MALARIA INDICATORS SURVEY
"EIPMD" 2013
WOMAN'S QUESTIONNAIRE
REPUBLIC OF MADAGASCAR
NATIONAL INSTITUTE OF STATISTICS
OFFICE OF DEMOGRAPHICS AND SOCIAL STATISTICS
IDENTIFICATION
NAME OF LOCALITY ______
NAME OF HEAD OF HOUSEHOLD ______
CLUSTER NUMBER ______
HOUSEHOLD NUMBER ______
REGION ______
COMMUNE ______
CITY/RURAL (CITY = 1, RURAL = 2) RESIDENCE ______
NAME AND LINE NUMBER OF WOMAN ______
INTERVIEWER VISITS
DATE _____
NAME OF INTERVIEWER ______
RESULT ______
TIME ______
MONTH ______
YEAR 2013
NAME ______
RESULT ______
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) ______
DATE ______
SECTION 1. SOCIODEMOGRAPHIC BACKGROUND OF RESPONDENT
INTRODUCTION AND INFORMED CONSENT
Hello. My name is ______. I work for the National Institute of Statistics. We are conducting a survey of malaria all over Madagascar. The information we collect will help the country plan health services. Your household was selected for the survey. I would like to ask you a few questions. The survey usually takes between 10 and 20 minutes. All the information you give us is strictly confidential and will not be shared with anyone other than members of the survey team.
You are not obligated to take part in this survey, but we hope that you will accept to answer the questions because your opinion is very important. If you decide not to participate, there will be no change in the services you can receive from health programs. If I happen to ask a question that you do not wish to answer, tell me and I will go on to the next question; you can also stop the interview at any time.
If you would like more information on any aspect of the survey, you can contact the people listed on the card that was already given to your household.
Mr. Victor Rabeza, National Institute of Statistics ("INSTAT"). Tel: 0340755950
Dr. Louise Ranaivo, National Program in the Fight Against Malaria ("PNLP"). Tel: 0330280739
Dr. Arsène Ratsimbasoa, National Program in the Fight Against Malaria ("PNLP"). Tel: 0340541965
Do you have any questions?
May I begin the interview now?
Interviewer's signature: ______
Date: ______
2 RESPONDENT DOES NOT AGREE 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?
COMPARE AND CORRECT 102 AND/0R 103 IF INCONSISTENT.
104. Have you ever attended school?
2 NO (Skip to 108)
105. What is the highest level of studies you 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 successfully completed at this level?
IF LESS THAN ONE YEAR WAS COMPLETED AT THIS LEVEL, RECORD '0'.
(Table)
LEVEL OF EDUCATION
PRIMARY LEVEL
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.
SHOW CARD TO RESPONDENT.
IF RESPONDENT CANNOT READ THE WHOLE SENTENCE, PROBE:
Can you read part of the sentence?
2 CAN 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 WITHOUT 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?
IF NONE, RECORD '00'.
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?
IF NONE, RECORD '00'.
DAUGHTERS ELSEWHERE ______
206. Have you ever given birth to a boy or girl who was born alive but who later died?
IF NO, PROBE: No baby who cried or showed other signs of life but who didn't survive?
2 NO (Skip to 208)
207. How many boys died?
How many girls died?
IF NONE, RECORD '00'.
DECEASED GIRLS ______
208. TOTAL UP THE ANSWERS TO 203, 205, AND 207 AND RECORD THE TOTAL.
TOTAL BIRTHS ______
I would like to be sure I understood correctly: you have had a TOTAL of ______ births in your life. Is that correct?
NO ______ PROBE AND CORRECT 201 - 208 AS NECESSARY
ONE BIRTH ______ (Ask question:)
TWO OR MORE BIRTHS______ (Ask question:)
IF NONE, RECORD '00'.
TOTAL IN LAST SIX YEARS ______
211. Now I would like to record the names of all the births you had in the last six years, whether they are still living or not, beginning with the most recent birth.
