IDENTIFICATION

PLACE NAME ____
NAME OF HOUSEHOLD HEAD ____
CLUSTER NUMBER (IIM I.D) ______
HOUSEHOLD NUMBER _____

INTERVIEWER VISITS

DATE ____
INTERVIEWER'S NAME ____
NEXT VISIT: DATE ___
TIME: ____
NOTES ____
FINAL VISIT

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:

SUPERVISOR
NAME
NUMBER __ __ __ __

INTRODUCTION AND CONSENT

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 ___

SECTION 1 BASIC CHARACTERISTICS OF WOMAN

101 RECORD TIME

102 In what month and year were you born? ASK RESPONDENT FOR A DOCUMENT TO PROVE HER BIRTH DATE

103 How old are you in completed years? COMPARE 102 AND 103 IF THERE ARE ANY INCONSISTENCIES

104 Have you ever attended school?

105 What is the highest (grade/form/year) you completed at that level?

106 What is the highest level of school you completed? IF NONE, RECORD 00

107 CHECK 105

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?

SECTION 2. REPRODUCTION

201 Now I would like to ask about all the births you have given during your life. Have you ever given birth?

202 Do you have any sons or daughters to whom you have given birth who are now living with you?

203 a How many sons live with you?
b How many daughters live with you?
IF NONE, RECORD 00

204 Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?

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

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?

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?

210 CHECK 208

211 Now I would like to ask you about recent births. How many births did you give between 2013 and 2018?

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?

215 Does (NAME) have twins?

216 In what month and year was (NAME) born?

217 Is (NAME) still alive?

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?

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?

222 Have you had any live births since the birth of (name)?

223 COMPARE 211 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK

224 CHECK 216. ENTER THE NUMBER OF BIRTHS BETWEEN 2013-2018.

225 Are you pregnant now?

226 How many months pregnant are you?

227 CHECK 224

SECTION 3. PREGNANCY AND INTERMITTENT PREVENTIVE TREATMENT

301 RECORD THE NAME AND SURVIVAL STATUS FOR THE LAST BIRTH IN 213 AND 217, LINE 01:

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

302A Has (Name) received a mosquito net during an antenatal care consultation?

302B How many months pregnant were you when you had the first antenatal care visit?

303 Who examined you? Anyone else? ASK TO IDENTIFY ALL THE PEOPLE WHO EXAMINED HER. RECORD ALL ANSWERS

303A How many antenatal care visits did you have during this pregnancy?

304 During this pregnancy, did you take SP/Fansidar to prevent malaria? SHOW EXAMPLE OF SP/FANSIDAR

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.

307. CHECK 216 AND 217

SECTION 4. FEVER IN CHILDREN

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

403 CHECK 213 AND 217

404 In the last 2 weeks has (NAME) had a fever?

405 At some point during the fever, has (CHILD'S NAME) drawn blood from the finger or heel to make a test?

406 Did you seek for advice or treatment when (CHILD'S NAME) had fever?

406A Why not?

406B Who made the decision not to seek advice or treatment?

406C Who made the decision to seek advice or treatment?

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 ____

408 CHECK 407

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?

412 What medicines did (NAME) take? Anything else?

413 CHECK 412: ANY A-I CODE MARKED?

414 CHECK 412. ANY THERAPY COMBINED BASED ON ARTEMISININ ('A)?

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?

416 CHECK 412. TOOK SP/FANSIDAR (B)

417 How many days after the onset of fever did (CHILD'S NAME) take Sp/Fansidar for the first time?

418 CHECK 412. TOOK CHLOROQUINE C

419 How many days after the onset of fever did (CHILD'S NAME) take chloroquine for the first time?

420 CHECK 412 TOOK AMODIAQUINE (D)

421 How many days after the onset of fever did (CHILD'S NAME) take amodiaquine for the first time?

422 CHECK 412. TOOK QUININE (E OR F)

423 How many days after the onset of fever did (CHILD'S NAME) take quinine for the first time?

424 CHECK 412 TOOK ARTESUNATE (G OR H)

425 How many days after the onset of fever did (CHILD'S NAME) take artesunate for the first time?

426 CHECK 412. TOOK A DIFFERENT ANTI-MALARIAL MEDICATION

427 How many days after the onset of fever did (CHILD'S NAME) take a different anti-malarial medication for the first time?

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

502 How can you get malaria?

503 What can you do to avoid getting malaria? Anything else? Record all answers

504 What can a pregnant woman do to prevent malaria? Anything else? Record all mentioned.

505 Does malaria have a cure?

506 What medicine can be used to cure malaria? Anything else? Record all mentioned.

507 In the last 6 months, have you heard any messages about malaria?

508 What messages about malaria did you see/hear about? Anything else? Record all mentioned

509 Where has (NAME) heard messages about malaria? Anywhere else? Record all mentioned

510 Has (name) ever seen this image?

511 Now I will ask you questions about your opinion on malaria. Tell me if you agree or disagree with the following sentences.

512 Can (NAME) complete the following sentence? "[One should] Sleep inside a mosquito net?" CORRECT ANSWER: EVERY NIGHT

513 Has (NAME) sleep inside a mosquito net yesterday night?

514 Why not?

515 What encourages you to sleep inside a mosquito net? Record all answers

516 RECORD TIME

INTERVIEWER'S OBSERVATIONS
TO BE FILLED OUT AFTER THE INTERVIEW

COMMENTS
COMMENTS ABOUT SPECIFIC QUESTIONS
OTHER COMMENTS

SUPERVISOR OBSERVATIONS

EDITOR OBSERVATIONS