2014 MALAWI MALARIA INDICATOR SURVEY
HOUSEHOLD QUESTIONNAIRE
PLACE NAME__
DISTRICT__
CLUSTER NUMBER__
HOUSEHOLD NUMBER__
NAME OR HOUSEHOLD HEAD__
DATE
INTERVIEWER'S NAME
RESULT
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
RESULT CODES
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) 9
TOTAL NUMBER OF VISITS
TOTAL PERSONS IN HOUSEHOLD
TOTAL ELIGIBLE WOMEN
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE
LANGUAGE OF QUESTIONNAIRE
LANGUAGE OF INTERVIEW
NATIVE LANGUAGE OF RESPONDENT
TRANSLATOR USED
SOMETIME 2
ALL THE TIME 3
LANGUAGE CODES:
2 TUMBUKA
3 YAO
4 ENGLISH
6 OTHER (SPECIFY)
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. I would like to ask you some questions about your household. The questions usually take about 15 or 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 this card. GIVE CARD WITH CONTACT INFORMATION. Do you have any questions? May I begin the interview now?
SIGNATURE OF INTERVIWER__
DATE__
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
1. LINE NO.
USUAL RESIDENTS AND VISITORS
2. 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 SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE. THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-10 FOR EACH PERSON.
RELATIONSHIP TO HEAD OF HOUSEHOLD
3. What is the relationship of (NAME) to the head of the household? SEE CODES BELOW.
WIFE OR HUSBAND 02
SON OR DAUGHTER 03
SON-IN-LAW OR DAUGHTER-IN-LAW 04
GRANDCHILD 05
PARENT 06
PARENT-IN-LAW 07
BROTHER OR SISTER 08
OTHER RELATIVE 09
ADOPTED/FOSTER/STEPCHILD 10
NOT RELATED 11
DON'T KNOW 98
4. Is (NAME) male or female?
FEMALE 2
5. Does (NAME) usually live here?
NO 2
6. Did (NAME) stay here last night?
NO 2
7. How old is (NAME)? IF 95 OR MORE, RECORD '95'.
8. CIRCLE LINE NUMBER OF ALL WOMEN AGE 15-49
9. CIRCLE LINE NUMBER OF ALL CHILDREN AGE 0-5
2A. Just to make sure that I have a complete listing: are there any other persons such as small children or infants that we have not listed?
NO
2B. Are there any other people who may not be members of your family, such as domestic servants, lodgers, or friends who usually live here?
NO
2C. Are there any guests or temporary visitors staying here, or anyone else who stayed here last night, who have not been listed?
NO
101. What is the main source of drinking water for members of your household?
PIPED INTO YARD/PLOT 12 (SKIP TO 104)
PUBLIC TAP/STANDPIPE 13
DUG WELL
UNPROTECTED WELL 32
UNPROTECTED SPRING 42
TANKER TRUCK 61
CART WITH SMALL TANK 71
SURFACE WATER (RIVER/DAM/LAKE/POND/STREAM/CANAL/IRRIGATION CHANNEL) 81
BOTTLED WATER 91
OTHER (SPECIFY) 96
102. Where is that water source located?
IN OWN YARD/PLOT 2 (SKIP TO 104)
ELSEWHERE 3
103. How long does it take to go there, get water, and come back?
DON'T KNOW 998
104. What kind of toilet facility do members of your household usually use?
PIT LATRINE
PIT LATRINE WITH SLAB 22
PIT LATRINE WITHOUT SLAB/OPEN PIT 23
BUCKET TOILET 41
HANGING TOILET/HANGING LATRINE 51
NO FACILITY/BUSH/FIELD 61 (SKIP TO 107)
OTHER (SPECIFY) 96
105. Do you share this toilet facility with other households?
NO 2 (SKIP TO 107)
106. How many household use this toilet facility?
10 OR MORE HOUSEHOLDS 95
DON'T KNOW 98
107. Does your household have:
Electricity?
A radio?
A television?
A cellular phone?
A telephone (landline)?
A refrigerator?
