MALARIA INDICATORS SURVEY IN MALI ("EIP" MALI 2021)
HOUSEHOLD 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")
NAME OF LOCALITY ______
NAME OF HEAD OF HOUSEHOLD ______
CLUSTER NUMBER ______
CONCESSION NUMBER ______
HOUSEHOLD NUMBER ______
(Repeat for up to 3 visits)
DATE _____
NAME OF INTERVIEWER ______
RESULT ______
NEXT VISIT
DATE ______
TIME ______
FINAL VISIT
DAY ______
MONTH ______
YEAR 2021
INTERVIEWER NUMBER ______
RESULT ______
TOTAL NUMBER OF VISITS ______
RESULT CODES:
2 NO FAMILY MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT
3 ENTIRE HOUSEHOLD ABSENT FOR LONG PERIOD
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR NO DWELLING AT ADDRESS
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY) ______
TOTAL PEOPLE IN HOUSEHOLD ______
TOTAL ELIGIBLE WOMEN ______
LINE NUMBER OF RESPONDENT FOR HOUSEHOLD QUESTIONNAIRE ______
LANGUAGE OF QUESTIONNAIRE 01
LANGUAGE OF QUESTIONNAIRE FRENCH
LANGUAGE OF INTERVIEW ______
NATIVE LANGUAGE OF RESPONDENT ______
INTERPRETER USED (YES = 1, NO = 2) ______
LANGUAGE CODE
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 ______
THIS PAGE IS INTENTIONALLY LEFT BLANK
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 15 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. If you want more information about the survey, you can also contact the persons named on this card.
GIVE THE CARD WITH CONTACT INFORMATION FOR THESE PERSONS
Do you have any questions to ask me?
May I begin the interview now?
SIGNATURE OF INTERVIEWER ______
DATE ______
2 RESPONDENT DOES NOT AGREE TO BE INTERVIEWED (Skip to END)
MINUTES ______
(Repeat Q.1 - 9 for up to 10 household members)
1. LINE NUMBER
2. HABITUAL RESIDENTS AND VISITORS
Please give me the names of the persons who usually live in your household and guests of the household who stayed here last night, starting with the head of the household.
AFTER LISTING THE NAMES AND RECORDING THE RELATIONSHIP AND GENDER FOR EACH PERSON, ASK QUESTIONS 2A - 2C TO MAKE SURE THAT THE LIST IS COMPLETE. THEN ASK THE APPROPRIATE QUESTIONS IN COLUMNS 5 - 9 FOR EACH PERSON.
3. RELATIONSHIP TO HEAD OF HOUSEHOLD
What is the relationship of (NAME) to the head of the household?
SEE CODES BELOW.
CODES FOR Q. 3: RELATIONSHIP TO HEAD OF HOUSEHOLD
02 WIFE/HUSBAND
03 CO-WIFE
04 SON OR DAUGHTER
05 SON-IN-LAW/DAUGHTER-IN-LAW
06 GRANDSON/GRANDDAUGHTER
07 FATHER/MOTHER
08 IN-LAW
09 BROTHER OR SISTER
10 OTHER RELATIVE
11 ADOPTED/FOSTER/STEPCHILD
12 NO RELATION
98 DK
4. GENDER
Is (NAME) male or female?
2 FEMALE
2A) Just to be sure that I have a complete list: are there any other people like small children or infants whom we have not listed?
NO ______
2B) Are there any people who are perhaps not family members, such as servants, renters or friends who usually live here?
NO ______
2C) Do you have any guests or temporary visitors who are in your home, or other people who slept here last night and were not listed?
NO ______
5. RESIDENCE
Does (NAME) usually live here?
2 NO
6. RESIDENCE
Did (NAME) stay here last night?
2 NO
IF 95 OR OLDER, RECORD '95'.
7A. IF AGE 15 OR OLDER
MARITAL STATUS
What is (NAME)'s current marital status?
