Data Cart

Your data extract

0 variables
0 samples
View Cart



MALARIA INDICATORS SURVEY IN MALI ("EIP" Mali 2021)
WOMAN'S QUESTIONNAIRE

DATE: 21 August 2021

MINISTRY OF THE ECONOMY AND FINANCE
NATIONAL INSTITUTE OF STATISTICS ("INSTAT")

MINISTRY OF HEALTH AND SOCIAL DEVELOPMENT
NATIONAL PROGRAM IN THE FIGHT AGAINST MALARIA ("PNLP")

IDENTIFICATION

NAME OF LOCALITY ______
NAME OF HEAD OF HOUSEHOLD ______
CLUSTER NUMBER ______
CONCESSION NUMBER ______
HOUSEHOLD NUMBER ______
NAME AND LINE NUMBER OF WOMAN ______

INTERVIEWER'S VISITS

DATE ______
NAME OF INTERVIEWER ______
RESULT ______

NEXT VISIT:
DATE ______
TIME ______

FINAL VISIT
DAY ______
MONTH ______
YEAR 2021
INTERVIEWER'S NUMBER______
RESULT CODE ______

TOTAL NUMBER OF VISITS ______

RESULT CODES:

1 COMPLETED
2 NOT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) ______

LANGUAGE OF QUESTIONNAIRE 01
LANGUAGE OF INTERVIEW ______
NATIVE LANGUAGE OF RESPONDENT ______
INTERPRETER USED (YES = 1, NO = 2) ______
LANGUAGE OF QUESTIONNAIRE FRENCH

CODE

01 FRENCH
02 BAMBARA/MALINKE
03 SONRAI/DJERMA
04 PEUL/FULFULDE
05 SENOUFO
06 MARKA/SONINKE
07 DOGON
08 MINIANKA
09 TAMASHEK
10 BOBO/DAFING
11 BOZO
96 OTHER (SPECIFY) ______

TEAM LEADER
NAME ______
NUMBER ______

INTRODUCTION AND CONSENT REQUEST

Hello. My name is ______. I work for the National Institute of Statistics ("INSTAT"). In collaboration with the National Program in the Fight Against Malaria ("PNLP"),we are conducting a national survey of malaria in Mali. The information that we collect will help the government improve health services. Your household was selected for this survey. We would like to ask you a few questions about your household. The questions usually take about 10-20 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 are not obligated to participate in this survey, but we hope that you will accept to answer our questions for your opinion is very important. If I happen to ask a question that you do not want to answer, tell me and I will go on to the next question; you can also stop the interview at any time.

If you want more information about the survey, you can also contact the person named on the card that was already given to your household.

Do you have any questions to ask me?
May I begin the interview now?

SIGNATURE OF INTERVIEWER ______
DATE ______
1 RESPONDENT AGREES TO BE INTERVIEWED (Continue to 101)
2 RESPONDENT DOES NOT AGREE TO BE INTERVIEWED (Skip to END)

SECTION 1. SOCIODEMOGRAPHIC BACKGROUND OF RESPONDENT.

101. RECORD THE TIME.

HOUR ______
MINUTES ______

102. In what month and year were you born?

MONTH ______
98 DK MONTH
YEAR ______
9998 DK YEAR

103. How old were you on your last birthday?

COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT.

AGE IN COMPLETED YEARS ______

104. Have you ever attended school?

1 YES
2 NO (Skip to 108)

105. What is the highest level of studies that you have reached: basic 1 (1st cycle), basic 2 (2nd cycle), secondary (high school, technical, professional), or higher?

1 BASIC 1st Cycle
2 BASIC 2nd Cycle
3 SECONDARY (High School/Technical/Professional)
4 HIGHER

106. What is the highest [GRADE/YEAR] that you have completed at this level?

IF LESS THAN ONE YEAR WAS COMPLETED AT THIS LEVEL, RECORD '00'.

[YEAR/GRADE] ______

Codes for Q. 106

BASIC 1st Cycle
0 LESS THAN 1 YEAR
1 1ST GRADE
2 2ND GRADE
3 3RD GRADE
4 4TH GRADE
5 5TH GRADE
6 6TH GRADE
BASIC 2nd Cycle
0 LESS THAN 1 YEAR
1 7TH GRADE
2 8TH GRADE
3 9TH GRADE
SECONDARY (High School, Technical, Professional)
0 LESS THAN 1 YEAR
1 10TH GRADE
2 11TH GRADE
3 12TH GRADE
4 4TH YEAR (College Prep)
HIGHER
0 LESS THAN 1 YEAR
1 1ST YEAR
2 2ND YEAR
3 3RD YEAR
4 4TH YEAR
5 5TH YEAR

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?

