal?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE OR MORE DAYS AFTER FEVER
4 FOUR OR MORE DAYS AFTER FEVER
8 DK
352. How many days did (NAME) take actipal?
8 DK
353. How many actipal tablets did (NAME) take per day?
.
CODE 'F' NOT CIRCLED ______ (Skip to 359)
355. IF YOU CAN SEE THE LARIMAL, CHECK IF THE EXPIRATION DATE HAS PASSED.
IF THE LARIMAL IS NOT AVAILABLE, ASK:
Did you use larimal that had expired?
2 EXPIRATION DATE PASSED
8 DK
356. How soon after the onset of the fever did (NAME) start using larimal?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE OR MORE DAYS AFTER FEVER
4 FOUR OR MORE DAYS AFTER FEVER
8 DK
357. How many days did (NAME) take larimal?
8 DK
358. How many tablets or ampoules of larimal did (NAME) take per day?
CODE 'G' NOT CIRCLED ______ (Skip to 364)
360. IF YOU CAN SEE THE ARTEMODI, CHECK IF THE EXPIRATION DATE HAS PASSED.
2 EXPIRATION DATE PASSED
8 DK
361. How soon after the onset of fever did (NAME) start taking artemodi?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE OR MORE DAYS AFTER FEVER
4 FOUR OR MORE DAYS AFTER FEVER
8 DK
362. How many days did (NAME) take artemodi?
8 DK
363. How many tablets of artemodi did (NAME) take per day?
CODE 'H' NOT CIRCLED ______ (Skip to 369)
365. IF YOU CAN SEE THE ARSUMOON, CHECK IF THE EXPIRATION DATE HAS PASSED.
2 EXPIRATION DATE PASSED
8 DK
366. How soon after the onset of the fever did (NAME) begin taking arsumoon?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE OR MORE DAYS AFTER FEVER
4 FOUR OR MORE DAYS AFTER FEVER
8 DK
367. How many days did (NAME) take arsumoon?
8 DK
368. How many arsumoon tablets did (NAME) take per day?
CODE 'I' NOT CIRCLED ______ (Skip to 374)
370. IF YOU CAN SEE THE FALCIMON, CHECK IF THE EXPIRATION DATE HAS PASSED.
2 EXPIRATION DATE PASSED
8 DK
371. How soon after the onset of the fever did (NAME) start taking falcimon?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE OR MORE DAYS AFTER FEVER
4 FOUR OR MORE DAYS AFTER FEVER
8 DK
372. How many days did (NAME) take falcimon?
8 DK
373. How many falcimon tablets did (NAME) take per day?
CODE 'J' NOT CIRCLED ______ (Skip to 380)
375. IF YOU CAN SEE THE ACT, CHECK IF THE EXPIRATION DATE HAS PASSED.
2 EXPIRATION DATE PASSED
8 DK
376. IF YOU CAN SEE THE ACT, DETERMINE IF IT IS FIXED-COMBINATION OR CO-BLISTER, OTHERWISE SHOW THE SAMPLE YOU HAVE AND ASK RESPONDENT WHICH ACT IT IS.
2 CO-BLISTER
8 DK
377. How soon after the onset of the fever did (NAME) start taking ACT?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE OR MORE DAYS AFTER FEVER
4 FOUR OR MORE DAYS AFTER FEVER
8 DK
378. How many days did (NAME) take ACT?
8 DK
379. How many ACT tablets did (NAME) take per day?
CODE 'K' NOT CIRCLED ______ (Skip to 385)
381. IF YOU CAN SEE THE OTHER ANTIMALARIAL, CHECK IF THE EXPIRATION DATE HAS PASSED.
2 EXPIRATION DATE PASSED
8 DK
382. How soon after the onset of the fever did (NAME) start using (NAME OF OTHER ANTIMALARIAL)?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE OR MORE DAYS AFTER FEVER
4 FOUR OR MORE DAYS AFTER FEVER
8 DK
383. How many days did (NAME) take (NAME OF OTHER ANTIMALARIAL)?
8 DK
384. How many tablets of (NAME OF OTHER ANTIMALARIAL) did (NAME) take per day?
385. Did (NAME) take all the medicine that was prescribed for him/her for the fever?
2 NO
8 DK (Skip to 387)
386. Why didn't (NAME) take all the medicine that was prescribed to him/her?
2 STOPPED BECAUSE CHILD CURED/HEALTH IMPROVED/MEDICINE NO LONGER NEEDED
6 OTHER (SPECIFY) ______
8 DK
387. Did (NAME) have any of the following symptoms?
Very high fever, higher than 39.5°?