2 DIVORCED/SEPARATED
3 WIDOWED
4 NEVER MARRIED AND NEVER LIVED WITH ANYONE
8. ELIGIBILITY
CIRCLE THE LINE NUMBERS OF ALL WOMEN AGE 15 - 49
9. ELIGIBILITY
CIRCLE THE LINE NUMBER OF ALL CHILDREN AGE 0 - 5
101. Where does the drinking water used by members of your household mainly come from?
12 FAUCET IN YARD/PLOT (Skip to 105)
13 FAUCET AT NEIGHBOR'S (Skip to 105)
14 PUBLIC FAUCET/FIRE HYDRANT (Skip to 103)
32 UNPROTECTED WELL (Skip to 103)
42 UNPROTECTED SPRING
61 TANKER TRUCK WATER
71 CART WITH CISTERN/BARREL
81 SURFACE WATER (RIVER/DAM/LAKE/POND/CANAL/IRRIGATION CANAL)
91 BOTTLED WATER
92 BAG WATER
96 OTHER (SPECIFY) ______ (Skip to 103)
102. Where does your household's water for other uses such as cooking or handwashing mainly come from?
12 FAUCET IN YARD/PLOT (Skip to 105)
13 FAUCET AT NEIGHBOR'S (Skip to 105)
14 PUBLIC FAUCET/FIRE HYDRANT
32 UNPROTECTED WELL
42 UNPROTECTED SPRING
61 TANKER TRUCK WATER
71 CART WITH CISTERN/BARREL
81 SURFACE WATER (RIVER/DAM/LAKE/POND/CANAL/IRRIGATION CANAL)
96 OTHER (SPECIFY) ______
103. Where is this water source located?
2 IN YOUR YARD/PLOT (Skip to 105)
3 ELSEWHERE
104. How long does it take to go there, fetch water, and come back?
998 DK
105. What kind of toilets do members of your household usually use?
IF UNABLE TO DETERMINE TYPE OF TOILET, ASK PERMISSION TO SEE THE FACILITY.
12 FLUSH CONNECTED TO SEPTIC TANK
13 FLUSH CONECTED TO LATRINES
14 FLUSH CONNECTED TO SOMETHING ELSE
15 FLUSH CONNECTED TO UNKNOWN PLACE
22 PIT LATRINE WITH SLAB
23 PIT LATRINE WITHOUT SLAB, OPEN PIT
41 BUCKETS/PAILS
51 SUSPENDED TOILETS/LATRINES
61 NO TOILET/NATURE (Skip to 109)
96 OTHER (SPECIFY) ______
106. Do you share these toilets with other households?
2 NO (Skip to 108)
107. Including your own household, how many households use these toilets?
95 10 OR MORE HOUSEHOLDS
98 DK
108. Where are these toilets located?
2 IN YOUR YARD/PLOT
3 ELSEWHERE
109. In this household, what kind of stove is usually used for cooking?
02 SOLAR OVEN (Skip to 111)
03 LIQUID PROPANE GAS ("GPL") STOVE/GAS STOVE (Skip to 111)
04 STOVE CONNECTED TO NATURAL GAS (Skip to 111)
05 BIOGAS STOVE (Skip to 111)
06 LIQUID FUEL STOVE
07 MANUFACTURED SOLID FUEL STOVE
08 TRADITIONAL SOLID FUEL STOVE
09 THREE STONE FIREPLACE/OPEN HEARTH
95 NO MEALS PREPARED IN HOUSEHOLD (Skip to 111)
96 OTHER (SPECIFY) ______
110. What kind of fuel or energy does this stove use?
02 GAS/DIESEL
03 PARAFFIN/OIL
04 COAL/LIGNITE
05 CHARCOAL
06 WOOD
07 STRAW/BRANCHES/GRASSES
08 AGRICULTURAL PRODUCTS
09 ANIMAL DUNG/WASTE
10 PROCESSED BIOMASS FUELS (PELLETS) OR WOOD PELLETS
11 TRASH/PLASTIC
12 SAWDUST
96 OTHER (SPECIFY) ______
111. How many rooms are used for sleeping in this household?
112. Does your household own any livestock, herds, other farm animals, or poultry?
2 NO (Skip to 114)
113. How many of the following animals does your household own?
IF NONE, MARK '00'.
IF 95 OR MORE, MARK '95'.
IF DON'T KNOW, MARK '98'.
114. Does any member of your household own any agricultural land?
2 NO (Skip to 116)
115. How many hectares of agricultural land is owned by household members?
IF 95 OR MORE, CIRCLE '950'.
950 95 HECTARES OR MORE
998 DK
116. In this household, do you have:
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
117. Does any member of your household own:
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
118. Does any member of the household have an account in a bank or in another financial institution?
2 NO
119. Does any member of this household use a cell phone to carry out financial transactions such as sending or receiving money, paying bills, buying goods or services, or receiving a salary?
2 NO
120. Does your household own any mosquito nets?
2 NO (Skip to 132)
121. How many mosquito nets does your household own?
IF FIFTEEN OR MORE MOSQUITO NETS, MARK '15'.