1 CANNOT READ AT ALL
2 CAN READ ONLY PARTS OF THE SENTENCE
3 CAN READ ENTIRE SENTENCE
4 NO CARD IN LANGUAGE REQUESTED (SPECIFY LANGUAGE) ______
5 BLIND/VISUALLY IMPAIRED

109. CHECK 108:

CODE '2', '3', OR '4' CIRCLED ______ (Continue to 110)
CODE '1' OR '5' CIRCLED ______ (Skip to 111)

110. Do you read a newspaper or magazine at least once a week, less than once a week, or not at all?

1 AT LEAST ONCE A WEEK
2 LESS THAN ONCE A WEEK
3 NOT AT ALL

111. Do you listen to the radio at least once a week, less than once a week, or not at all?

1 AT LEAST ONCE A WEEK
2 LESS THAN ONCE A WEEK
3 NOT AT ALL

112. Do you watch television at least once a week, less than once a week, or not at all?

1 AT LEAST ONCE A WEEK
2 LESS THAN ONCE A WEEK
3 NOT AT ALL

113. Do you have a mobile phone?

1 YES
2 NO (Skip to 115)

114. Is your mobile phone a smart phone?

1 YES
2 NO

115. Have you ever used the internet from any place or any device?

1 YES
2 NO (Skip to 118)

116. In the last 12 months, have you used the internet?

IF NECESSARY, PROBE TO DETERMINE IF USED IN ANY PLACE WITH ANY DEVICE.

1 YES
2 NO (Skip to 118)

117. In the last month, how many times have you used the internet: almost every day, at least once a week, less than once a week or not at all?

1 ALMOST EVERY DAY
2 AT LEAST ONCE A WEEK
3 LESS THAN ONCE A WEEK
4 NOT AT ALL

118. What religion do you practice?

01 MUSLIM
02 CATHOLIC
03 PROTESTANT
04 OTHER CHRISTIAN RELIGION
05 ANIMIST
06 WITHOUT RELIGION
96 OTHER (SPECIFY) ______

119. What is your ethnicity?

01 BAMBARA
02 MALINKE
03 PEUL
04 SARAKOLE/SONINKE/MARKA
05 KASSONKE
06 SONRAI
07 DOGON
08 TUAREG/BELLA
09 SENOUFO/NINIANKA
10 BOBO
11 BOZO
12 ARAB/MOOR
16 OTHER MALIAN ETHNICITY (SPECIFY) ______
21 ECOWAS COUNTRY
22 OTHER AFRICAN COUNTRIES
23 OTHER NATIONALITIES

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?

1 YES
2 NO (Skip to 206)

202. Do you have any sons or daughters to whom you gave birth who are currently living with you?

1 YES
2 NO (Skip to 204)

203. a) How many sons live with you?
b) How many daughters live with you?

IF NONE, RECORD '00'.

a) SONS AT HOME ______
b) 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?

1 YES
2 NO (Skip to 206)

205. a) How many sons are living but do not live with you?
b) How many daughters are living but do not live with you?

IF NONE, RECORD '00'.

a) SONS ELSEWHERE ______
b) 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, made a sound, tried to breathe, or showed other signs of life for a short time?

1 YES
2 NO (Skip to 208)

207. a) How many boys died?
b) How many girls died?

IF NONE, RECORD '00'.

a) DECEASED BOYS ______
b) DECEASED GIRLS ______

208. TOTAL UP THE ANSWERS TO 203, 205, AND 207 AND RECORD THE TOTAL.
IF NONE, RECORD '00'.

TOTAL BIRTHS ______

209. CHECK 208:

I would like to be sure I understood correctly: you have had a TOTAL of ______ births in your life. Is that correct?

YES ______ (Continue to 210)
NO ______ (PROBE AND CORRECT 201 - 208 AS NECESSARY)

210. CHECK 208:

ONE OR MORE BIRTHS ______ (Continue to 211)
NO BIRTHS ______ (Skip to 224)

211. Now I would like to ask you questions about your most recent births. How many births did you have between 2016 - 2021?

