2017 MALAWI MALARIA INDICATOR SURVEY
WOMAN'S QUESTIONNAIRE
MINISTRY OF HEALTH
NATIONAL MALARIA CONTROL PROGRAM
PLACE NAME
NAME OF HOUSEHOLD HEAD
CLUSTER NUMBER
HOUSEHOLD NUMBER
NAME AND LINE NUMBER OF WOMAN
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NO.
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
TOTAL NUMBER OF VISITS
LANGUAGE OF QUESTIONNAIRE 01
LANGUAGE OF INTERVIEW
NATIVE LANGUAGE OF RESPONDENT
TRANSLATOR USED
NO 2
LANGUAGE OF QUESTIONNAIRE: ENGLISH
LANGUAGE CODES
CHICHEWA 02
TUMBUKA 03
OTHER (SPECIFY) 06
SUPERVISOR
NAME
NUMBER
Hello. My name is__. I am working with the Malaria Control Program. We are conducting a survey 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 15 to 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)
SECTION 1. RESPONDENT'S BACKGROUND
101. RECORD THE TIME.
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'.
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 PART 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
NGONI 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, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?
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'.
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 NECESSECARY)
NO BIRTHS (SKIP TO 225)
211. Now I'd like to ask you about your more recent births. How many births have you had in 2012-2017? RECORD NUMBER OF LIVE BIRTHS IN 2012-2017
NONE 00 (SKIP TO 225)
212. Now I would like to record the names of all your births in 2012-2017, whether still alive or not, starting with the most recent one you had. RECORD IN 213 THE NAMES OF ALL THE BIRTHS BORN IN 2012-2017. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS. IF THERE ARE MORE THAN 5 BIRTHS, USE ADDITIONAL QUESTIONNAIRE STARTING WITH THE SECOND ROW.
213. What name was given to your (most recent/previous) baby? RECORD NAME. BIRTH HISTORY NUMBER.
214. Is (NAME) a boy or a girl?
GIRL 2
215. Were any of these births twins?
MULTIPLE 2
216. On what day, month, and year was (NAME) born?
MONTH__
YEAR__
NO 2 (NEXT BIRTH)
218. IF ALIVE: How old was (NAME) at (NAME)'s last birthday? RECORD AGE IN COMPLETED YEARS.
219. IF ALIVE: Is (NAME) living with you?
NO 2
220. IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD. RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD.
221. Were there any other live births between (NAME) and (NAME OF PREVIOUS BIRTH), including any children who died after birth?
NO 2 (NEXT BIRTH)
222. Have you had any live births since the birth of (NAME OF MOST RECENT BIRTHS)?
NO 2
223. COMPARE 211 WITH NUMBER OF BIRTHS IN BIRTH HISTORY
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)
224. CHECK 216: ENTER THE NUMBER OF BIRTHS IN 2012-2017
NONE 0
NO 2 (SKIP TO 227)
DON'T KNOW 8 (SKIP TO 227)
226. How many months pregnant are you? RECORD NUMBER OF COMPLETED MONTHS.
NO BIRTHS IN 2012-2017 (SKIP TO 501)
Q. 224 IS BLANK (SKIP TO 501)
SECTION 3. PREGNANCY AND INTERMITTENT PREVENTATIVE TREATMENT
301. RECORD THE NAME AND SURVIVAL STATUS OF THE MOST RECENT BIRTH FROM 213 AND 217.
NAME__
LIVING (CONTINUE)
DEAD (CONTINUE)
302. 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?
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
HAS D
304. During this pregnancy, did you take SP/Fansidar or Novidar SP to keep you from getting malaria?
NO 2 (SKIP TO 306D)
DON'T KNOW (SKIP TO 306D)
305. How many times did you take SP/Fansidar or Novidar SP during this pregnancy?
306. Did you get the SP/Fansidar or Novidar SP during any antenatal care visit, during another visit to a health facility or from another source. IF MORE THAN ONE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST.
ANOTHER FACILITY VISIT 2 (SKIP TO 306D)
OTHER SOURCE 6 (SKIP TO 306D)
306A. How many times did you take SP/Fansidar or Novidar SP during an antenatal care visit?
306B. Did you take the SP/Fansidar or Novidar SP under direct observation by the health personnel each time?
NO 2
306C. How many times did you take the SP/Fansidar or Novidar SP under direct observation by the health personnel?
306D. Did you take CPT (cotrimoxazole preventive therapy) during the last pregnancy?