ASK RESPONDENT TO SHOW YOU ALL THE MOSQUITO NETS IN HOUSEHOLD. OBSERVE AND ASK QUESTIONS ABOUT EACH MOSQUITO NET, ONE BY ONE.
122. ASSIGN EACH MOSQUITO NET A SEQUENTIAL NUMBER AND RECORD THE NUMBER HERE.
123. WAS THIS MOSQUITO NET OBSERVED?
2 NOT OBSERVED
124. How many months has your household had the mosquito net?
IF LESS THAN ONE MONTH, RECORD '00'.
95 MORE THAN 36 MONTHS
98 UNSURE
125. OBSERVE OR ASK THE BRAND/TYPE OF MOSQUITO NET. IF BRAND IS NOT KNOWN AND YOU CANNOT SEE THE MOSQUITO NET, SHOW RESPONDENT PHOTOS OF COMMON BRANDS AND TYPES OF MOSQUITO NETS.
12 PERMANET
13 INTERCEPTOR
14 SERENA
15 YORKOOL
16 YAMEI
17 DAWA PLUS
18 OTHER/DK BRAND
98 DK TYPE
126. Did you get the mosquito net during the mass distribution campaigns between 2018 and 2020, during an antenatal visit, or during a vaccination visit?
2 YES, 2109 CAMPAIGN
3 YES, 2020 CAMPAIGN (Skip to 128)
4 YES, ANTENATAL CONSULTATION (Skip to 128)
5 YES, VACCINATION VISIT (Skip to 128)
7 NO (Skip to 128)
127. Where did you get the mosquito net?
02 PRIVATE HEALTH FACILITY
03 PHARMACY
04 SHOP/MARKET
05 NGO
06 RELIGIOUS INSTITUTION
07 SCHOOL
96 OTHER
98 DK
128. Last night, did anyone sleep under this mosquito net?
2 NO (Skip to 130)
8 UNSURE (Skip to 131)
129. Who slept under this mosquito net last night?
RECORD PERSON'S NAME AND LINE NUMBER FROM HOUSEHOLD SCHEDULE.
LINE NUMBER ______
130. What is the main reason that this mosquito net was not used last night?
02 DON'T LIKE SHAPE/COLOR/SIZE OF MOSQUITO NET
03 DON'T LIKE SMELL/ALLERGIC
04 UNABLE TO HANG IT/LAZINESS
05 SLEPT OUTSIDE
06 USUAL PERSON TO USE IT DID NOT SLEEP HERE LAST NIGHT
07 NO MOSQUITOS/NO MALARIA
08 EXTRA MOSQUITO NET/KEPT FOR LATER/FOR VISITORS
09 DEFECTIVE MOSQUITO NET/BAD CONDITION/NOT USABLE
10 THINK IT'S UNNECESSARY TO USE
96 OTHER (SPECIFY) ______
131. RETURN TO 122 FOR NEXT MOSQUITO NET; IF NO MORE MOSQUITO NETS, CONTINUE TO 132.
OTHER CHARACTERISTICS OF DWELLING
132. OBSERVE MAIN MATERIAL OF DWELLING'S FLOOR.
RECORD OBSERVATION.
12 DUNG
22 PALMS/BAMBOO
32 VINYL OR ASPHALT STRIPS
33 TILES
34 CEMENT
35 CARPET
133. OBSERVE MAIN MATERIAL OF DWELLING'S ROOF.
RECORD OBSERVATION.
12 THATCH/PALM LEAVES/LEAVES/MILLET STALKS
13 CLUMPS OF EARTH
22 PALMS/BAMBOO
23 WOOD PLANKS
24 CARDBOARD
25 TARP/PLASTIC
32 WOOD
33 ZINC/CEMENT FIBER
34 TILES
35 CEMENT
36 SHINGLES
134. OBSERVE MAIN MATERIAL OF DWELLING'S EXTERIOR WALLS.
RECORD OBSERVATION.
12 BAMBOO/CANE/PALMS/TRUNKS
13 EARTH
22 STONES WITH MUD
23 UNFINISHED ADOBE
24 PLYWOOD
25 CARDBOARD
26 SALVAGED WOOD
32 STONES WITH LIME/CEMENT
33 BRICKS
34 CEMENT BLOCKS
35 FINISHED ADOBE
36 WOODEN PLANKS/SHINGLES
MINUTES ______
TO BE FILLED OUT ONCE THE INTERVIEW IS COMPLETED
COMMENTS ABOUT THE INTERVIEW:
COMMENTS ABOUT PARTICULAR QUESTIONS:
OTHER COMMENTS:
OBSERVATIONS OF TEAM LEADER