2014 MALAWI MALARIA INDICATOR SURVEY
WOMAN'S QUESTIONNAIRE
PLACE NAME
DISTRICT
CLUSTER NUMBER
HOUSEHOLD NUMBER
NAME OF HOUSEHOLD HEAD
NAME AND LINE NUMBER OF WOMAN
DATE
INTERVIEWER'S NAME
RESULT
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
TOTAL NUMBER OF VISITS
RESULT CODES
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER 7
LANGUAGE OF QUESTIONNAIRE
LANGUAGE OF INTERVIEW
NATIVE LANGUAGE OF RESPONDENT
TRANSLATOR USED
SOMETIME 2
ALL THE TIME 3
LANGUAGE CODES
TUMBUKA 2
YAO 3
ENGLISH 4
OTHER (SPECIFY) 6
SUPERVISOR
NAME__
OFFICE EDITOR__
KEYED BY__
SECTION 1. RESPONDENT'S BACKGROUND
INTRODUCTION AND CONSENT
INFORMED CONSENT
Hello. My name is __. I am working with the Ministry of Health. We are conducting a survey about health all over Malawi. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 10-20 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 2 (END)
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: primary, secondary, or higher?
SECONDARY 2
HIGHER 3
106. What is the highest (grade/form/year) you completed at that level? IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.
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 WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?
ABLE TO READ ONLY PARTS OF THE SENTENCE 2
ABLE TO READ THE WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) 4
BLIND/VISUALLY IMPAIRED 5
CCAP 02
ANGELICAN 03
SEVENTH DAY ADVENT/BAPTIST 04
OTHER CHRISTIAN 05
MUSLIM 06
NO RELIGION 07
OTHER (SPECIFY) 96
110. What is your tribe or ethnic group?
TUMBUKA 02
LOMWE 03
TONGA 04
YAO 05
SENA 06
NKHONDE 07
NGON 08
OTHER (SPECIFY) 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 who are now living with you?
NO 2 (SKIP TO 204)
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 who are alive but do not live with you?
NO 2 (SKIP TO 206)
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 born alive but later died? IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?
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'.
NONE 00 (SKIP TO 224)
209. CHECK 208: Just to make sure that I have this right: you have had in TOTAL__
Births during your life. Is that correct?
NO (PROBE AND CORRECT 201-208 AS NECESSARY)
210. CHECK 208:
ONE BIRTH (Was this child born in the last six years?) IF NO CIRCLE '00'.
TWO OR MORE BIRTHS (How many of these children were born in the last six years?) IF NONE CIRCLE '00'.
NONE 00 (SKIP TO 224)
211. Now I would like to record the names of all your births in the last six years, whether still alive or not, starting with the most recent one you had. RECORD NAMES OF ALL THE BIRTHS IN THE LAST 6 YEARS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS.
212. What name was given to your (most recent/previous) baby? RECORD NAME. BIRTH HISTORY NUMBER
NUMBER__
213. Is (NAME) a boy or a girl?
GIRL 2
214. Were any of these births twins?
MULTIPLE 2
215. In what month and year was (NAME) born? PROBE: When is his/her birthday?
YEAR__
NO 2 (NEXT BIRTH)
217. IF ALIVE: How old was (NAME) at his/her last birthday? RECORD AGE IN COMPLETED YEARS.
218. IF ALIVE: Is (NAME) living with you?
NO 2
219. IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD)
220. Were there any other live births between (NAME) and (NAME OF BIRTH ON PREVIOUS LINE), INCLUDING ANY CHILDREN WHO DIED AFTER BIRTH?
NO 2 (NEXT BIRTH)
221. Have you had any live births since the birth of (NAME OF MOST RECENT BIRTH)? IF YES, RECORD BIRTH(S) IN TABLE
NO 2
222. COMPARE 210 WITH NUMBER OF BIRHTS IN HISTORY ABOVE AND MARK:
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)
223. CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2006 OR LATER.
NONE 0
NO 2 (SKIP TO 226)
UNSURE 8 (SKIP TO 226)
225. How many months pregnant are you? RECORD NUMBER OF COMPLETED MONTHS.
NO BIRHTS IN 2008 OR LATER OR IS BLANK (SKIP TO 501)
SECTION 3A. PREGNANCY AND INTERMITTENT PREVENTATIVE TREATMENT
301. CHECK 215: ENTER IN THE TABLE THE NAME AND SURVIVAL STATUS OF THE MOST RECENT BIRTH. Now I would like to ask some questions about your last pregnancy that resulted in a live birth.
