REPUBLIC OF MOZAMBIQUE
MALARIA INDICATOR SURVEY
IIM 2018
WOMEN'S QUESTIONNAIRE
PLACE NAME ____
NAME OF HOUSEHOLD HEAD ____
CLUSTER NUMBER (IIM I.D) ______
HOUSEHOLD NUMBER _____
DATE ____
INTERVIEWER'S NAME ____
NEXT VISIT: DATE ___
TIME: ____
NOTES ____
FINAL VISIT
MONTH __ __
YEAR __ __ __ __
TOTAL NUMBER OF VISITS ___
TOTAL NUMBER OF ELIGIBLE CHILDREN ___
LANGUAGE OF QUESTIONNAIRE 01
LANGUAGE OF INTERVIEW ___
NATIVE LANGUAGE OF RESPONDENT ___
TRANSLATOR USED (YES = 1, NO = 2) ___
LANGUAGE OF QUESTIONNAIRE: PORTUGUESE
LANGUAGE CODES:
02 ENGLISH
03 EMAKHUWA 08 CINYANJA 09 CINDAU
04 XICHANGANA 10 XITSWA
05 CISENA 11 CINYUNGWE
06 ELOMWE 12 CIYAO
07 ECHUWABO
96 SHONA
SUPERVISOR
NAME
NUMBER __ __ __ __
My name is (SAY THE NAME). I am an interviewer for the National Institute of Health (INS), Ministry of Health. We are conducting a national malaria survey. The information we are gathering will help the Mozambican government to plan health services. As part of the survey, we would like to ask you some questions about your child births, how to prevent or treat malaria and what actions should be taken when the child shows signs or symptoms of malaria. The interview usually takes 30 minutes. The information you provide to us will be strictly confidential and will only be shared with my team members.
Your participation in this survey is voluntary and if you have any questions that you do not want to answer, please let us know and we will move on to the next question. You can stop the interview at any time. If you need more information about this survey, you can ask or contact the people mentioned in the brochure that you have already received
Any questions?
Can I start the interview?
INTERVIEWER SIGNATURE ___
DATE ___
RESPONDENT REFUSES TO BE INTERVIEWED 2 (END THE INTERVIEW)
SECTION 1 BASIC CHARACTERISTICS OF WOMAN
101 RECORD TIME
MINUTES __ __
102 In what month and year were you born? ASK RESPONDENT FOR A DOCUMENT TO PROVE HER BIRTH DATE
DK MONTH 98
YEAR __ __ __ __
DK YEAR 9998
103 How old are you in completed years? COMPARE 102 AND 103 IF THERE ARE ANY INCONSISTENCIES
104 Have you ever attended school?
NO 2 (GO TO 108)
105 What is the highest (grade/form/year) you completed at that level?
ELEMENTARY EP 1
ELEMENTARY EP2
ELEMENTARY VOCATIONAL 3
HIGH ESG 1 4
HIGH ESG 2 5
BASIC VOCATIONAL 6
HIGH VOCATIONAL 7
UNIVERSITY 8
106 What is the highest level of school you completed? IF NONE, RECORD 00
CODE 04-08 MARKED ___ (GO TO 201)
108 Now, I would like you to read this sentence to me. SHOW CARD TO RESPONDENT. IF RESPONDENT CANNOT READ THE COMPLETE SENTENCE, ASK: Can you read some part of the sentence?
CAN READ IT PARTIALLY 2
CAN READ READ THE WHOLE SENTENCE 3
NO CARD WITH RESPONDENT'S LANGUAGE AVAILABLE (SPECIFY LANGUAGE) 4
BLIND 5
201 Now I would like to ask about all the births you have given during your life. Have you ever given birth?
NO 2 (GO TO 206)
202 Do you have any sons or daughters to whom you have given birth who are now living with you?
NO 2 (GO TO 204)
203 a How many sons live with you?
b 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 (GO TO 206)
205 a How many sons are alive but do not live with you?
b And how many daughters are alive but do not live with you?