RECORD THE NAME OF ALL BIRTHS IN THE LAST SIX YEARS IN Q.212. RECORD TWINS/TRIPLETS ON SEPARATE LINES.
212. What name was given to your (last/preceding) baby?
213. Is (NAME) a single or multiple birth?
2 MULTIPLE
214. Is (NAME) a boy or a girl?
2 GIRL
215. In what month and year was (NAME) born?
PROBE:
YEAR ______
2 NO (Go to NEXT BIRTH)
217. IF LIVING:
How old was (NAME) on his/her last birthday?
RECORD AGE IN COMPLETED YEARS.
218. IF LIVING:
Does (NAME) live with you?
2 NO
RECORD CHILD'S LINE NUMBER FROM HOUSEHOLD SCHEDULE.
(RECORD '00' IF CHILD IS NOT LISTED IN HOUSEHOLD)
220. Where there other live births between (NAME) and (NAME OF BIRTH FROM PRECEDING LINE)?
1 YES
2 NO
221. Have you had other live births since that of (NAME OF LAST BIRTH)? IF YES, RECORD THE BIRTH(S) IN THE BIRTH SCHEDULE.
2 NO
222. COMPARE 210 TO THE NUMBER OF BIRTHS RECORDED IN THE TABLE BELOW AND CHECK OFF:
NUMBERS ARE DIFFERENT ______ (PROBE AND CORRECT)
223. CHECK 215 AND RECORD THE NUMBER OF BIRTHS IN 2008 OR LATER.
IF NONE, RECORD '0'.
______
2 NO (Skip to 226)
8 UNSURE (Skip to 226)
225. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.
NO BIRTHS IN 2008 OR LATER ______ (Skip to 401)
SECTION 3A. PREGNANCY AND INTERMITTENT PREVENTIVE TREATMENT
301. RECORD THE NAME AND SURVIVORSHIP STATUS OF LAST BIRTH IN 302.
Now, I would like to ask you some questions about your last pregnancy in the last 6 years.
302. ACCORDING TO Q. 212 AND Q. 216 (LINE 01)
NAME: ______
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)
304. Whom did you see?
Anyone else?
PROBE TO DETERMINE EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
B NURSE/MIDWIFE/MEDICAL ASSISTANT
D UNTRAINED TRADITIONAL BIRTH ATTENDANT
Y NO ONE
304A. Do you have a health card?
IF CARD IS AVAILABLE, SEE IF IT CONTAINS INFORMATION ON PREVENTIVE TREATMENT FOR MALARIA DURING THIS PREGNANCY.
2 YES, CARD, BUT DIDN'T SEE
3 YES, CARD SEEN, BUT NO INFORMATION ON PREVENTIVE TREATMENT FOR MALARIA
4 YES, CARD SEEN AND INFORMATION ON PREVENTIVE TREATMENT FOR MALARIA
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?
RECORD ALL MENTIONED.
IF TYPE OF MEDICATION IS NOT DETERMINED, SHOW COMMON ANTIMALARIALS TO RESPONDENT.
B CHLOROQUINE
C QUININE
X OTHER (SPECIFY) ______
Z DK
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 obtain the intermittent preventive treatment (SP/Fansidar) during an antenatal visit, during another visit to a health facility, or from another source?
1 ANTENATAL VISIT
2 OTHER VISIT TO HEALTH FACILITY
3 OUTREACH SERVICE/MOTHER AND CHILD HEALTH WEEK ("SSME")
6 OTHER SOURCE (SPECIFY) ______
OTHER ______ (Skip to 315)
313. How many times did you take the medication 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 2008 OR LATER ______ (Skip to 401)
SECTION 3B. FEVER IN CHILDREN
316. RECORD IN SCHEDULE THE LINE NUMBER AND NAME OF EACH LIVING CHILD BORN IN 2008 OR LATER.
(IF THERE ARE MORE THAN 2 LIVING CHILDREN BORN IN 2008 OR LATER, USE AN ADDITIONAL QUESTIONNAIRE).