RECORD TOTAL NUMBER OF BIRTHS IN 2016 - 2021

TOTAL IN 2016 - 2021______
00 NONE (Skip to 224)

212. Now I would like to record the names of all the births you had in 2016 - 2021, whether they are still living or not, beginning with the most recent birth.

RECORD THE NAME OF ALL BIRTHS IN 2016 - 2021 IN Q.213. RECORD TWINS/TRIPLETS ON SEPARATE ROWS. IF THERE ARE MORE THAN 4 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, BEGINNING ON THE SECOND ROW.

(Repeat 213 - 221 for up to 4 births)

213. What name was given to your (last/preceding) baby?

RECORD THE NAME.
NUMBER IN BIRTH HISTORY.

01 ______

214. Is (NAME) a boy or a girl?

1 BOY
2 GIRL

215. Is (NAME) a single or multiple birth?

1 SINGLE
2 MULTIPLE

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

DAY ______
MONTH ______
YEAR ______

217. Is (NAME) still alive?

1 YES
2 NO (Go to NEXT BIRTH)

218. IF LIVING:
How old was (NAME) on his/her last birthday?

RECORD AGE IN COMPLETED YEARS.

AGE IN YEARS ______

219. IF LIVING:
Does (NAME) live with you?

1 YES
2 NO

220. IF LIVING:

RECORD CHILD'S LINE NUMBER FROM HOUSEHOLD SCHEDULE.
RECORD '00' IF CHILD IS NOT LISTED IN HOUSEHOLD.

LINE NUMBER FROM HOUSEHOLD SCHEDULE ______ (Go to NEXT BIRTH)

221.Were there other live births between (NAME OF PRECEDING BIRTH) and (NAME), including babies who died after birth?

1 YES (ADD BIRTH)
2 NO (GO TO NEXT BIRTH)

222. Have you had other live births since that of (NAME OF LAST BIRTH)?

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

223. COMPARE 211 WITH NUMBER OF BIRTHS IN BIRTH HISTORY

NUMBERS ARE EQUAL ______ (Continue to 224)
NUMBERS ARE DIFFERENT ______ (PROBE AND CORRECT)

224. Are you pregnant now?

1 YES
2 NO (Skip to 301)
8 UNSURE (Skip to 301)

225. How many weeks or months pregnant are you?

RECORD THE NUMBER OF COMPLETED WEEKS OR MONTHS.

1 WEEKS ______
2 MONTHS ______

SECTION 3. PREGNANCY AND INTERMITTENT PREVENTIVE TREATMENT

301. CHECK 216:

ONE OR MORE BIRTHS 0 - 35 MONTHS BEFORE SURVEY ______ (Continue to 302)
NO BIRTHS 0 - 35 MONTHS BEFORE SURVEY ______ (Skip to 401)

302. RECORD NAME OF LAST BIRTH FROM 213, ROW 01:

LAST BIRTH:
NAME: ______

303. 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?

1 YES
2 NO (Skip to 308)

304. Whom did you see?
Anyone else?

PROBE TO DETERMINE EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEALTH PROFESSIONAL
A DOCTOR
B NURSE/MIDWIFE
C VILLAGE MIDWIFE "MATRONE"
OTHER PERSONNEL
D TRAINED TRADITIONAL BIRTH ATTENDANT "ATR"
E TRADITIONAL BIRTH ATTENDANT
F COMMUNITY HEALTH WORKER/POST
X OTHER (SPECIFY) ______

305. Where did you receive antenatal care for this pregnancy?
No other place?

PROBE TO DETERMINE TYPE OF PLACE.

IF UNABLE TO DETERMINE IF PLACE IS PUBLIC OR PRIVATE SECTOR, RECORD 'X' AND WRITE THE NAME OF THE PLACE.