NO 2
108. What type of fuel does your household mainly use for cooking?
LPG/NATURAL GAS 02
BIOGAS 03
KEROSENE 04
COAL, LIGNITE 05
CHARCOAL 06
WOOD 07
STRAW/SHRUBS/GRASS 08
ANIMAL DUNG 09
NO FOOD COOKED IN HOUSEHOLD 95
OTHER (SPECIFY) 96
109. MAIN MATERIAL OF THE FLOOR. RECORD OBSERVATION.
DUNG 12
PALM/BAMBOO 22
BROKEN BRICKS 23
VINYL OR ASPHALT STRIPS 32
CERAMIC TILES 33
CEMENT 34
CARPET 35
110. MAIN MATERIAL OF ROOF. RECORD OBSERVATION.
THATCH/PALM LEAF 12
PALM/BAMBOO/GRASS 22
WOOD PLANKS 23
CARDBOARD 24
WOOD 32
CALAMINE/CEMENT FIBER 33
CERAMIC TILES 34
CEMENT 35
ROOFING SHINGLES 36
111. MAIN MATERIAL OF THE EXTERIOR WALLS. RECORD OBSERVATION.
CANE/PALM/TRUNKS 12
DIRT 13
STONE WITH MUD 22
PLYWOOD 23
CARDBOARD 24
REUSED WOOD 25
STONE WITH LIME/CEMENT 32
BURNT BRICKS 33
UNBURNT BRICKS 34
CEMENT BLOCKS 35
WOOD PLANKS 36
112. How many rooms in this household are used for sleeping?
112A. How many separate rooms are in this household?
112B. How many separate sleeping spaces are there in your household?
113. Does any member of this household own:
A bicycle?
A motorcycle or motor scooter?
A car or truck?
NO 2
114. Does any member of this household own any agricultural land?
NO 2 (SKIP TO 116)
115. How many hectares of agricultural land do members of this household own? 1 HECTARE=2.47 ACRES. 1 ACRE=0.4 HECTARE. 1 FOOTBALL PITCH=1 HECTARE. IF 95 OR MORE, CIRCLE '950'. RECORD IN UNITS RESPONDENT USES.
HECTARES 2__
FOOTBALL PITCHES 3__
95 OR MORE HECTARES 9995
DON'T KNOW 9998
116. Does this household own any livestock, herds, other farm animals, or poultry?
NO 2 (SKIP TO 118)
117. How many of the following animals does this household own? IF NONE, ENTER '00'. IF 95 OR MORE, ENTER '95'. IN UNKNOWN, ENTER '98'.
Goats?
Pigs?
Cattle?
Sheep?
Poultry (chickens, ducks, pigeons)?
Other? (SPECIFY)
118. Does any member of this household have a bank account?
NO 2
119. At any time in the past 12 months, has anyone come into your dwelling to spray the interior walls against mosquitos?
NO 2 (SKIP TO 121)
DON'T KNOW 8 (SKIP TO 121)
119A. How many months ago was the house sprayed? IF LESS THAN 1 MONTH AGO, RECORD '00'.
PRIVATE COMPANY 2
NONGOVERNMENTAL ORGANIZATION (NGO) 3
OTHER (SPECIFY) 6
DON'T KNOW 8
120A. At any time in the past 12 months, have the walls in your dwelling been plastered or painted?
NO 2 (SKIP TO 121)
DON'T KNOW (SKIP TO 121)
120B. How many months ago were the walls plastered or painted? IF LESS THA 1 MONTH AGO, RECORD '00'
121. Does your household have any mosquito nets that can be used while sleeping?
NO 2 (SKIP TO 130)
122. How many mosquito nets does your household have? IF 7 OR MORE NETS, RECORD '7'.
122A. Has anyone in your household ever sold or given away a mosquito net?
NO 2 (SKIP TO 130)
DON'T KNOW 8 (SKIP TO 130)
123. ASK THE RESPONDENT TO SHOW YOU ALL THE NETS IN THE HOUSEHOLD. IF MORE THAN 3 NETS, USE ADDITIONAL QUESTIONNAIRE(S).
NOT OBSERVED 2
123A. OBSERVE (OR ASK ABOUT) THE CONDITION OF THE MOSQUITO NET: DOES THE NET HAVE HOLES IN IT (HOLES THE SIZE OF THE TIP OF YOUR THUMB OR LARGER)?
NO 2
123B. OBSERVE (OR ASK) THE COLOR OF THE MOSQUITO NET.
DARK BLUE 02
LIGHT BLUE 03
RED 04
BLACK 05
WHITE 06
OTHER 96
123C. OBSERVE (OR ASK) THE SHAPE OF THE MOSQUITO NET.
RECTANGLE 2 (SKIP TO 123F)
OTHER 6 (SKIP TO 123F)
123D. Was this net altered to become a conical net?
NO 2 (SKIP TO 123F)
DON'T KNOW 8 (SKIP TO 123F)
123E. How many nets were used to make the mosquito net conical?
TWO NETS 2
THREE OR MORE NETS 3
123F. Is the net hanging for sleeping?