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 ______
NAME ______
319. Did (NAME) have a fever at any time in the last 2 weeks?
2 NO (GO TO NEXT COLUMN IN 317 OR, IF NO MORE CHILREN, SKIP TO 389)
8 DK (GO TO NEXT COLUMN IN 317 OR, IF NO MORE CHILREN, SKIP TO 389)
320. How many days ago did the fever begin?
98 DK
321. Did you seek out any advice or treatment for the fever from any source?
2 NO (Skip to 324)
322. Where did you seek advice or treatment?
Anywhere else?
RECORD ALL SOURCES MENTIONED.
B HOSPITAL CENTER I
C BASIC HEALTH CENTER II
D BASIC HEALTH CENTER 1
E OTHER PUBLIC (SPECIFY) ______
G PRIVATE HEALTH CENTER
H PHARMACY/MEDICINE DEPOT
I PRIVATE DOCTOR
J FAMILY PLANNING CENTER/"FISA"
K ADOLESCENT HEALTH SERVICE ("TOP" NETWORK)
L OTHER PRIVATE MEDICAL (SPECIFY) ______
[###translator's note: "FISA" is a family planning association in Madagascar]
N SHOP
O KIOSK
P TRADITIONAL HEALER
Q FRIEND/FAMILY MEMBER
R MARKET
X OTHER (SPECIFY) ______
323. How many days after the onset of the fever did you start looking for a treatment for (NAME)?
323A. Do you have a health card for (NAME)?
IF CARD AVAILABLE, SEE IF IT CONTAINS INFORMATION ON TREATMENT OF CURRENT/RECENT FEVER
2 YES, CARD, BUT DIDN'T SEE
3 YES, CARD SEEN, BUT NO INFORMATION ON TREATMENT OF FEVER
4 YES, CARD SEEN AND INFORMATION ON TREATMENT OF FEVER
324. At any time during the illness, did someone draw blood from (NAME)'s finger or heel?
2 NO (Skip to 325)
8 DK (Skip to 325)
324A. Where was (NAME)'s blood drawn last time?
12 HOSPITAL CENTER I
13 PRIMARY HEALTH CENTER II
14 PRIMARY HEALTH CENTER I
15 OTHER PUBLIC (SPECIFY) ______
22 PRIVATE HEALTH CENTER
23 PHARMACY/MEDICINE DEPOT
24 PRIVATE DOCTOR
25 FAMILY PLANNING CENTER/("FISA")
26 ADOLESCENT HEALTH SERVICE ("TOP" NETWORK)
27 OTHER PRIVATE MEDICAL (SPECIFY) ______
32 OTHER (SPECIFY) ______
325. Did (NAME) take any medicine for the fever at any time during the illness?
2 NO (Skip to 389)
8 DK (Skip to 389)
326. What medication did (NAME) take?
Any other medication?
RECORD ALL MENTIONED.
ASK TO SEE THE MEDICINE IF TYPE OF MEDICINE ISN'T KNOWN. IF TYPE OF MEDICINE CANNOT BE IDENTIFIED, SHOW COMMON ANTIMALARIALS TO THE RESPONDENT.
B CHLOROQUINE
C AMODIAQUINE
D QUININE
E ACTIPAL (ACT)
F LARIMAL (ACT)
G ARTEMODI (ACT)
H ARSUMOON (ACT)
I FALCIMON (ACT)
J ASAQ WINTHROP (ACTm)
K ARTEFAN (ACTm)
L OTHER UNDETERMINED ARTEMISININE COMBINATION (ACT/ACTm)
M OTHER ANTIMALARIAL (SPECIFY) ______
O INJECTION
Q ACETAMINOPHEN
R IBUPROFEN
S PARACETAMOL
X OTHER (SPECIFY) ______
Z DK
327. How much did you pay in all for the medicine and health visits for (NAME)'s fever?
RECORD COST IN ARIARY.
