2017 MALAWI MALARIA INDICATOR SURVEY
HOUSEHOLD QUESTIONNAIRE
MINISTRY OF HEALTH
NATIONAL MALARIA CONTROL PROGRAM
PLACE NAME
NAME OF HOUSEHOLD HEAD
CLUSTER NUMBER
HOUSEHOLD NUMBER
DATE
INTERVIEWER'S NAME
RESULT
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
FINAL VISIT
DAY
MONTH
YEAR
INT. NO.
RESULT
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 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 Ministry of Health. We are conducting a survey about malaria 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 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 this card. GIVE CARD WITH CONTACT INFORMATION. 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__
1. LINE NO.
2. Please give me the names of the persons who usually live in your 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 5-9 FOR EACH PERSON.
2A. Just to make sure that I have a complete listing; are there any other people 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
REATIONSHIP 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
7A. What is (NAME)'s date of birth? On what day, month, and year was (NAME) born? IF DON?T KNOW DAY, RECORD '98'. IF DON?T KNOW MONTH, RECORD '98'. IF DON?T KNOW YEAR, RECORD '9998'.
MONTH__
YEAR__
7. How old is (NAME)? IF 95 OR MORE, RECORD '95'.
8. CIRCLE LINE NUMBER OF ALL WOMEN AGE 15-49
9. CIRCLE LINE NUBER OF ALL CHILDREN AGE 0-5
TICK HERE IF CONTINUATION SHEET USED
101. What is the main source of drinking water for members of your household?
PIPED INTO YEARD/PLOT 12 (SKIP TO 105)
PIPED TO NEIGHBOR 13 (SKIP TO 105)
PUBLIC TAP/STANDPIPE 14 (SKIP TO 103)
DUG WELL
UNPROTECTED WELL 32 (SKIP TO 103)
UNPROTECTED SPRING 42 (SKIP TO 103)
TANKER TRUCK 61 (SKIP TO 103)
CART WITH SMALL TANK 71 (SKIP TO 103)
SURFACE WATER (RIVER/DAM/LAKE/POND/STREAM/CANAL/IRRIGATION CHANNEL) 81 (SKIP TO 103)
BOTTLED WATER 91
SACHET WATER 92
OTHER (SPECIFY) 96 (SKIP TO 103)
102. What is the main source of water used by your household for other purposes such as cooking and handwashing?
PIPED INTO YEARD/PLOT 12 (SKIP TO 105)
PIPED TO NEIGHBOR 13 (SKIP TO 105)
PUBLIC TAP/STANDPIPE 14
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
OTHER (SPECIFY) 96
103. Where is that water source located?
IN OWN YARD/PLOT 2 (SKIP TO 105)
ELSEWHERE 3
104. How long does it take to go there, get water, and come back?
DON?T KNOW 998
105. What kind of toilet facility do members of your household usually use? IF NOT POSSIBLE TO DETERMINE, ASK PERMISSION TO OBSERVE THE FACILITY.
FLUSH TO SEPTIC TANK 12
FLUSH TO PIT LATRINE 13
FLUSH TO SOMEWHERE ELSE 14
FLUSH, DON?T KNOW WHERE 15
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 108)
OTHER (SPECIFY) 96
106. Do you share this toilet facility with other households?
NO 2 (SKIP TO 108)
107. Including your own household, how many household use this toilet facility?
10 OR MORE HOUSEHOLDS 95
DON?T KNOW 98
108. What type of fuel does your household mainly use for cooking?
LPG 02
NATURAL GAS 03
BIOGAS 04
KEROSENE 05
COAL, LIGNITE 06
CHARCOAL 07
WOOD 08
STRAW/SHRUBS/GRASS 09
AGRICULTURAL CROP RESIDUE 10
ANIMAL DUNG 11
NO FOOD COOKED IN HOUSEHOLD 95
OTHER (SPECIFY) 96
109. How many rooms in this household are used for sleeping?
109A. How many separate rooms are in this household?