HOME
A RESPONDENT'S HOME
B OTHER HOME
PUBLIC MEDICAL SECTOR
C NATIONAL HOSPITAL
D REGIONAL HOSPITAL
E REFERRAL HEALTH CENTER
F DISPENSARY/MATERNITY
G COMMUNITY HEALTH CENTER
H COMMUNITY HEALTH AGENT SITES
I OTHER PUBLIC MEDICAL SECTOR (SPECIFY) ______
PRIVATE MEDICAL SECTOR
J PRIVATE HOSPITAL/CLINIC
K MEDICAL OFFICE
L PRIVATE TREATMENT CENTER
M OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ______
X OTHER (SPECIFY) ______

306. How many weeks or months pregnant were you when you received your first antenatal care for this pregnancy?

1 WEEKS ______
2 MONTHS ______
998 DK

307. During this pregnancy, how many times did you receive antenatal care?

NUMBER OF TIMES ______
98 DK

308. During this pregnancy, did you take sulfadoxine pyrimethamine (SP) to prevent malaria?

1 YES
2 NO (Skip to 401)
8 DK (Skip to 401)

309. During this pregnancy, how many times did you take the 3 tablets of SP?

NUMBER OF TIMES ______

310. Were you given the SP during an antenatal visit, during another visit to a health facility, or did you get it elsewhere?

IF MORE THAN ONE SOURCE, RECORD THE FIRST SOURCE ON THE LIST.

1 ANTENATAL VISIT
2 OTHER VISIT TO HEALTH FACILITY
6 ELSEWHERE

SECTION 4. FEVER IN CHILDREN

401. CHECK 216, 217, AND 218 IN BIRTH HISTORY: WERE ANY CHILDREN BORN 0 - 59 MONTHS BEFORE SURVEY WHO ARE STILL ALIVE?

ONE OR MORE CHILDREN BORN 0 - 59 MONTHS BEFORE SURVEY AND STILL ALIVE ______ (Continue to 402)
NO CHILDREN BORN 0 - 59 MONTHS BEFORE SURVEY WHO ARE STILL ALIVE ______ (Skip to 501)

402. Now I would like to ask you some questions about the health of your children born in the last five years. (We will talk about one child at a time, beginning with the youngest).

403. RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 213 OF SURVIVING CHILDREN BORN 0 - 59 MONTHS BEFORE SURVEY, BEGINNING WITH THE LAST-BORN.

NAME OF CHILD ______
BIRTH HISTORY NUMBER ______

404. In the last two weeks, has (NAME) been sick with a fever?

1 YES
2 NO
8 DK

[###translator's note: unclear skip instructions]

405. Did anyone draw blood from (NAME)'s finger or heel at any time during (NAME)'s illness?

1 YES
2 NO
8 DK

[###translator's note: unclear skip instructions]

406. Did a health care provider tell you that (NAME) had malaria?

1 YES
2 NO
8 DK

407. Did you seek out any advice or treatment for the illness?

1 YES
2 NO (Skip to 412)

408. Where did you go to seek advice or treatment?

Anywhere else?

PROBE TO DETERMINE TYPE OF PLACE.

IF UNABLE TO DETERMINE IF PLACE IS PUBLIC OR PRIVATE SECTOR, RECORD 'X' AND WRITE THE NAME OF THE PLACE.

PUBLIC SECTOR
A NATIONAL HOSPITAL
B REGIONAL HOSPITAL
C REFERRAL HEALTH CENTER
D DISPENSARY/MATERNITY
E COMMUNITY HEALTH CENTER
F COMMUNITY HEALTH AGENT SITES "ASC"
G OTHER PUBLIC MEDICAL SECTOR (SPECIFY) ______
PRIVATE MEDICAL SECTOR
H PRIVATE HOSPITAL/CLINIC
I MEDICAL OFFICE
J PRIVATE TREATMENT CENTER
K PHARMACY
L OTHER PRIVATE MEDICAL SECTOR
OTHER SOURCE
M SHOP
N ITINERANT MEDICINE PEDDLER
O TRADITIONAL HEALER/PRACTITIONER
P MARKET
X OTHER (SPECIFY) ______

409. CHECK 408:

TWO OR MORE CODES CIRCLED ______ (Continue to 410)
ONLY ONE CODE CIRCLED ______ (Skip to 411)

410. Where did you go first to seek advice or treatment?

USE LETTER CODES FROM 408.

FIRST PLACE ______

411. How many days after the illness began did you seek advice or treatment for (NAME)?

IF SAME DAY, RECORD '00'.

DAYS ______

412. Did (NAME) take medicine for the illness at any time during the illness?

1 YES
2 NO (Skip to 415A)
8 DK (Skip to 415A)

413. What medicine did (NAME) take?
No other medicine?

RECORD ALL MENTIONED.
IF MEDICINE IS NOT KNOWN, ASK TO SEE THE BOX OR PRESCRIPTION.