IF MORE THAN 99,000 ARIARY, RECORD 99,000.
99995 FREE
99998 DK
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 the fever did (NAME) start taking the SP/Fansidar?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE DAYS AFTER FEVER
4 FOUR 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 the fever did (NAME) start taking the chloroquine?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE DAYS AFTER FEVER
4 FOUR DAYS AFTER FEVER
8 DK
337. How many days did (NAME) take the chloroquine?
8 DK
338. How many tablets of chloroquine 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 the amodiaquine?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE DAYS AFTER FEVER
4 FOUR DAYS AFTER FEVER
8 DK
342. How many days did (NAME) take the amodiaquine?
8 DK
343. How many tablets of amodiaquine did (NAME) take per day?
CODE '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 the quinine?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE DAYS AFTER FEVER
4 FOUR DAYS AFTER FEVER
8 DK
347. How many days did (NAME) take the quinine?
8 DK
348. How many tablets of quinine 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 the Actipal?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE DAYS AFTER FEVER
4 FOUR DAYS AFTER FEVER
8 DK
352. How many days did (NAME) take the Actipal?
8 DK
353. How many tablets of Actipal 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.
2 EXPIRATION DATE PASSED
8 DK
356. How soon after the onset of the fever did (NAME) start taking the Larimal?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE DAYS AFTER FEVER
4 FOUR DAYS AFTER FEVER
8 DK
357. How many days did (NAME) take the Larimal?
8 DK
358. How many tablets 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 the fever did (NAME) start taking the Artemodi?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE DAYS AFTER FEVER
4 FOUR DAYS AFTER FEVER
8 DK
362. How many days did (NAME) take the 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) start taking the Arsumoon?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE DAYS AFTER FEVER
4 FOUR DAYS AFTER FEVER
8 DK
367. How many days did (NAME) take the Arsumoon?
8 DK
368. How many tablets of Artsumoon did (NAME) take per day?
IF 7 OR MORE TABLETS, RECORD '7'.
CODE 'I' NOT CIRCLED ______ (Skip to 373A)
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 the Falcimon?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE DAYS AFTER FEVER
4 FOUR DAYS AFTER FEVER
8 DK
372. How many days did (NAME) take the Falcimon?
8 DK
373. How many tablets of Falcimon did (NAME) take per day?
CODE 'J' NOT CIRCLED ______ (Skip to 373F)
373B. IF YOU CAN SEE THE ASAQ WINTHROP (ACTm), CHECK IF THE EXPIRATION DATE HAS PASSED.
2 EXPIRATION DATE PASSED
8 DK
373C. How soon after the onset of the fever did (NAME) start taking the ASAQ Winthrop?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE DAYS AFTER FEVER
4 FOUR DAYS AFTER FEVER
8 DK
373D. How many days did (NAME) take the ASAQ Winthrop?
8 DK
373E. How many tablets of ASAQ Winthrop did (NAME) take per day?
CODE 'K' NOT CIRCLED ______ (Skip to 374)
373G. IF YOU CAN SEE THE ARTEFAN (ACTm), CHECK IF THE EXPIRATION DATE HAS PASSED.
2 EXPIRATION DATE PASSED
8 DK
373H. How soon after the onset of the fever did (NAME) start taking the ARTEFAN (ACTm)?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE DAYS AFTER FEVER
4 FOUR DAYS AFTER FEVER
8 DK
373I. How many days did (NAME) take the ARTEFAN (ACTm)?
8 DK
373J. How many tablets of ARTEFAN (ACTm) did (NAME) take per day?
CODE 'L' 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 WHETHER IT'S A COMBINATION OR COBLISTER, OTHERWISE SHOW THE SAMPLE YOU HAVE AND ASK RESPONDENT WHICH ACT IT IS.