109B. How many separate sleeping spaces are there in your household?
110. Does this household own any livestock, herds, other farm animals, or poultry?
NO 2 (SKIP TO 112)
111. How many of the following animals does this household own? IF NONE, RECORD '00'. IF 95 OR MORE, RECORD '95'. IF UNKNOWN, RECORD '98'.
a) Milk cows or bulls?
b) Other cattle?
c) Horses, donkeys, or mules?
d) Goats?
e) Sheep?
f) Chickens or other poultry?
g) Pigs?
h) Rabbits?
112. Does any member of your household own any agricultural land?
NO 2 (SKIP TO 114)
113. How many hectares of agricultural land do members of this household own? 1 ACRE IS 0.4 HECTARE. 1 FOOTBALL PITCH IS 2.5 ACRE. IF 95 OR MORE HECTARES, CIRCLE '950'. IF 95 OR MORE FOOT PITCH, CIRCLE '950'. IF 95 OR MORE ACRES, RECORD IN HECTARES.
FOOTBALL PITCH__ 2
SCRES__ 3
95 OR MORE HECTARES/FOOTBALL PITCH 950
DON?T KNOW 998
114. Does your household have:
a) Electricity?
b) A radio?
c) A television?
d) A non-mobile telephone?
e) A computer/Tablet computer?
f) A refrigerator?
g) A koloboyi?
h) A paraffin lamp?
i) A bed with a mattress?
j) A torch?
k) A sofa set?
NO 2
115. Does any member of this household own:
a) A wrist watch?
b) A mobile phone?
c) A bicycle?
d) A motorcycle or motor scooter?
e) An animal-drawn cart?
f) a car or truck?
g) A boat with motor
NO 2
116. Does any member of this household have a bank account?
NO 2
119. Does your household have any mosquito nets?
NO 2 (SKIP TO 131)
120. How many mosquito nets does your household have? IF 7 OR MORE NETS, RECORD '7'
121. ASK THE RESPONDENT TO SHOW YOU ALL THE NETS IN THE HOUSEHOLD. IF MORE THAN 3 NETS, USE ADDITIONAL QUESTIONNAIRE(S).
OBSERVED NOT HANGING/PACKAGED 2
NOT OBSERVED 3
121A. 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
121B. OBSERVE OR ASK THE COLOR OF THE MOSQUITO NET.
DARK BLUE 02
LIGHT BLUE 03
RED 04
BLACK 05
WHITE 06
OTHER 96
121C. OBSERVE OR ASK THE SHAPE OF THE MOSQUITO NET.
RECTANGULAR 2 (SKIP TO 122)
OTHER 6 (SKIP TO 122)
121D. Was this net altered to become a conical net?
NO 2 (SKIP TO 122)
NOT SURE 8 (SKIP TO 122)
121E. How many nets were used to make the mosquito net conical
TWO NETS 2
THREE OR MORE NET 3
122. How many months ago did your household get the mosquito net? IF LESS THAN ONE MONTH AGO, RECORD '00'.
MORE THAN 36 MONTHS AGO 95
NOT SURE 98
123. OBSERVE OR ASK BRAND/TYPE OF MOSQUITO NET. IF BRAND IS UNKNOWN AND YOU CANNOT OBSERVE THE NET, SHOW PICTURES OF TYPICAL NET TYPES/BRANDS TO RESPONDENT.
DURANET 12
INTERCEPTOR 13
LIFENET 14
MAGNET 15
OLYSET 16
OLYSET PLUS 17
PERMANET 2.0 18
PERMANET 3.0 19
ROYAL SENTRY 20
YORKOOL 21
OTHER/DON?T KNOW BRAND 26
DON?T KNOW TYPE 98
126. Did you get the net through the 2015-2016 mass distribution campaign, during an antenatal care visit, at birth, or first immunization visit?