NO 2 (SKIP TO 306F)
DON'T KNOW 8 (SKIP TO 306F)
306E. How long did you take cotrimoxazole during the last pregnancy? IF LESS THAN 1 WEEK, RECORD DAYS; IF LESS THAN 1 MONTH, RECORD DAYS.
WEEKS__ 2
MONTHS__ 3
DON'T KNOW 998
NO ANC (SKIP TO 307)
306G. Do you have an ANC card for the time you were pregnant with (NAME)?
YES, NOT SEEN 2 (SKIP TO 307)
NO CARD 3 (SKIP TO 307)
306H. CHECK ANC CARD AND RECORD NUMBER OF SP/FANSIDAR GIVEN
NONE 0
NO LIVING CHILDREN BORN IN 2012-2017 (SKIP TO 501)
401. CHECK 213: RECORD THE BIRTH HISTORY NUMBER IN 402 AND THE NAME AND SURVIVAL STATUS IN 403 FOR EACH BIRTH IN 2012-2017. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE MOST RECENT BIRTH. IF THERE ARE MORE THAN 2 BIRTHS, USE ADDITIONAL QUESTIONNAIRE(S). Now I would like to ask some questions about the health of your children born since January 2012. (We will talk about each separately.)
402. BIRTH HISTORY NUMBER FROM 213 IN BIRTH HISTORY
LIVING (CONTINUE)
DEAD (SKIP TO 426)
404. Has (NAME) been ill with a fever at any time in the last 2 weeks?
NO 2 (SKIP TO 426)
DON'T KNOW 8 (SKIP TO 426)
404A. How many days ago did the fever start? IF LESS THAN ONE DAY, RECORD '00'.
405. At any time during the illness, did (NAME) have blood taken from (NAME)'s finger or heel for testing?
NO 2
DON'T KNOW 8
406. Did you seek advice or treatment for the illness from any source?
NO 2 (SKIP TO 411)
407. Where did you seek advice or treatment? Anywhere else? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE(S).
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST/OUTREACH C
MOBILE CLINIC D
HSA E
OTHER PUBLIC SECTOR (SPECIFY) F
HEALTH CENTER H
PHARMACY J
PRIVATE DOCTOR K
MOBILE CLINIC L
HSA M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) N
MACRO P
YOUTH DROP IN CENTRE Q
OTHER SOURCE
TRADITIONAL PRACTITIONER S
MARKET T
ITINERANT DRUG SELLER U
407A. How much did you spend on the treatment including consultation and fees, if any?
FREE 99995
DON'T KNOW 99998
407B. How much did you spend on the drugs?
FREE 99995
DON'T KNOW 99998
ONLY ONE CODE CIRCLED (SKIP TO 410)
409. Where did you first seek advice or treatment? USE LETTER CODE FROM 407
409A. How far is your house from the (FIRST PLACE IN 409)
15KM OR MORE 2
409B. How much did you spend on transport to and from the (FIRST PLACE IN 409)
FREE 99995
DON'T KNOW 99998
409C. Did you take any days off work to care for your child's illness?
NO 2 (SKIP TO 410)
409D. How many days did you take off work to care for your child's illness?
410. How many days after the illness began did you first seek advice or treatment for (NAME)? IF THE SAME DAY RECORD '00'
411. At any time during the illness, did (NAME) take any drugs for the illness?
NO 2 (SKIP TO 410)
DON'T KNOW 8 (SKIP TO 410)
412. What drugs did (NAME) take? Any other drugs? RECORD ALL MENTIONED.
ASAQ (COMBINED AMODIAQUINE AND ARTESUNATE) B
SP/FANSIDAR/NOVIDAR SP C
QUININE TABLETS D
INJECTION/IV E
ARTESUNATE RECTAL F
INJECTION/IV G
OTHER ANTIMALARIAL (SPECIFY) H
INJECTION/IV J
ACETAMINOPHEN/PANADOL/PARACETAMOL L
IBUPROFEN M
DON'T KNOW Z
413. CHECK 412: ANY CODE A-H CIRCLED?
NO (SKIP TO 426)
414. CHECK 412: LA ('A') GIVEN
CODE 'A' NOT CIRCLED (SKIP TO 416)
415. How long after the fever started did (NAME) first take LA?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
415A. For how many days did (NAME) take LA?
415B. Did you have LA at home or did you get it from somewhere else? IF SOMEWHERE ELSE, PROBE FOR SOURCE. IF MORE THAN ONE SOURCE ASK: Where did you get the LA first?