IF NONE, RECORD 00
B DAUGHTERS ELSEWHERE __ __
206 Have you ever given birth to a boy or a girl who was born alive but later died? If not, probe: any baby who cried or showed signs of life but survived only a few hours or days?
NO 2 (GO TO 208)
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 NECESSARY)
NO BIRTHS ___ (GO TO 225)
211 Now I would like to ask you about recent births. How many births did you give between 2013 and 2018?
NONE 00 (GO TO 225)
212 Now I would like to know the names of all children born in 2013 - 2018, whether they are alive or dead, starting with the most recent child. RECORD IN 213, THE NAMES OF ALL CHILDREN BORN ALIVE IN THE LAST 5 YEARS (Even if the child is no longer living or is not the current partner's child). RECORD TWINS AND TRIPLETS ON SEPARATE LINES. IF YOU HAVE MORE THAN 5 CHILDREN, USE AN ADDITIONAL QUESTIONNAIRE, STARTING ON THE SECOND LINE.
213 What is the name of your most recent child? RECORD NAME. BIRTH ORDER.
214 Is (NAME) a boy or a girl?
GIRL 2
MULT 2
216 In what month and year was (NAME) born?
MONTH __ __
YEAR __ __ __ __
NO 2 (GO TO NEXT CHILD)
218 IF ALIVE: How old was (NAME) at his/her last birthday? RECORD AGE IN COMPLETED YEARS.
219 IF ALIVE: Is (NAME) living with you?
NO 2
220 IF ALIVE. RECORD ORDER NUMBER OF CHILDREN FROM HOUSEHOLD QUESTIONNAIRE. RECORD 00 IF CHILD WAS NOT LISTED.
221 Were there any other births between the birth of (NAME) OF BIRTH O PREVIOUS) and from (NAME), including children who died right after the childbirth?
NO 2 (NEXT BIRTH)
222 Have you had any live births since the birth of (name)?
NO 2
223 COMPARE 211 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK
NUMBERS ARE DIFFERENT ___ (PROBE AND RECONCILE)
224 CHECK 216. ENTER THE NUMBER OF BIRTHS BETWEEN 2013-2018.
NONE 0
NO 2 (GO TO 227)
UNSURE 8 (GO TO 227)
226 How many months pregnant are you?
NO BIRTHS BETWEEN 2013-2018 (GO TO 501)
Q. 224 IS EMPTY ___ (GO TO 501)
SECTION 3. PREGNANCY AND INTERMITTENT PREVENTIVE TREATMENT
301 RECORD THE NAME AND SURVIVAL STATUS FOR THE LAST BIRTH IN 213 AND 217, LINE 01:
ALIVE ___ (GO TO 302)
DEAD (GO TO 302)
302 Now I would like to ask about the more recent birth that resulted in a live birth. When you were pregnant with the child (NAME), did you attend antenatal care appointments? ASK FOR THE NOTEBOOK OR PAPER FROM ANTENATAL APPOINTMENTS
NO 2 (GO TO 304)
302A Has (Name) received a mosquito net during an antenatal care consultation?
NO 2
302B How many months pregnant were you when you had the first antenatal care visit?
DK 98
303 Who examined you? Anyone else? ASK TO IDENTIFY ALL THE PEOPLE WHO EXAMINED HER. RECORD ALL ANSWERS
NURSE B
MIDWIFE C
APE E
303A How many antenatal care visits did you have during this pregnancy?
DK 98
304 During this pregnancy, did you take SP/Fansidar to prevent malaria? SHOW EXAMPLE OF SP/FANSIDAR
NO 2 (GO TO 307)
DK 8 (GO TO 307)
305 During this pregnancy, how many times did you take SP/Fansidar?
306 Has (NAME) obtained SP/fansidar during antenatal care appointments, at some other health facility appointments, or elsewhere? IF MORE THAN ONE LOCATION, RECORD THE FIRST CODE MARKED IN THE LIST.