Anemia?
Extreme weakness?
Loss of consciousness?
Respiratory failure?
Convulsions?
Abnormal bleeding?
Jaundice (with yellowing of eyes)?
Black or brown urine?
Uncontrollable vomiting?
Refusing to eat or nurse?
2 NO
8 DK
2 NO
8 DK
2 NO
8 DK
2 NO
8 DK
2 NO
8 DK
2 NO
8 DK
2 NO
8 DK
2 NO
8 DK
2 NO
8 DK
2 NO
8 DK
2 NO
8 DK
388. RETURN TO NEXT COLUMN IN 317, OR, IF NO MORE CHILDREN, CONTINUE TO 389.
389. CHECK 319: ANY CHILD HAVE FEVER?
NO CHILDREN HAD FEVER ______ (Skip to 394)
390. When your child/children have a fever, to what extent is it urgent or not urgent to immediately seek out an antimalarial treatment?
IF NOT URGENT: Is it not very urgent or not at all urgent?
2 VERY URGENT
3 NOT VERY URGENT
4 NOT AT ALL URGENT
391. When your child/children have a fever, do you agree that he/she should first be treated with herbal medicine or other practices?
IF NO (NOT IN AGREEMENT): Are you rather opposed or completely opposed?
2 RATHER AGREE
3 RATHER OPPOSE
4 COMPLETELY OPPOSE
392. When your child/children have a fever, is the treatment (including medical visits) affordable or not affordable?
IF UNAFFORDABLE: Is it unaffordable or really unaffordable?
2 AFFORDABLE
3 UNAFFORDABLE
4 REALLY UNAFFORDABLE
393. When your child/children have a fever, are antimalarials always available or not available?
IF NOT AVAILABLE: Are they rarely available or never available?
2 AVAILABLE OFTEN ENOUGH
3 RARELY AVAILABLE
4 NEVER AVAILABLE
394. If you child's fever is treated with an antimalarial, does the fever come down quickly?
IF NO: Is this rarely or never?
2 SOMETIMES
3 RARELY
4 NEVER
395. Do you keep partial doses of antimalarial medicine for possible future use?
2 NO
SECTION 4. KNOWLEDGE
401. How does a person contract malaria?
RECORD ALL MENTIONED.
B MOSQUITO BITE
C NOT TAKING PREVENTIVE MEDICINE
D PHYSICAL EFFORT/FATIGUE
E DIRECT EXPOSURE TO SUNLIGHT DURING WORK
F STAYING OUT IN THE RAIN
G SUDDEN CHANGE OF CLIMATE
H MALNUTRITION
I EATING FRUIT
J LACK OF PERSONAL HYGIENE
K IN THE BUSH
W OTHER (SPECIFY) ______
X OTHER (SPECIFY) ______
Z DK
402. In your opinion, what is the main symptom of malaria?
12 LACK OF APPETITE AND VOMITING
13 HIGH TEMPERATURE WITH CONVULSIONS
14 HIGH TEMPERATURE WITH FAINTING
15 PERSISTANT FEVER
16 CONVULSIONS
17 JAUNDICE
96 OTHER (SPECIFY) ______
98 DK
403. What are effective ways to prevent malaria?
RECORD ALL MENTIONED.
B SLEEPING UNDER MOSQUITO NET SOAKED IN INSECTICIDE
C TAKING PREVENTIVE MEDICINE
D TAKING TABLETS DURING PREGNANCY
E USING INSECTICIDE/DIFFUSER/CREAM/LOTION
F USING ANTI-MOSQUITO COIL
G AVOIDING CATCHING COLD
H AVOIDING EXPOSURE TO DIRECT SUNLIGHT
I CLEANING SURROUNDINGS
J INDOOR RESIDUAL SPRAYING
W OTHER (SPECIFY) ______
X OTHER (SPECIFY) ______
Z DK
404. Who are the people most at risk for getting malaria?
RECORD ALL MENTIONED
B CHILDREN
C PREGNANT WOMEN
D WOMEN
E MEN
F ELDERLY PEOPLE
G EVERYONE
W OTHER (SPECIFY) ______
405. In the last 12 months, have you:
Attended any training about treatment of malaria by a village leader?