2 COBLISTER
8 DK
377. How soon after the onset of the fever did (NAME) start taking the ACT?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE DAYS AFTER FEVER
4 FOUR DAYS AFTER FEVER
8 DK
378. How many days did (NAME) take the ACT?
8 DK
379. How many tablets of ACT did (NAME) take per day?
CODE 'M' 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 taking the (NAME OF OTHER ANTIMALARIAL)?
1 NEXT DAY
2 TWO DAYS AFTER FEVER
3 THREE DAYS AFTER FEVER
4 FOUR DAYS AFTER FEVER
8 DK
383. How many days did (NAME) take the (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 for him/her?
2 STOPPED BECAUSE CHILD CURED/HEALTH IMPROVED/MEDICINE NO LONGER NECESSARY
6 OTHER (SPECIFY) ______
8 DK
387. Did (NAME) have any of the following symptoms?
Very high fever, higher than 39.5 degrees C?
Anemia?
Prostration, that is, extreme weakness?
Loss of consciousness?
Severe respiratory failure?
Convulsions?
Abnormal breathing?
Icterus/Jaundice (with coloring of eyes)?
Black or brown urine?
Uncontrollable vomiting?
Refused 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
388. RETURN TO NEXT COLUMN IN 317, OR IF NO MORE CHILDREN, CONTINUE TO 389.
RETURN TO FIRST COLUMN IN 317 OF NEW QUESTIONNAIRE, OR, IF NO MORE CHILDREN, CONTINUE TO 389.
389. CHECK 319: DID ANY CHILDREN HAVE A FEVER?
NO CHILDREN HAD FEVER ______ (Skip to 394)
390. When your child has/children have a fever, how urgent is it 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 has/children have a fever, do you agree or disagree that he/she should first be treated with medicinal herbs or other practices?
IF NO (DISAGREE): Are you somewhat opposed or completely opposed?
2 SOMEWHAT AGREE
3 SOMEWHAT OPPOSED
4 COMPLETELY OPPOSED
392. When your child has/children have a fever, is the treatment (including consultations) affordable or unaffordable?
IF UNAFFORDABLE: Is it unaffordable or truly unaffordable?
2 AFFORDABLE
3 UNAFFORDABLE
4 TRULY UNAFFORDABLE
393. When your child has/children have a fever, are antimalarials always available or not available?
IF UNAVAILABLE: Are they rarely available or never available?
2 OFTEN AVAILABLE
3 RARELY AVAILABLE
4 NEVER AVAILABLE
394. If your child's fever is treated with an antimalarial, does the fever go down rapidly?
IF NO: Rarely or never?
2 SOMETIMES
3 RARELY
4 NEVER
395. Do you keep partial doses of antimalarial medicine in order to use them some time in the future?
2 NO
401. How can a person contract malaria?
PROBE: No other way?
RECORD ALL MENTIONED.
B MOSQUITO BITE
C NOT TAKING PREVENTIVE MEDECINE
D PHYSICAL EFFORT/FATIGUE
E DIRECT EXPOSURE TO SUNLIGHT WHILE WORKING
F STAYING OUT IN THE RAIN
G SUDDEN CHANGE IN 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 primary symptom of malaria?
12 LACK OF APPETITE AND VOMITING
13 HIGH FEVER WITH CONVULSIONS
14 HIGH FEVER WITH FAINTING
15 PERSISTENT FEVER
16 CONVULSIONS
17 JAUNDICE
96 OTHER (SPECIFY) ______
98 DK
403. What are effective ways of preventing malaria?
PROBE: No other way?
RECORD ALL MENTIONED.
B SLEEPING UNDER AN INSECTICIDE-TREATED MOSQUITO NET
C SLEEPING UNDER AN INSECTICIDE-TREATED MOSQUITO NET EVERY DAY
D TAKING PREVENTIVE MEDICINE
E TAKING TABLETS DURING PREGNANCY
F USING INSECT REPELLANT/DIFFUSER/CREAMS/LOTIONS
G USING ANTI-MOSQUITO COIL
H AVOIDING CATCHING COLD
I AVOIDING EXPOSURE TO DIRECT SUNLIGHT
J CLEANING SURROUNDINGS
K SPRAYING INSIDE DWELLING
W OTHER (SPECIFY) ______
X OTHER (SPECIFY) ______
Z DK
404. Which people are most vulnerable to malaria?
PROBE: No one else?