OTHER APPOINTMENT 2
ELSEWHERE 6
NO CHILD BORN BETWEEN 2013-2018 ___ (GO TO 501)
401 CHECK 213: RECORD THE NUMBER OF BIRTHS IN 402 AND THE NAME AND SURVIVAL STATUS OF EACH BIRTH IN 2013-2018. ASK THE QUESTIONS OF ALL THESE BIRTHS, BEGINNING WITH THE LAST BIRTH. IF THERE ARE MORE THAN 2 BIRTH, USE ADDITIONAL QUESTIONNAIRE
Now I would like to ask you about the children that were born in the last five years. (Let's talk about each child separately.)
402. BIRTH NUMBER IN 213 IN BIRTH HISTORY
ALIVE (GO TO 404)
DEAD (GO TO 428)
404 In the last 2 weeks has (NAME) had a fever?
NO 2 (GO TO 428)
DK 8 (GO TO 428)
405 At some point during the fever, has (CHILD'S NAME) drawn blood from the finger or heel to make a test?
NO 2
DK 8
406 Did you seek for advice or treatment when (CHILD'S NAME) had fever?
NO 2
COSTS TOO MUCH B
TOO DISTANT C
NO TRANSPORTATION D
HAD A LOT OF WORK TO DO E
FEVER WAS NOT SERIOUS F
HAD NOT PERMISSION G
OTHER (SPECIFY) X
406B Who made the decision not to seek advice or treatment?
FATHER 2
BROTHER OR SISTER 3
GRANDMOTHER OR GRANDFATHER 4
WHOLE FAMILY 5
OTHER (SPECIFY) 96
DK 98
406C Who made the decision to seek advice or treatment?
FATHER 2
BROTHER OR SISTER 3
GRANDMOTHER OR GRANDFATHER 4
WHOLE FAMILY 5
OTHER (SPECIFY) 96
DK 98
407 Where did you seek advice or treatment? Anywhere else? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF IMPOSSIBLE TO DETERMINE PUBLIC OR PRIVATE, WRITE THE NAME(S) OF THE PLACE(S). NAME OF PLACE ____
MOBILE UNIT B
APE C
ANOTHER PUBLIC UNIT (SPECIFY) D
PHARMACY F
DOCTOR G
OTHER (SPECIFY) H
TRADITIONAL HEALER J
NEIGHBORHOOD K
COMMUNITY ACTIVIST/VOLUNTEER L
1 CODE MARKED ___ (GO TO 410)
409 Where did you seek advice or treatment for the first time? USE CODE FROM 407
410 How many days after the onset of the illness did you seek advice or treatment for (CHILD'S NAME) for the first time?
411 During the time you had a fever, did (CHILD'S NAME) take some medicine?
NO 2 (GO TO 428)
DK (GO TO 428)
412 What medicines did (NAME) take? Anything else?
SP/FANSIDAR B
CHLOROQUINE C
AMODIAQUINE D
QUININE
PILLS E
INJECTION/IV F
ARTESUNATE
SUPPOSITORY G
INJECTION/IV H
PILLS/SYRUP J
INJECTION/IV K
PARACETAMOL M
IBUPROFEN N
DK Z
413 CHECK 412: ANY A-I CODE MARKED?
NO (GO TO 428)
414 CHECK 412. ANY THERAPY COMBINED BASED ON ARTEMISININ ('A)?
CODE A NOT MARKED ___ (GO TO 416)
415 How many days after the onset of fever did (CHILD'S NAME) take the combination therapy based on artemisinin (TCA) for the first time?