ANTIMALARIALS
A ACT ARTEMISININ COMBINATION THERAPY
B SP/FANSIDAR
C CHLOROQUINE
D AMODIAQUINE
QUININE
E TABLETS
F INJECTION/IV
ARTESUNATE
G RECTAL TREATMENT
H INJECTION/IV/IM
ARTEMETHER
I TABLETS
J INJECTION/IV/IM
K OTHER ANTIMALARIAL (SPECIFY) ______
ANTIBIOTICS
L AMOXICILLIN
M COTRIMOXAZOLE
N OTHER TABLET/SYRUP
O OTHER INJECTION/IV
OTHER MEDICATION
P ASPIRIN
Q PARACETAMOL /PANADOL /ACETAMINOPHEN
R IBUPROFEN
X OTHER (SPECIFY) ______
Z DK

414. CHECK 413: ACT ARTEMISININ COMBINATION THERAPY ('A') GIVEN

CODE 'A' CIRCLED ______ (Continue to 415)
CODE 'A' NOT CIRCLED ______ (Skip to 415A)

415. How soon after the fever began did (NAME) start to take ACT artemisinin combination therapy?

0 SAME DAY
1 NEXT DAY
2 TWO DAYS AFTER THE FEVER
3 THREE OR MORE DAYS AFTER THE FEVER
8 DK

415A. CHECK 216 IN BIRTH HISTORY FOR CHILD LISTED IN 403:

CHILD BORN 3 - 59 MONTHS BEFORE SURVEY ______ (Continue to 415B)
CHILD BORN 0 - 2 MONTHS BEFORE SURVEY ______ (Skip to 416)

415B. In this month or last month, did (NAME) receive Seasonal Malaria Chemoprevention ("CPS"), that is, medicine to prevent malaria during the rainy season?

1 YES
2 NO
8 DK

415C. May I see (NAME)'s "CPS" card?

IF CARD IS NOT OFFERED, PROBE TO FIND OUT WHY IT IS NOT AVAILABLE.

1 CARD SEEN
2 CARD NOT GIVEN BY ADMINISTRATION AGENTS
3 CARD WAS LOST
4 CARDHOLDER ABSENT
5 CARD DAMAGED
6 OTHER (SPECIFY) ______

[###translator's notes: unclear skip instructions]

415D. CHECK COMPLETION OF (NAME)'S "CPS" CARD

a) DAY 1 (FIRST DAY) COMPLETED BY ADMINISTRATION AGENTS
b) DAY 2 (SECOND DAY) COMPLETED BY PARENTS/RESPONSIBLE PERSONS
c) DAY 3 (THIRD DAY) COMPLETED BY PARENTS/RESPONSIBLE PERSONS

a) DAY 1
1 COMPLETED
2 NOT COMPLETED
b) DAY 2
1 COMPLETED
2 NOT COMPLETED
c) DAY 3
1 COMPLETED
2 NOT COMPLETED

415E. CHECK 415D a):
COMPLETION OF FIRST DAY (D1)

CODE "1" CIRCLED, D1 COMPLETED______ (SKIP TO 415G)
CODE "2" CIRCLED, D1 NOT COMPLETED______ (Continue to 415F)

415F. What was the main reason that (NAME)'s "CPS" card was not completed on the first day (D1)?

01 OMISSION ON PART OF ADMINISTRATION AGENTS
02 DON'T KNOW HOW TO COMPLETE
03 LACK OF PEN
04 DID NOT HAVE ANY INFORMATION ABOUT COMPLETING THE CARD
05 PARENTS FORGOT
06 CHILD DIED
96 OTHER (SPECIFY) ______

415G. CHECK 415D b):
COMPLETION OF SECOND DAY (D2)

CODE "1" CIRCLED, D2 COMPLETED_______ (SKIP TO 415K)
CODE "2" CIRCLED, D2 NOT COMPLETED______ (Continue to 415H)

415H. What was the main reason that (NAME)'s "CPS" card was not completed on the second day (D2)?

02 DON'T KNOW HOW TO COMPLETE
03 LACK OF PEN
04 DID NOT HAVE ANY INFORMATION ABOUT COMPLETING THE CARD
05 PARENTS FORGOT
06 CHILD DIED
96 OTHER (SPECIFY) ______

415I. Did (NAME) take the tablet for the second day (D2)?

1 YES (Skip to 415K)
2 NO
8 DK (Skip to 415K)

415J. Why didn't (NAME) take the tablet for the second day (D2)?