Attended any training about treatment of malaria by a community agent?
Attended any training about treatment of malaria by a mobile video unit?
Attended any training about treatment of malaria by someone else?
Heard about treatment of malaria on the radio?
Seen something about treatment of malaria on the television?
Seen something about treatment of malaria in a newspaper or magazine?
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
406. In the past 12 months have you received any messages about the treatment of malaria concerning:
Use of ACT?
Price of treatment?
Availability of treatment?
Effectiveness of treatment?
Other messages on treatment of malaria?
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
407. In the last 12 months, have you:
Attended any training on prevention of malaria (long-lasting insecticidal nets, indoor residual spraying campaign, Intermittent Preventive Treatment) by a community agent?
Attended any training on prevention of malaria (long-lasting insecticidal nets, indoor residual spraying campaign, Intermittent Preventive Treatment) by mobile video unit?
Attended any training on prevention of malaria (long-lasting insecticidal nets, indoor residual spraying campaign, Intermittent Preventive Treatment) by someone else?
Heard about prevention of malaria (long-lasting insecticidal nets, indoor residual spraying campaign, Intermittent Preventive Treatment) on the radio?
Seen something concerning prevention of malaria (long-lasting insecticidal nets, indoor residual spraying campaign, Intermittent Preventive Treatment) on television?
Seen something concerning prevention of malaria (long-lasting insecticidal nets, indoor residual spraying campaign, Intermittent Preventive Treatment) in a newspaper or a magazine?
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
408. In the last 12 months, have you received any messages on long-lasting insecticidal nets for prevention of malaria as regards:
When to get a long-lasting insecticidal net?
Is a long-lasting insecticidal net free?
How to hang up a long-lasting insecticidal net?
How to take care of a long-lasting insecticidal net?
When to use a long-lasting insecticidal net?
Reason for having a long-lasting insecticidal net?
Any other message on long-lasting insecticidal nets?
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
409. In the last 12 months, have you received any messages about the indoor residual spraying campaign for the prevention of malaria about:
The fact that indoor residual spraying is not dangerous for one's health?
Any other message about indoor residual spraying?
2 NO
2 NO
2 NO
410. In the last 12 months, have you received any messages about pregnant women for the prevention of malaria concerning:
Any other message about pregnant women for prevention of malaria?
2 NO
2 NO
411. Do you know a place where you can get antimalarials?
2 NO
412. Does a child with a fever have to go to the health centre or can he/she stay at home for treatment?
2 HOME
8 DK
Larimal?
Artemodi?
Arsumoon?
Falcimon?
ACT?
ACTm?
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
415. In your opinion, which is the most effective antimalarial for treating pregnant women who have symptoms of malaria?
12 LARIMAL
13 ARTEMODI
14 ARSUMOON
15 FALCIMON
16 ACT
17 ACTm
96 OTHER (SPECIFY) ______
98 DK
416. In your opinion, which is the most effective antimalarial for treating children under the age of five?
12 LARIMAL
13 ARTEMODI
14 ARSUMOON
15 FALCIMON
16 ACT
17 ACTm
96 OTHER (SPECIFY) ______
98 DK
417. What should a pregnant woman do during her pregnancy to prevent malaria?
B SLEEP UNDER A LONG-LASTING INSECTICIDAL MOSQUITO NET
C IPT (INTERMITTENT PREVENTIVE TREATMENT)
X OTHER (SPECIFY) ______
Z DK
418. Where should a pregnant woman go to receive 2 doses of Intermittent Preventive Treatment (SP) during her pregnancy?
2 HOSPITAL
6 OTHER (SPECIFY) ______
8 DK
419. Your friends or neighbors encourage pregnant women to get tablets in health centres in order to help prevent contraction of malaria.
Do you agree or disagree?
IF DISAGREE: Do you disagree or totally disagree?
2 AGREE
3 DISAGREE
4 TOTALLY DISAGREE
420. In your opinion, what are the advantages of sleeping under an insecticidal mosquito net?
RECORD ALL MENTIONED.