YES, ANC 2 (SKIP TO 128)
YES, AT BIRTH 3 (SKIP TO 128)
YES, IMMUNIZATION VISIT 4 (SKIP TO 128)
NO 5
127. Where did you get the net?
GOVERNMENT HEALTH CENTER 02
GOVERNMENT HEALTH POST/OUTREACH 03
CHAM/MISSION 04
PRIVATE HEALTH FACILITY 05
PHARMACY 06
SHOP/MARKET 07
WORKPLACE 08
OTHER (SPECIFY) 96
DON?T KNOW 98
128. Did anyone sleep under this mosquito net last night?
NO 2 (SKIP TO 130)
NOT SURE 8 (SKIP TO 130)
129. Who slept under this mosquito net last night? RECORD THE PERSON'S NAME AND LINE NUMBER FROM HOUSEHOLD SCHEDULE.
LINE NUMBER__
130. GO BACK TO 121 FOR NEXT NET; OR, IF NO MORE NETS, GO TO 131.
ADDITIONAL HOUSEHOLD CHARACTERISTICS
131. OBSERVE MAIN MATERIAL OF THE FLOOR OF THE DWELLING. RECORD OBSERVATION.
DUNG 12
PALM/BAMBOO 22
VINYL OR ASPHALT STRIPS 32
CERAMIC TILES 33
CEMENT 34
CARPET 35
132. OBSERVE MAIN MATERIAL OF THE ROOF OF THE DWELLING. RECORD OBSERVATION.
THATCH/PALM LEAF 12
SOD 13
PALM/BAMBOO 22
WOOD PLANKS 23
CARDBOARD 24
WOOD 32
CALAMINE/CEMENT FIBER 33
CERAMIC TILES 34
CEMENT 35
ROOFING SHINGLES 36
133. OBSERVE THE MAIN MATERIAL OF THE EXTERIOR WALLS OF THE DWELLING. RECORD OBSERVATON.
CANE/PALM/TRUNKS 12
DIRT 13
STONE WITH MUD 22
UNCOVERED ADOBE 23
PLYWOOD 24
CARDBOARD 25
REUSED WOOD 26
STONE WITH LIME/CEMENT 32
BRICKS 33
CEMENT BLOCKS 34
COVERED ADOBE 35
WOOD PLANKS/SHINGLES 36
ADDITIONAL MOSQUITO NETS RELATED QUESTIONS
134. Has anyone in your household ever sold or given away a mosquito net?
NO 2
DON?T KNOW 8
135. 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
136. If you have a choice, what shape of mosquito net do you prefer?
RECTANGULAR 2 (SKIP TO 138)
DON?T KNOW/NO PREFERENCE 8 (SKIP TO 139)
137. What are the reasons why you prefer a conical-shaped net over a rectangular-shaped net?
EASIER TO STORE WHEN NOT HUNG B (SKIP TO 139)
EASIER TO TRAVEL WITH OUTSIDE THE HOUSEHOLD C (SKIP TO 139)
BETTER FIT AROUND THE SLEEPING PLACE D (SKIP TO 139)
TALLER E (SKIP TO 139)
MORE PEOPLE CAN SLEEP UNDER NET (WIDER) F (SKIP TO 139)
LOOKS NICER G (SKIP TO 139)
STRONGER H (SKIP TO 139)
OTHER (SPECIFY) X (SKIP TO 139)
138. What are the reasons why you prefer a rectangular-shaped net over a conical-shaped net?
EASIER TO STORE WHEN NOT HUNG B
EASIER TO TRAVEL WITH OUTSIDE THE HOUSEHOLD C
BETTER FIT AROUND THE SLEEPING PLACE D
TALLER E
MORE PEOPLE CAN SLEEP UNDER NET (WIDER) F
LOOKS NICER G
STRONGER H
OTHER (SPECIFY) X
MINUTES__
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT INTERVIEW
COMMENTS ON SPECIFIC QUESTIONS
ANY OTHER COMMENTS
SUPERVISOR'S OBSERVATIONS
EDITOR'S OBSERVATIONS