301A. FROM 212 AND 216, LINE 01:
LIVING (CONTINUE)
DEAD (CONTINUE)
302. When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?
NO 2 (SKIP TO 304)
303. Whom did you see? Anyone else? PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
NURSE/MIDWIFE B
PATIENT ATTENDANT C
HSA D
OTHER (SPECIFY) X
303A. How many times did you receive antenatal care during this pregnancy?
DON'T KNOW 98
304. During this pregnancy, did you take SP/Fansidar or Novidar SP to keep you from getting malaria?
NO 2 (SKIP TO 310B)
DON'T KNOW 8 (SKIP TO 310B)
307. How many times did you take (SP/Fansidar or Novidar SP) during this pregnancy?
308. CHECK 303: ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY
OTHER (SKIP TO 309A)
309. Did you get the (SP/Fansidar) during any antenatal care visit, during another visit to a health facility or from another source? CIRCLE ALL MENTIONED.
ANOTHER FACILITY VISIT B (SKIP TO 310B)
OTHER SOURCE C (SKIP TO 310B)
309A. CHECK 309: SP FROM ANTENATAL VISIT
OTHER (SKIP TO 310B)
309B. How many times did you take (SP/Fansidar or Novidar SP) during an antenatal visit?
310. Did you take the (SP/Fansidar or Novidar SP) under direct observation by the health worker each time?
NO 2
310A. How many times did you take the (SP/Fansidar or Novidar SP) under observation by the health worker?
310B. During this pregnancy, did you take Cotrimoxazole to keep you from getting malaria?
NO 2 (SKIP TO 311)
DON'T KNOW 8 (SKIP TO 311)
310C. How long did you take Cotrimoxazole during this pregnancy?
WEEKS__ 2
MONTHS__ 3
NO LIVING CHILDREN BORN IN 2008 OR LATER (SKIP TO 501)
401. CHECK 215: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2006 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES). Now I would like to ask some questions about the health of your children born since January 2006. (We will talk about each separately).
402. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY
LIVING (CONTINUE)
DEAD (GO TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 501)
404. Has (NAME) been ill with a fever at any time in the last 2 weeks?
NO 2 (GO TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 501)
DEAD (GO TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 501)
404A. How many days ago did the fever start? IF LESS THAN ONE DAY, RECORD '00'.
405. Did you seek advice or treatment for the illness from any source?
NO 2 (SKIP TO 410)
406. Where did you seek advice or treatment? Anywhere else? PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST/OUTREACH C
MOBILE CLINIC D
HSA E
OTHER PUBLIC F
HEALTH CENTER H
PHARMACY K
PRIVATE DOCTOR L
MOBILE CLINIC M
HSA N
OTHER PRIVATE MEDICAL O
BLM P
MACRO Q
YOUTH DROP IN CENTRE R
TRADITIONAL PRACTITIONER T
406A. How many days after the fever began did you first seek treatment for (NAME)?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
406B. How much did you spend on the treatment including consultation and fees, if any?
FREE 99995
DON'T KNOW 99998
406C. How much did you spend on the drugs?
FREE 99995
DON'T KNOW 99998
ONLY ONE CODE CIRCLED (SKIP TO 409)
408. Where did you first seek advice or treatment? USE LETTER CODE FROM 406.
408A. How far is your house from the (FIRST PLACE IN 408)?
MORE THAN 15 KM 2
408B. How much did you spend on transport to and from the (FIRST PLACE IN 408)?
FREE 99995
DON'T KNOW 99998
408C. Did you take any days off work in order to care for your child's sickness?
NO 2 (SKIP TO 409)
408D. How many days did you take off work to care for your child's illness?
409. at any time during the illness, did (NAME) have blood taken from his/her finger or heel for testing?
NO 2 (SKIP TO 409C)
DON'T KNOW 8 (SKIP TO 409C)
409A. Was the blood tested for malaria?
NO 2 (SKIP TO 409C)
DON'T KNOW 8 (SKIP TO 409C)
409B. Were you told the result?
NO 2
DON'T KNOW 8
409C. Is (NAME) still sick with a fever?