RECORD ALL MENTIONED.
B CHILDREN
C PREGNANT WOMEN
D WOMEN
E MEN
F OLD PEOPLE
G EVERYONE
W OTHER (SPECIFY) ______
404A. CHECK COVER PAGE: CLUSTER NUMBER
CLUSTERS [117 - 126] [237 - 243] [ 275 - 284]______ (Continue to 404B, 2nd question)
OTHER CLUSTERS ______ (Skip to 405)
404B. (1st question)
In the months of November and December 2012, did you hear or receive any messages about the insecticidal mosquito net distribution campaign?
(2nd question)
In the months of December 2012 and February 2013, did you hear or receive any messages about the insecticidal mosquito net distribution campaign?
2 NO (Skip to 405)
404C. Did you hear or receive any messages BEFORE the distribution?
2 NO (Skip to 404E)
404D. How did you hear or receive these messages?
Any other way?
RECORD ALL MENTIONED.
B GROUP ACTIVITY
C RADIO/TV ADS
X OTHER (SPECIFY) ______
404E. Did you hear or receive any messages DURING the distribution?
2 NO (Skip to 404G)
404F. How did you hear or receive these messages?
Any other way?
RECORD ALL MENTIONED.
B GROUP ACTIVITY
C RADIO/TV ADS
X OTHER (SPECIFY) ______
404G. Did you hear or receive any messages AFTER the distribution?
2 NO (Skip to 404I)
404H. How did you hear or receive these messages?
Any other way?
RECORD ALL MENTIONED.
B GROUP ACTIVITY
C RADIO/TV ADS
X OTHER (SPECIFY) ______
404I. What messages did you hear or receive (before, during or after the distribution campaign)?
No other kinds of messages?
RECORD ALL MENTIONED.
B WHEN TO GET AN INSECTICIDE-TREATED MOSQUITO NET
C THE INSECTICIDE-TREATED MOSQUITO NET IS FREE
D HOW TO HANG UP THE INSECTICIDE-TREATED MOSQUITO NET
E HOW TO CARE FOR THE INSECTICIDE-TREATED MOSQUITO NET
F WHEN TO USE THE INSECTICIDE-TREATED MOSQUITO NET
G BENEFITS OF TAKING THE INSECTICIDE-TREATED MOSQUITO NET
W OTHER (SPECIFY) ______
X OTHER (SPECIFY) ______
405. In the last 12 months, have you:
Attended any awareness campaign on malaria treatment given by a community leader?
Attended any awareness campaign on malaria treatment delivered by a mobile video unit (MVU)?
Heard about malaria treatment on the radio?
Seen something about malaria treatment on TV?
Seen something about malaria treatment in a newspaper or magazine?
2 NO
2 NO
2 NO
2 NO
2 NO
406. In the last 12 months, have you received any messages about malaria treatment, concerning:
ACTIPAL use?
ACT use?
Treatment cost?
Treatment availability?
Treatment effectiveness?
Other messages about malaria treatment?
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
407. In the last 12 months, have you:
Attended any awareness campaign on malaria prevention (insecticidal nets "MID"/Indoor Spraying Campaign "CAID"/Intermittent Preventive Treatment "TPI") by a community leader?
Attended any awareness campaign on malaria prevention (insecticidal nets "MID"/Indoor Spraying Campaign "CAID"/Intermittent Preventive Treatment "TPI") by a Mobile Video Unit?
Heard about malaria prevention (insecticidal nets "MID"/Indoor Spraying Campaign "CAID"/Intermittent Preventive Treatment "TPI") on the radio?