GOVERNMENT HEALTH FACILITY/WORKER 02
CHAM/MISSION FACILITY/WORKER 03
PRIVATE HEALTH FACILITY/WORKER 04
BLM HEALTH FACILITY/WORKER 05
MACRO HEALTH FACILITY/WORKER 06
YOUTH DROP IN CENTRE 07
SHOP 08
OTHER (SPECIFY) 96
415C. Did you purchase the LA?
NO 2 (SKIP TO 416)
415D. How much did you pay for the LA?
DON'T KNOW 99998
416. CHECK 412: ASAQ (COMBINED AMODIAQUINE AND ARTESUNATE) ('B') GIVEN
CODE 'B' NOT CIRCLED (SKIP TO 418)
417. How long after the fever started did (NAME) first take ASAQ?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
418. CHECK 412: SP/FANSIDAR/NOVIDAR SP ('C') GIVEN
CODE 'C' NOT CIRCLED (SKIP TO 420)
419. 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
420. CHECK 412: QUININE ('D' OR 'E') GIVEN
CODE 'D' OR 'E' NOT CIRCLED (SKIP TO 422)
421. 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
422. CHECK 412: ARTESUNATE ('F' OR 'G') GIVEN
CODE 'F' OR 'G' NOT CIRCLED (SKIP TO 424)
423. 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
424. CHECK 412: OTHER ANTIMALARIAL ('H') GIVEN
CODE 'H' NOT CIRCLED (SKIP TO 426)
425. 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
426. GO BACK TO 403 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501
SECTION 5. KNOWLEDGE OF MALARIA
501. Have you heard of an illness called malaria?
NO 2 (SKIP TO 516)
502. 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 THE RAIN F
COLD OR CHANGING WEATHER G
WITCHCRAFT H
OTHER (SPECIFY) X
DON'T KNOW Z
503. 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
PLAE EYES I
SALTY-TASTING PALMS J
FEELING WEAK K
REFUSE TO EAT OR DRINK L
OTHER (SPECIFY) X
DON'T KNOW Z
504. How can someone protect themselves against malaria? Anything else? RECORD ALL MENTIONED.
SLEEP UNDER AN INSECTACIDE-TREATED MOSQUITO NET B
USE MOSQUITO REPELLANT C
TAKE PREVENTATIVE MEDICATION D
SPRAY THE HOUSE/ROOMS WITH INSECTICIDE E
CLEAR WEEDS AROUND THE HOUSE F
USE MOSQUITO COILS G
CUT GRASS AROUND THE HOUSE H
FILL IN STAGNANT WATERS (PUDDLES) I
KEEP 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 THE 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
CHILLS/SHIVERING H
UNABLE TO EAT I
VOMITING J
CRYING ALL THE TIME K
RESTLESS L
DIARRHEA
OTHER (SPECIFY) X
DON'T KNOW Z
506. In the past six months, have you listened or seen any messages or information about malaria?
NO 2 (SKIP TO 510)
507. Where did you hear or see these messages of information?
a) At a government clinic/hospital?
b) From a community health worker?
c) From a friend/relative?
d) At workplace?
e) In drama groups?
f) From peer educators?
g) On a poster or billboard?
h) On the television?
i) On the radio?
j) In a newspaper?
k) Anywhere else?
NO 2
508. How many months ago was the last time you heard or saw the messages?
509. 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
510. Has anyone ever provided you with information on malaria at your home?
NO 2 (SKIP TO 514)
511. Who gave you the information at your home? Anyone else? RECORD ALL MENTIONED.
COMMUNITY HEALTH WORKER B
FRIENDS/FAMILY C
EMPLOYER D
PEER EDUCATORS E
OTHER (SPECIFY) X
DON'T KNOW Z
512. How long ago did someone visit your house to provide you information about malaria?
513. What type of messages about malaria did you hear or see? Anything else? RECORD ALL MENTIONED.
MALARIA CAN KILL B
MOSQUITO SPREAD MALAIRA 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 ACTIVITES J
OTHER (SPECIFY) X
DON'T KNOW Z
514. Has any mosquito net in this house been used for any reason other than sleeping?
NO 2 (SKIP TO 516)
515. 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 INTERVIEW
COMMENTS ABOUT INTERVIEW
COMMENTS ON SPECIFIC QUESTIONS
ANY OTHER COMMENTS
SUPERVISOR'S OBSERVATIONS
EDITOR'S OBSERVATIONS