B KILLS MOSQUITOS/OTHER INSECTS
C KEEPS OUT MOSQUITOS/OTHER INSECTS
D BEST FOR PREVENTING MALARIA
E BEST FOR PREVENTING MISCARRIAGE AND STILLBIRTH
F WOMAN BETTER PROTECTED AGAINST ILLNESSES
G SAVES MONEY BECAUSE CHILD NOT ILL
H TO PREVENT LOW BIRTHWEIGHT
I ONE SLEEPS WELL
X OTHER (SPECIFY) ______
Z DK
421. In your opinion, what are the disadvantages of sleeping under an insecticidal mosquito net?
RECORD ALL MENTIONED
B CAUSES IRRITATIONS/COUGH
C MAKES SICK
D MAKES NAUSEOUS
E DANGEROUS CHEMICAL PRODUCT
F PRODUCT USED CAN KILL FETUS/CAUSE MISCARRIAGE
G CAN SUFFOCATE/BREATHING DIFFICULTIES
H INSECTICIDE USED NOT EFFECTIVE
I MOSQUITO NET GETS DIRTY QUICKLY
J NO DISADVANTAGE
X OTHER (SPECIFY) ______
Z DK
422. In what months or seasons of the year should people sleep under an insecticidal mosquito net?
2 WET SEASON
3 ALL YEAR
8 DK
423. Do you think that a Super Moustiquaire mosquito net selling for 3,000 Ariary is affordable?
2 NO
8 DK
424. Do you often, rarely, or never have conversations with your friends or neighbors about malaria?
2 RARELY
3 NEVER
425. To what extent do you think it is important for your children to sleep under an insecticidal mosquito net: extremely important, very important, not very important, not important at all?
2 VERY IMPORTANT
3 NOT VERY IMPORTANT
4 NOT IMPORTANT AT ALL
426. Do you ever use mosquito nets for other purposes besides sleeping: all the time, sometimes, rarely, never?
2 SOMETIMES
3 RARELY
4 NEVER
4 HAVE NEVER HAD A MOSQUITO NET
[###translator's note: numbering is incorrect in original]
427. Now I would like to know your opinion about certain statements. Please do your best and really say what you think. I realize that these questions seem repetitive but I am asking them so as to really determine your opinion.
428. Do you totally agree or disagree with the following opinion:
Insecticidal mosquito nets have negative effects on health.
IF DISAGREE: Do you disagree or totally disagree?
2 AGREE
3 DISAGREE
4 TOTALLY DISAGREE
429. Do you agree or disagree with the following opinion:
In this community, most people sleep under an insecticidal mosquito net every night.
IF DISAGREE: Do you disagree or totally disagree?
2 AGREE
3 DISAGREE
4 TOTALLY DISAGREE
430. Do you agree or disagree with the following opinion:
You can hang a mosquito net anywhere people sleep in your dwelling.
IF DISAGREE: Do you disagree or totally disagree?
2 AGREE
3 DISAGREE
4 TOTALLY DISAGREE
431. Do you agree or disagree with the following opinion:
A person is at risk of contracting malaria only during the rainy season.
IF DISAGREE: Do you disagree or totally disagree?
2 AGREE
3 DISAGREE
4 TOTALLY DISAGREE
432. What brand of insecticidal mosquito net do you prefer?
12 PERMANET
13 SUPER MOUSTIQUAIRE
14 MILAY
15 TSARALAY
16 INTERCEPTOR
17 POLYESTER
18 POLYETHYLENE
19 DOESN'T MATTER
96 OTHER
98 NONE/DK
433. Do you know of a place where you can get a mosquito net?
2 NO (Skip to 435)
434. What are all the places you know where you can get an insecticidal net?
Any other place?
PROBE TO DETERMINE THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTRE OR CLINIC IS PRIVATE OR PUBLIC ESTABLISHMENT, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE) ______
B BASIC HEALTH CENTRE I
D PRIVATE HEALTH CENTRE
E PHARMACY/DRUG DEPOT
F PRIVATE DOCTOR
H SHOP
I KIOSK
J FRIENDS/RELATIVES
X OTHER (SPECIFY) ______
MINUTES ______
INTERVIEWER'S OBSERVATIONS
TO BE FILLED OUT AFTER INTERVIEW IS COMPLETED
______
COMMENTS ON PARTICULAR QUESTIONS:
______
OTHER COMMENTS:
______
TEAM LEADER'S OBSERVATIONS
______
DATE: ______