Seen something about malaria prevention (insecticidal nets "MID"/Indoor Spraying Campaign "CAID"/Intermittent Preventive Treatment "TPI") on TV?
Seen something about malaria prevention (insecticidal nets "MID"/Indoor Spraying Campaign "CAID"/Intermittent Preventive Treatment "TPI") in a newspaper or magazine?
2 NO
2 NO
2 NO
2 NO
2 NO
408. In the last 12 months, have you received any messages about insecticide-treated nets for prevention of malaria such as:
Where to get an insecticide-treated mosquito net?
When to get an insecticide-treated mosquito net?
The insecticide-treated mosquito net is free?
How to hang an insecticide-treated mosquito net?
How to take care of an insecticide-treated mosquito net?
When to use an insecticide-treated mosquito net?
Benefits of taking an insecticide-treated mosquito net?
Any other message about an insecticide-treated mosquito net?
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 Spraying Campaign ("CAID") for prevention of malaria such as:
Staying outside of the house after the indoor spraying?
The fact that indoor spraying is not dangerous to one's health?
Any other message about indoor spraying?
2 NO
2 NO
2 NO
410. In the last 12 months, have you received any messages about malaria prevention for pregnant women such as:
Intermittent Preventive Treatment?
Any other message about malaria prevention for pregnant women?
2 NO
2 NO
410A. In the last 12 months, have you attended any awareness-raising event for the fight against malaria in a public place, led by a community agent, for example in small group sessions during market days?
2 NO (Skip to 410C)
8 DON'T REMEMBER (Skip to 410C)
410B. What were the topics of the awareness raising?
No other subjects?
RECORD ALL MENTIONED
B USE OF RAPID TESTS
C TREATMENT WITH ACTs
D OTHER (SPECIFY) ______
F INDOOR SPRAYING CAMPAIGN
G INTERMITTENT PREVENTIVE TREATMENT FOR PREGNANT WOMEN
W OTHER (SPECIFY) ______
410C. In the last 12 months, was your household visited by a community agent to talk about the fight against malaria?
2 NO (Skip to 410E)
8 DON'T REMEMBER (Skip to 410E)
410D. What were the discussion topics?
No other topics?
RECORD ALL MENTIONED.
B USE OF RAPID TESTS
C TREATMENT WITH ACTs
D OTHER (SPECIFY) ______
F INDOOR SPRAYING CAMPAIGN
G INTERMITTENT PREVENTIVE TREATMENT FOR PREGNANT WOMEN
W OTHER (SPECIFY) ______
410E. In the last 12 months, have you attended a big outdoor event organized as part of the fight against malaria?
2 NO (Skip to 411)
8 DON'T REMEMBER (Skip to 411)
410F. What kind of events?
No other events?
RECORD ALL MENTIONED.
B PUPPET SHOW
C FOLK PERFORMANCE
D SPORTING EVENT OR COMPETITION
E MOBILE VIDEO UNIT SCREENING
W OTHER (SPECIFY) ______
411. Do you know of a place where you can get antimalarials?
2 NO
412. Does a child who has a fever need to go to a health center or can he/she stay at home for treatment?
2 HOME
8 DK
ACTipal?
Larimal?
Artemia?
Arsumoon?
Falcimon?
ACT?
ACTm?
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
415. In your opinion, which antimalarial is the most effective for treating pregnant women who have malaria symptoms?
DO NOT READ ANSWERS.
12 LARIMAL
13 ARTEMODI
14 ARSUMOON
15 FALCIMON
16 ACT
17 ACTm
96 OTHER (SPECIFY) ______
98 DK
416. In your opinion, which antimalarial is the most effective for treating children under the age of five?
DO NOT READ ANSWERS.