1 UNDESIRABLE EFFECTS AFTER MEDICINE OF PREVIOUS DAY
2 FORGOT
3 REFUSED
4 CHILD DIED
6 OTHER (SPECIFY) ______

415K. CHECK 415C:
POSSESSION OF "CPS" CARD

CODE "1" CIRCLED, "CPS" CARD SEEN ______ (Continue to 415L)
CODES "2" TO "6" CIRCLED, "CPS" CARD NOT SEEN ______ (SKIP TO 415N)

415L. CHECK 415D c):
COMPLETION OF THIRD DAY (D3)

CODE "1" CIRCLED, D3 COMPLETED______ (Skip to 416)
CODE "2" CIRCLED, D3 NOT COMPLETED______

415M. What was the main reason that (NAME)'s "CPS" card was not completed on the third day (D3)?

02 DON'T KNOW HOW TO FILL OUT
03 LACK OF PEN
04 DID NOT HAVE ANY INFORMATION ABOUT COMPLETING THE CARD
05 PARENTS FORGOT
06 CHILD DIED
96 OTHER (SPECIFY) ______

415N. Did (NAME) take the tablet for the third day (D3)?

1 YES (Skip to 416)
2 NO
8 DK (Skip to 416)

415O. Why didn't (NAME) take the tablet for the third day (D3)?

1 UNDESIRABLE EFFECTS AFTER MEDICINE OF PREVIOUS DAY
2 FORGOT
3 REFUSED
4 CHILD DIED
6 OTHER (SPECIFY) ______

416. CHECK 216 AND 217 IN BIRTH HISTORY: ANY OTHER CHILDREN BORN 0 - 59 MONTHS BEFORE SURVEY AND WHO ARE STILL ALIVE?

NO OTHER CHILDREN BORN IN THE 0 - 59 MONTHS BEFORE SURVEY AND STILL ALIVE ______
THERE ARE OTHER CHILDREN BORN IN THE 0 - 59 MONTHS BEFORE SURVEY WHO ARE STILL ALIVE ______ (Go to 403)

SECTION 5. KNOWLEDGE AND BELIEFS

501. In the last 6 months, have you seen or heard any messages about malaria?

1 YES
2 NO (Skip to 503)

502. Where did you see or hear a message about malaria?

Other sources?

A RADIO
B TELEVISION
C POSTER/BILLBOARD
D HOSPITAL/HEALTH FACILITY
E COMMUNITY HEALTH AGENT
F COMMUNITY POST/NGO PRESENTER/COMMUNITY-BASED ORGANIZATION
G TOWN CRIER/VILLAGE/MARKET/NEIGHBORHOOD
H COMMUNITY EVENT
I SCHOOL/TEACHERS
J FRIEND/NEIGHBOR/FAMILY/CHURCH/MOSQUE
K INTERNET/SOCIAL MEDIA/TELEPHONE MESSAGE
X OTHER SOURCE (SPECIFY) ______
Z DON'T REMEMBER

502A. In the last 6 months, did you see or hear the following message about malaria on television or on the radio:

a) Have the whole family sleep under an insecticidal net every night and in every season?
1 YES, TV
2 YES, RADIO
3 YES, TV AND RADIO
4 NO
b) To be protected against malaria you need to take SP at least 3 times?
1 YES, TV
2 YES, RADIO
3 YES, TV AND RADIO
4 NO
c) Go to a health center for your antenatal visits starting in the 4th month of pregnancy in order to receive the SP?
1 YES, TV
2 YES, RADIO
3 YES, TV AND RADIO
4 NO

503. Are there ways to avoid contracting malaria?

1 YES
2 NO (Skip to 505)

504. What are the things that people can do to avoid contracting malaria?

RECORD ALL MENTIONED.

A SLEEP UNDER A MOSQUITO NET
B SLEEP UNDER AN INSECTICIDAL MOSQUITO NET
C TAKE PREVENTIVE MEDICINE
D USE INSECT REPELLING DIFFUSER/CREAMS/LOTIONS
E USE AN ANTI-MOSQUITO SMOKE COIL
F DRINK ROOT/PLANT JUICE INFUSIONS AS PREVENTIVE
G AVOID WATER RESERVES
H INDOOR RESIDUAL SPRAYING
I USE SCREENS ON WINDOWS
J USE ELECTRIC BUG ZAPPERS
K USE AIR CONDITIONERS/FAN
L COVERING BODY
M AVOID EATING OILY FOODS/OIL/FAT
X OTHER (SPECIFY) ______
Z DK

505. Now I am going to read you some statements and I would like you to say if you agree or disagree with these statements. If you do not know, answer, "I don't know".