ONE DAY AFTER 1
TWO DAYS AFTER 2
THREE DAYS AFTER 3
DK 8
416 CHECK 412. TOOK SP/FANSIDAR (B)
CODE B NOT MARKED ___ (GO TO 418)
417 How many days after the onset of fever did (CHILD'S NAME) take Sp/Fansidar for the first time?
ONE DAY AFTER 1
TWO DAYS AFTER 2
THREE DAYS AFTER 3
DK 8
418 CHECK 412. TOOK CHLOROQUINE C
CODE C NOT MARKED (GO TO 420)
419 How many days after the onset of fever did (CHILD'S NAME) take chloroquine for the first time?
ONE DAY AFTER 1
TWO DAYS AFTER 2
THREE DAYS AFTER 3
DK 8
420 CHECK 412 TOOK AMODIAQUINE (D)
CODE D NOT MARKED ___ (GO TO 422)
421 How many days after the onset of fever did (CHILD'S NAME) take amodiaquine for the first time?
ONE DAY AFTER 1
TWO DAYS AFTER 2
THREE DAYS AFTER 3
DK 8
422 CHECK 412. TOOK QUININE (E OR F)
CODE E OR F NOT MARKED ___ (GO TO 424)
423 How many days after the onset of fever did (CHILD'S NAME) take quinine for the first time?
ONE DAY AFTER 1
TWO DAYS AFTER 2
THREE DAYS AFTER 3
DK 8
424 CHECK 412 TOOK ARTESUNATE (G OR H)
CODE G OR H NOT MARKED ___ (GO TO 426)
425 How many days after the onset of fever did (CHILD'S NAME) take artesunate for the first time?
ONE DAY AFTER 1
TWO DAYS AFTER 2
THREE DAYS AFTER 3
DK 8
426 CHECK 412. TOOK A DIFFERENT ANTI-MALARIAL MEDICATION
CODE I NOT MARKED ___ (GO TO 428)
427 How many days after the onset of fever did (CHILD'S NAME) take a different anti-malarial medication for the first time?
ONE DAY AFTER 1
TWO DAYS AFTER 2
THREE DAYS AFTER 3
DK 8
428 GO BACK TO THE NEXT COLUMN OF 403; IF NO MORE BIRTHS, GO TO 501.
SECTION 5. KNOWLEDGE OF MALARIA
501 What are the symptoms of malaria? Anything else? Record all answers
CHILLS/TREMORS B
HEADACHE C
JOINT PAIN D
REDUCED APPETITE E
VOMIT F
CONVULSIONS G
COUGH H
NASAL CONGESTION I
OTHER (SPECIFY) X
DK Z
FLEAS/LICE/BEDBUGS 2
CONTAMINATED FOOD 3
DIRTY WATER 4
TRASH/DIRT 5
MAGIC SPELL 6
DEFICIENT PERSONAL HYGIENE 7
OTHER (SPECIFY) 96
DK 98
503 What can you do to avoid getting malaria? Anything else? Record all answers
SLEEP INSIDE A 'REMILD' B
SPRAYING THE HOUSE WITH INSECTICIDE C
USING 'SERPENTINA/BAYGON' D
KEEPING DOORS AND WINDOWS CLOSED E
USING SPRAY INSECT REPELLENT F
CUTTING GRASS G
ELIMINATE STILL WATER NEAR THE HOUSE H
BURN LEAVES/EUCALYPTUS I
OTHER (SPECIFY) X
DK Z
504 What can a pregnant woman do to prevent malaria? Anything else? Record all mentioned.
SLEEP INSIDE A 'REMILD' B
SPRAYING THE HOUSE WITH INSECTICIDE C
USING 'SERPENTINA/BAYGON' D
KEEPING DOORS AND WINDOWS CLOSED E
USING SPRAY INSECT REPELLENT F
CUTTING GRASS G
ELIMINATE STILL WATER NEAR THE HOUSE H
BURN LEAVES/EUCALYPTUS I
OTHER (SPECIFY) X
DK Z
NO 2 (GO TO 507)
DK 8 (GO TO 507)