NO 2
DON'T KNOW 8
410. At any time during the illness, did (NAME) take any drugs for the illness?
NO 2 (SKIP TO 429)
DON'T KNOW 8 (SKIP TO 429)
411. What drugs did (NAME) take? Any other drugs? RECORD ALL MENTIONED.
CHLOROQUINE B
AMODIAQUINE C
QUININE D
LA (COARTEM) E
ARTESUNATE F
AA/ASAQ (COMBINED AMODIAQUINE AND ARTESUNATE) G
OTHER ANTIMALARIAL (SPECIFY) H
INJECTION J
ACETAMINOPHEN/PANADOL/PARACETAMOL L
IBUPROFEN M
412. CHECK 411: ANY CODE A-H CIRCLED?
NO (SKIP TO 429)
413. CHECK 411: SP/FANSIDAR/NOVIDAR SP ('A') GIVEN
CODE 'A' NOT CIRCLED (SKIP TO 415)
414. How long after the fever started did (NAME) first take SP/Fansidar/Novidar SP?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
415. CHECK 411: CHLOROQUINE ('B') GIVEN
CODE 'B' NOT CIRCLED (SKIP TO 417)
416. 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
417. CHECK 411: AMODIAQUINE ('C') GIVEN
CODE 'C' NOT CIRCLED (SKIP TO 419)
418. 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
419. CHECK 411: QUININE ('D') GIVEN
CODE 'D' NOT CIRCLED (SKIP TO 421)
420. 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
421. CHECK 411: LA (COARTEM) ('E') GIVEN
CODE 'E' NOT CIRCLED (SKIP TO 423)
422. How long after the fever started did (NAME) first take LA/COARTEM?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
422A. For how many days did (NAME) take LA/COARTEM?
422B. Did you have LA/COARTEM at home or did you get it from somewhere else? IF SOMEONE ELSE, PROBE FOR SOURCE. IF MORE THAN ONCE SOURCE ASK: Where did you get the LA/COARTEM first?
GOVERNMENT HEALTH FACILITY/WORKER 2
PRIVATE HEALTH FACILITY/WORKER 3
SHOP 4
OTHER (SPECIFY) 6
DON'T KNOW 8
422C. Did you purchase the LA/COARTEM?
NO 2 (SKIP TO 423)
422D. How much did you pay for the LA/COARTEM?
DON'T KNOW 99998
423. CHECK 411: ARTESUNATE ('F') GIVEN
CODE 'F' NOT CIRCLED (SKIP TO 425)
424. 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
425. CHECK 411: AA/ASAQ (CONBINED AMODIAQUINE AND ARTESUNATE ('G') GIVEN
CODE 'G' NOT CIRCLED (SKIP TO 427)
426. How long after the fever started did (NAME) first take AA/ASAQ?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
427. CHECK 411: OTHER ANTIMALARIAL ('H') GIVEN
CODE 'H' NOT CIRCLED (GO BACK TO 403 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 429)
428. 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
429. Was (NAME) admitted in a hospital in the last 12 months?
NO 2 (SKIP TO 430)