In this community, people only have malaria during the rainy season.
Do you agree or disagree?

1 AGREE
2 DISAGREE
8 DK/UNSURE

506. When a child has a fever, you always worry by thinking it may be malaria.
Do you agree or disagree?

1 AGREE
2 DISAGREE
8 DK/UNSURE

507. Having malaria is not a problem because it can be treated easily.
Do you agree or disagree?

1 AGREE
2 DISAGREE
8 DK/UNSURE

508. Only weakened children can die from malaria.
Do you agree or disagree?

1 AGREE
2 DISAGREE
8 DK/UNSURE

508A. The consequences of contracting malaria can be serious.
Do you agree or disagree?

1 AGREE
2 DISAGREE
8 DK/UNSURE

509. You can sleep under a mosquito net all night long when there are lots of mosquitos.
Do you agree or disagree?

1 AGREE
2 DISAGREE
8 DK/UNSURE

510. You can sleep under a mosquito net all night long when there are few mosquitos.
Do you agree or disagree?

1 AGREE
2 DISAGREE
8 DK/UNSURE

511. You don't like to sleep under a mosquito net when the weather is too hot.
Do you agree or disagree?

1 AGREE
2 DISAGREE
8 DK/UNSURE

511A. You don't like to sleep under a mosquito net because it resembles a shroud.
Do you agree or disagree?

1 AGREE
2 DISAGREE
8 DK/UNSURE

511B. You don't like to sleep under an insecticidal mosquito net because you can't have privacy.
Do you agree or disagree?

1 AGREE
2 DISAGREE
8 DK/UNSURE

512. When a child has a fever, it is better to begin by giving him/her the medicine that you have in the house.
Do you agree or disagree?

1 AGREE
2 DISAGREE
8 DK/UNSURE

513. In your community, people take their child to see a health provider the same day or the next day that a fever appears.
Do you agree or disagree?

1 AGREE
2 DISAGREE
8 DK/UNSURE

514. In your community, people who have a mosquito net usually sleep under the mosquito net every night.
Do you agree or disagree?

1 AGREE
2 DISAGREE
8 DK/UNSURE

515. In your opinion, what is the main cause of malaria?

01 MOSQUITO BITE
02 OVERCONSUMPTION OF OIL/EGGS
03 FATIGUE DUE TO WORK
04 INSUFFICIENT SLEEP/FATIGUE
05 DIRECT EXPOSURE TO SUN
06 EATING MANGOES/SUGARY FRUITS
07 DRINKING MILK
08 DIRTY WATER/DIRTY ENVIRONMENT/FILTH
09 UNCLEAN/POORLY CONSERVED FOOD/FLIES
10 COLD FOOD/FROZEN FOOD
11 COLD/HUMIDITY/RAINS
96 OTHER (SPECIFY) ______
98 DK

516. In your opinion, what are the symptoms of malaria?
PROBE: Other symptoms?

RECORD ALL MENTIONED.

A FEVER
B LACK OF APPETITE/VOMITING
C HIGH FEVER WITH CONVULSIONS
D HIGH FEVER WITH FAINTING
E PERSISTANT FEVER
F CONVULSIONS
G JAUNDICE
H YELLOW URINE/DARK COLORED URINE
I MIGRAINES/HEADACHES
J ACHES/JOINT PAIN
K DIARRHEA
L PALLOR/ITCHING
X OTHER (SPECIFY) ______
Z DK

517. RECORD TIME.

HOUR ______
MINUTES ______

OBSERVATIONS OF INTERVIEWER

TO BE FILLED OUT ONCE THE INTERVIEW IS FINISHED

COMMENTS ON THE INTERVIEW:

______

COMMENTS ON PARTICULAR QUESTIONS:

______

OTHER COMMENTS:

______

OBSERVATIONS OF TEAM LEADER

______

REFERENCE DATES

YEAR OF SURVEY: 2021
FIVE YEARS BEFORE SURVEY: 2016
CHILDREN OVER AGE OF FIVE: 2015
CHILDREN UNDER AGE FOUR: 2018
CHILDREN UNDER AGE THREE: 2019
CHILDREN UNDER AGE 16: 2006