506 What medicine can be used to cure malaria? Anything else? Record all mentioned.
SP/FANSIDAR B
CHLOROQUINE C
AMODIAQUINE D
QUININE
PILLS E
INJECTION/IV F
ARTESUNATE
SUPPOSITORY G
INJECTION/IV H
PILLS/SYRUP J
INJECTION/IV K
PARACETAMOL M
IBUPROFEN N
DK Z
507 In the last 6 months, have you heard any messages about malaria?
NO 2 (GO TO 510)
508 What messages about malaria did you see/hear about? Anything else? Record all mentioned
MALARIA CAN KILL YOU B
MOSQUITOES TRANSMIT MALARIA C
IT IS IMPORTANT TO SLEEP INSIDE A MOSQUITO NET D
WHO HAS TO SLEEP INSIDE A MOSQUITO NET E
SEEK TREATMENT FOR FEVER F
SEEK TREATMENT FOR FEVER QUICKLY (24 HOURS) G
IMPORTANCE OF HOUSE SPRAYING H
DO NOT PLASTER WALL AFTER SPRAYING I
ENVIRONMENTAL SANITATION ACTIVITIES J
IT IS IMPORTANT FOR PREGNANT WOMEN TO HAVE ANTENATAL CARE K
PREGNANT WOMEN SHOULD TAL SP/FANSIDAR L
OTHER (SPECIFY) X
DK Z
509 Where has (NAME) heard messages about malaria? Anywhere else? Record all mentioned
TV B
ELEMENTARY POLYVALENT AGENT C
ACTIVIST/VOLUNTEER D
CELL PHONE/SMS E
MOSQUE/CHURCH F
COMMUNITY EVENT G
POSTER/T-SHIRT/FLYER/BROCHURE H
SCHOOL I
TELEPHONE/INTERNET/SOCIAL MEDIA (SMS, FACEBOOK, WHATSAPP, TWITTER) J
ANTENATAL CARE APPOINTMENT K
HEALTH POST OR HOSPITAL L
OTHER (SPECIFY) X
DK Z
510 Has (name) ever seen this image?
NO 2
NO 2
NO 2
511 Now I will ask you questions about your opinion on malaria. Tell me if you agree or disagree with the following sentences.
DISAGREE 2
DK 8
DISAGREE 2
DK 8
DISAGREE 2
DK 8
DISAGREE 2
DK 8
DISAGREE 2
DK 8
DISAGREE 2
DK 8
DISAGREE 2
DK 8
DISAGREE 2
DK 8
DISAGREE 2
DK 8
DISAGREE 2
DK 8
512 Can (NAME) complete the following sentence? "[One should] Sleep inside a mosquito net?" CORRECT ANSWER: EVERY NIGHT
NO 2
513 Has (NAME) sleep inside a mosquito net yesterday night?
NO 2
I DON'T LIKE USING IT B (GO TO 516)
IT'S TOO HOT C (GO TO 516)
THERE ARE NO MOSQUITOES D (GO TO 516)
ALLERGY E (GO TO 516)
I SLEPT OUTDOORS F (GO TO 516)
OTHER (SPECIFY) X (GO TO 516)
DK Z (GO TO 516)
515 What encourages you to sleep inside a mosquito net? Record all answers
THE NET FORM/MORE SPACE B
IT'S EASY TO GET INSIDE AND OUTSIDE C
THE NET COLOR D
MY FAMILY HAS MORE NETS E
THERE ARE MORE PEOPLE IN MY COMMUNITY THAT USE NETS F
THE LEADERS IN MY COMMUNITY TALK ABOUT THE USE OF NETS H
OTHER (SPECIFY) X
DK Z
MINUTES __ __
INTERVIEWER'S OBSERVATIONS
TO BE FILLED OUT AFTER THE INTERVIEW
COMMENTS
COMMENTS ABOUT SPECIFIC QUESTIONS
OTHER COMMENTS