430. GO BACK TO 403 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501.
SECTION 5. KNOWLEDGE OF MALARIA
501. Have you ever heard of an illness called malaria?
NO 2
502. What signs or symptoms would lead you to think that a person has malaria? Anything else? RECORD ALL MENTIONED.
FEELING COLD B
HEADACHE C
NAUSEA/VOMITING D
DIARRHEA E
DIZZINESS F
LOSS OF APPETITE G
BODY ACHE OR JOINT PAIN H
PALE EYES I
SALTY TASTING PALMS J
FEELING WEAK K
REFUSE TO EAT OR DRINK L
OTHER (SPECIFY) X
DON'T KNOW Z
503. What do you think is the cause of malaria? Anything else? RECORD ALL MENTIONED.
EATING IMMATURE SUGARCANE B
EATING COLD SIMA C
EATING DIRTY FOOD D
DRINKING DIRTY WATER E
GETTING SOAKED IN RAIN F
COLD OR CHANGING WEATHER G
WITCHCRAFT H
OTHER (SPECIFY) X
DON'T KNOW Z
504. How can someone protect themselves against malaria? Anything else? RECORD ALL MENTIONED.
SLEEP UNDER AN INSECTICIDE TREATED MOSQUITO NET B
USE MOSQUITO REPELLANT C
AVOID MOSQUITO BITES D
TAKE PREVENTATIVE MEDICATION E
SPRAY HOUSE WITH INSECTICIDE F
USE MOSQUITO COILS G
CUT GRASS AROUND THE HOUSE H
FILL IN PUDDLES (STAGNANT WATER) I
KEEP HOUSE AND SURROUNDINGS CLEAN J
BURN LEAVES K
AVOID DRINKING DIRTY WATER L
AVOID EATING BAD FOOD M
PUT SCREENS ON WINDOWS N
AVOID GETTING SOAKED IN RAIN O
OTHER (SPECIFY) X
DON'T KNOW Z
505. What are the danger signs of malaria? Anything else? RECORD ALL MENTIONED
FAINTING B
ANY FEVER C
HIGH FEVER D
STIFF NECK E
FEELING WEAK F
NOT ACTIVE G
CHILS/SHIVERING H
UNABLE TO EAT I
VOMITING J
CRYING ALL THE TIME K
RESTLESS L
DIARRHEA M
OTHER (SPECIFY) X
DON'T KNOW Z
506. In your opinion, which people are most affected by malaria in your community? Anybody else? RECORD ALL MENTIONED.
ADULTS B
PREGNANT WOMEN C
OLDER ADULTS D
EVERYONE E
OTHER (SPECIFY) X
DON'T KNOW Z
507. In the last six months, have you listened or saw messages or information about malaria?
NO 2 (SKIP TO 511)
508. Where did you hear or see these messages or information? Anywhere else? RECORD ALL MENTIONED.
COMMUNITY HEALTH WORKER B
FRIENDS/FAMILY C
WORKPLACE D
DRAMA GROUPS E
PEER EDUCATORS F
POSTER/BILLBOARDS G
TELEVISION H
RADIO I
NEWSPAPER J
OTHER (SPECIFY) X
DON'T KNOW Z
509. How many months ago was the last time you heard or saw the message?
510. What type of messages about malaria did you hear or see? Anything else RECORD ALL MENTIONED.
MALARIA CAN KILL B
MOSQUITO SPREAD MALARIA C
SLEEPING UNDER A MOSQUITO NET IS IMPORTANT D
WHO SHOULD SLEEP UNDER A MOSQUITO NET E
SEEK TREATMENT FOR FEVER F
SEEK TREATMENT FOR FEVER PROMPTLY (WITHIN 24 HOURS) G
IMPORTANCE OF HOUSE SPRAYING H
NOT PLASTERING WALLS AFTER SPRAYING I
ENVIRONMENTAL SANITATION ACTIVITIES J
OTHER (SPECIFY) X
DON'T KNOW Z
511. Has anyone ever provided you with information on malaria at your home?
NO 2 (SKIP TO 515)
512. Who gave you the information at your home? Anybody else? RECORD ALL MENTIONED.
COMMUNITY HEALTH WORKER B
FRIENDS/FAMILY C
EMPLOYER D
PEER EDUCATORS E
OTHER (SPECIFY) X
DON'T KNOW Z
513. How long ago did someone visit your house to provide you with information about malaria?
514. What type of messages about malaria did you hear or see? Anything else? RECORD ALL MENTIONED.
MALARIA CAN KILL B
MOSQUITO SPREAD MALARIA C
SLEEPING UNDER A MOSQUITO NET IS IMPORTANT D
WHO SHOULD SLEEP UNDER A MOSQUITO NET E
SEEK TREATMENT FOR FEVER F
SEEK TREATMENT FOR FEVER PROMPTLY (WITHIN 24 HOURS) G
IMPORTANCE OF HOUSE SPRAYING H
NOT PLASTERING WALLS AFTER SPRAYING I
ENVIRONMENTAL SANITATION ACTIVITIES J
OTHER (SPECIFY) X
DON'T KNOW Z
515. CHECK HOUSEHOLD QUESTIONNAIRE 121:
HAS NO MOSQUITO NET (SKIP TO 523)
516. Has the community health worker in you village ever helped hang a mosquito net in this house?
NO 2
517. Has any mosquito net in this house been used for any reason other than sleeping?
NO 2
518. What was it used for? Anything else? RECORD ALL MENTIONED.
COVER/PROTECTION B
WINDOW SCREEN C
CLOTHING/WEDDING VEIL D
OTHER (SPECIFY) X
DON'T KNOW Z
MINUTES__
TO BE FILLED IN AFTER COMPLETING THE INTERVIEW
COMMENTS ABOUT RESPONDENT
COMMENTS ON SPECIFIC QUESTIONS
ANY OTHER COMMENTS
NAME OF SUPERVISOR
DATE