12 LARIMAL
13 ARTEMODI
14 ARSUMOON
15 FALCIMON
16 ACT
17 ACTm
18 ASAQ/ARTESUNATE AMODIAQUINE
96 OTHER (SPECIFY) ______
98 DK
417. What must a pregnant woman do during pregnancy to prevent malaria?
RECORD ALL MENTIONED
B SLEEP UNDER AN INSECTICIDE TREATED NET
C TPI
X OTHER (SPECIFY) ______
8 DK
418. Where should a pregnant woman go to get 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 centers in order to prevent contracting 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 insecticide treated net?
DO NOT READ ANSWERS.
PROBE: No other advantages?
RECORD ALL MENTIONED.
B KILLS MOSQUITOS/OTHER INSECTS
C KEEPS MOSQUITOS/OTHER INSECTS AWAY
D BEST FOR PREVENTING MALARIA
E BEST FOR PREVENTING MISCARRIAGES/STILLBIRTHS
F WOMAN BETTER PROTECTED AGAINST ILLNESSES
G SAVES MONEY BECAUSE CHILD NOT SICK
H PREVENTS LOW BIRTH WEIGHT AT BIRTH
I YOU SLEEP WELL
X OTHER (SPECIFY) ______
Z DK
421. In your opinion, what are the disadvantages of sleeping under an insecticide treated net?
PROBE: No other disadvantages?
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/DIFFICULTY BREATHING
H INSECTICIDE USED NOT EFFECTIVE
I MOSQUITO NET GETS DIRTY QUICKLY
J NO DISADVANTAGES
X OTHER (SPECIFY) ______
Z DK
422. During which months or seasons of the year should people sleep under an insecticide treated net?
2 WET SEASON
3 ALL YEAR LONG
8 DK
423. Do you think that a Super Moustiquaire brand mosquito net sold for 3000 ariary is affordable?
2 NO
8 DK
424. Do you have conversations with your friends or neighbors about malaria often, rarely, or never?
2 RARELY
3 NEVER
425. To what extent do you think it is important for your children to sleep under an insecticide treated net: extremely important, very important, not very important, not at all important?
2 VERY IMPORTANT
3 NOT VERY IMPORTANT
4 NOT AT ALL IMPORTANT
426. Do you ever use the mosquito nets for something other than sleeping: all the time, sometimes, rarely, never?
2 SOMETIMES
3 RARELY
4 NEVER
5 NEVER HAD A MOSQUITO NET
427. Now I would like to know your opinion about certain statements. I ask that you make an effort to say what you really think. I realize that some of the questions may seem repetitious but I am asking them to determine your true opinion.
428. Do you agree or disagree with the following opinion: Insecticide treated 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 insecticide treated 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 home.
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 only risks contracting malaria during the rainy season.
IF DISAGREE: Do you disagree or totally disagree?
2 AGREE
3 DISAGREE
4 TOTALLY DISAGREE
432. What brand of insecticide treated net do you prefer?
12 PERMANET
13 SUPER MOUSTIQUAIRE
14 MILAY
15 TSARALAY
16 INTERCEPTOR
17 POLYESTER
18 POLYETHELENE
19 DOESN'T MATTER
96 OTHER
98 NONE/DK
433. Do you know where you can get a mosquito net?
2 NO (Skip to 435)
434. What are all the places you know of where you can get an insecticide treated net?
No other place?
PROBE TO DETERMINE THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PRIVATE OR PUBLIC ESTABLISHMENT, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE) ______
B BASIC HEALTH CENTER I
D PRIVATE HEALTH CENTER
E PHARMACY/DRUG DISPENSARY
F PRIVATE DOCTOR
H SHOP
I KIOSK
J FRIENDS/RELATIVES
X OTHER (SPECIFY) ______
MINUTES _____
INTERVIEWER'S OBSERVATIONS
TO BE FILLED OUT WHEN INTERVIEW IS COMPLETED
COMMENTS ABOUT RESPONDENT:
______
COMMENTS ABOUT PARTICULAR QUESTIONS:
______
OTHER COMMENTS:
______
TEAM LEADER'S OBSERVATIONS:
______