NO 2
124. How many months ago did you household get the mosquito net? IF LESS THAN ONE MONTH AGO, RECORD '00'.
MORE THAN 36 MONTHS AGO 95
NOT SURE 98
125. Is this net a long-lasting net, re-treatable, or an untreated net? OBSERVE OR ASK THE BRAND/TYPE OF MOSQUITO NET.
ITN/LONG-LASTING NET
OLYSNET (LIGHT BLUE, SQUARE)
LIFENET (WHITE, SQUARE)
PERMANET (GREEN, SQUARE)
CONVENTIONAL NETS: CAN BE RE-TREATABLE OR UNTREATED
THERE ARE OTHER BRANDS
BE AWARE THAT MANY BRANDS MAY EXIST AND BE DISTRIBUTED BY DIFFERENT ORGANIZATIONS.
OLYSET 12
LIFENET 13
PERMANET 14
OTHER/DK BRAND 16
OTHER/DK BRAND 26
OTHER/DK BRAND 36
DK BRAND 98
125A. When you received this net, did it come with a treatment kit?
NO 2
NOT SURE 8
126. Since you got the net, was it ever soaked or dipped in a liquid to kill or repel mosquitoes?
NO 2 (SKIP TO 128)
NOT SURE 8 (SKIP TO 128)
127. How many months ago was the net last soaked or dipped? IF LESS THAN ONE MONTH AGO, RECORD '00'.
MORE THAN 24 MONTHS AGO 95
NOT SURE 98
127A. Did you pay to have the net soaked or dipped?
NO 2 (SKIP TO 128)
NOT SURE 8 (SKIP TO 128)
127B. How much did you pay to soak or dip the net?
DON'T KNOW 9998
128. Where did you obtain the net?
NEIGHBORHOOD HEALTH COMMITTEE (NHC) 02
COMMUNITY HEALTH WORKER (CHW) 03
SHOP 04
PHARMACY 05
WORKPLACE 06
OTHER (SPECIFY) 96
DON'T KNOW 98
128A. Did you purchase the net?
NO 2 (SKIP TO 129)
NOT SURE 8 (SKIP TO 129)
128B. How much did you pay for the net when you purchased it?
DON'T KNOW 9998
129. Did anyone sleep under this mosquito net last night?
NO 2 (SKIP TO 130C)
NOT SURE 8
129A. Who slept under this mosquito net last night? RECORD THE PERSON'S NAME AND LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.
LINE NO.__
130. NEXT NET; OR, IF NO MORE NETS, GO TO 131.
131. ANY CHILDREN UNDER AGE 5 WHO DID NOT SLEEP UNDER A MOSQUITO NET
NO (SKIP TO 131B)
131A. Why did (NAME OF CHILD) (and (NAME OF CHILD)) not sleep under a mosquito net last night? Any other reason? RECORD ALL MENTIONED.
TOO COLD B
CHILD CRIES C
CHILD AFRAID D
NOT ENOUGH NET E
NET NOT HUNG UP F
USED BY ADULTS G
NET NOT USED WHEN TRAVELING H
NET NOT IN GOOD CONDITION I
NET BAD FOR CHILDREN'S HEALTH J
OTHER (SPECIFY) X
131B. If you have a choice, what color of mosquito net do you prefer?
GREEN 2
RED 3
WHITE 4
BLACK 5
OTHER (SPECIFY) 6
DON'T KNOW/NO PREFERENCE 8
131C. If you have a choice, what shape of mosquito net do you prefer?
RECTANGULAR 2 (SKIP TO 131E)
DON'T KNOW/NO PREFERENCE 8 (SKIP TO 201)
131D. What are the reasons why you prefer a conical-shaped net over a rectangular-shaped net? Anything else? CIRCLE ALL MENTIONED.
EASIER TO STORE WHEN NOT HUNG B (SKIP TO 201)
EASIER TO TRAVEL WITH OUTSIDE THE HOUSEHOLD C (SKIP TO 201)
BETTER FIT AROUND SLEEPING PLACE D (SKIP TO 201)
TALLER E (SKIP TO 201)
MORE PEOPLE CAN SLEEP UNDER NET (WIDER) F (SKIP TO 201)
LOOKS NICER G (SKIP TO 201)
STRONGER H (SKIP TO 201)
OTHER (SPECIFY) X (SKIP TO 201)
131E. What are the reasons why you prefer a rectangular-shaped net over a conical-shaped net?
EASIER TO STORE WHEN NOT HUNG B (SKIP TO 201)
EASIER TO TRAVEL WITH OUTSIDE THE HOUSEHOLD C (SKIP TO 201)
BETTER FIT AROUND SLEEPING PLACE D (SKIP TO 201)
TALLER E (SKIP TO 201)
MORE PEOPLE CAN SLEEP UNDER NET (WIDER) F (SKIP TO 201)
LOOKS NICER G (SKIP TO 201)
STRONGER H (SKIP TO 201)
OTHER (SPECIFY) X (SKIP TO 201)