Date: 26 January 2021
NATIONAL INSTITUTE OF STATISTICS (INS)
NATIONAL PROGRAM IN THE FIGHT AGAINST MALARIA (PNLP)
NIGER MALARIA INDICATOR SURVEY
HOUSEHOLD QUESTIONNAIRE
IDENTIFICATION
NAME OF LOCALITY ______
NAME OF HEAD OF HOUSEHOLD ______
CLUSTER NUMBER ______
CONCESSION NUMBER ______
HOUSEHOLD NUMBER ______
(Repeat for up to 3 visits)
NAME OF INTERVIEWER ______
RESULT ______
TIME ______
MONTH ______
YEAR ______
INTERVIEWER NUMBER ______
RESULT ______
2 NO FAMILY MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT
3 ENTIRE HOUSEHOLD ABSENT FOR LONG PERIOD
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR NO DWELLING AT ADDRESS
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY) ______
TOTAL NUMBER OF PEOPLE IN HOUSEHOLD ______
TOTAL NUMBER OF ELIGIBLE WOMEN ______
RESPONDENT'S LINE NUMBER FOR HOUSEHOLD QUESTIONNAIRE ______
LANGUAGE OF QUESTIONNAIRE 01
LANGUAGE OF QUESTIONNAIRE FRENCH
INTERVIEW LANGUAGE ______
NATIVE LANGUAGE OF RESPONDENT ______
INTERPRETER (YES = 1, NO = 2) ______
02 HAUSA
03 ZARMA
04 TAMASHEQ
05 FULFULDE
06 KANURI/TEBU
07 ARABIC
08 GOURMANCHÉ
96 OTHERS (SPECIFY) ______
TEAM LEADER
NAME ______
NUMBER ______
INTRODUCTION AND REQUEST FOR CONSENT
Hello. My name is ______. I am working for the National Institute of Statistics (INS). In collaboration with the National Program in the Fight Against Malaria (PNLP), we are conducting a survey about malaria all over Niger. The information we collect will help the government to improve health services in general and those involved in the fight against malaria in particular. Your household was selected for the survey. I would like to ask you some questions about your household. The questions usually take about 15 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 people listed on this card.
GIVE CARD WITH CONTACT INFORMATION
Do you have any questions?
May I begin the interview now?
INTERVIEWER'S SIGNATURE ______
DATE ______
2 RESPONDENT DECLINES TO BE INTERVIEWED (Skip to END)
MINUTES ______
HOUSEHOLD SCHEDULE
(Repeat Q 1 - 9 for up to 10 household members)
2. HABITUAL RESIDENTS AND VISITORS
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 ASKING QUESTIONS 2 - 7 FOR EACH PERSON, ASK QUESTIONS 2A - 2C TO MAKE CERTAIN THAT THE LIST IS COMPLETE.
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 ______
3. RELATIONSHIP TO HEAD OF HOUSEHOLD
What is the relationship of (NAME) to the head of the household?
______
4. GENDER
Is (NAME) male or female?
2 FEMALE
5. RESIDENCE
Does (NAME) usually live here?
2 NO
6. RESIDENCE
Did (NAME) stay here last night?
2 NO
IF 95 OR OLDER, RECORD '95'.
8. ELIGIBILITY
CIRCLE THE LINE NUMBER OF ALL WOMEN AGE 15 - 49
01
9. ELIGIBILITY
CIRCLE THE LINE NUMBER OF ALL CHILDREN AGE 0 - 5
01
CODES FOR Q. 3: FAMILY RELATIONSHIP TO HEAD OF HOUSEHOLD
02 WIFE OR HUSBAND
03 SON OR DAUGHTER
04 SON-IN-LAW/DAUGHTER-IN-LAW
05 GRANDSON/GRANDDAUGHTER
06 FATHER/MOTHER
07 FATHER-IN-LAW/MOTHER-IN-LAW
08 BROTHER OR SISTER
09 OTHER FAMILY RELATIONSHIP
10 ADOPTED/FOSTER/STEPCHILD
11 NO FAMILY RELATION
98 DK
HOUSEHOLD CHARACTERISTICS
101. Where does the drinking water used by members of your household mainly come from?
12 FAUCET IN YARD/PLOT (Skip to 105)
13 FAUCET AT NEIGHBOR'S (Skip to 105)
14 PUBLIC FOUNTAIN/STANDPIPE (Skip to 103)
21 BOREHOLE/PUMP WELL
32 UNPROTECTED WELL
42 UNPROTECTED SPRING
61 TANKER WATER
71 CART WITH SMALL TANK/BARREL
81 SURFACE WATER (RIVER/DAM/LAKE/POND/IRRIGATION CANAL)
91 BOTTLED WATER
92 BAG WATER
96 OTHER (SPECIFY) ______ (Skip to 103)
[translator's note: Skip instructions for Codes 14 - 92 are not clear]
102. Where does the water needed by the household for other uses such as cooking and handwashing mainly come from?
12 FAUCET IN YARD/PLOT (Skip to 105)
13 FAUCET AT NEIGHBOR'S (Skip to 105)
14 PUBLIC FOUNTAIN/STANDPIPE
21 BOREHOLE/PUMP WELL
32 UNPROTECTED WELL
42 UNPROTECTED SPRING
61 TANKER WATER
71 CART WITH SMALL TANK/BARREL
81 SURFACE WATER (RIVER/DAM/LAKE/POND/IRRIGATION CANAL)
96 OTHER (SPECIFY) ______
103. Where is this water source located?
2 IN YOUR YARD/PLOT (Skip to 105)
3 ELSEWHERE
104. How long does it take to go there, fetch the water and come back?
998 DK
105. What kind of toilet do members of your household usually use?
IF UNABLE TO DETERMINE TYPE OF TOILET, ASK PERMISSION TO SEE THE FACILITY.
12 CONNECTED TO SEPTIC SYSTEM
13 CONNECTED TO TOILET PIT
14 CONNECTED TO SOMETHING ELSE
15 CONNECTED TO UNKNOWN PLACE
22 PIT LATRINE WITH SLAB
23 PIT LATRINE WITHOUT SLAB/OPEN PIT
31 COMPOSTING TOILET
41 BUCKET/TIN PAIL
51 SUSPENDED TOILET/LATRINE
61 NO TOILET/IN NATURE (Skip to 109)
96 OTHER (SPECIFY) ______
106. Do you share this toilet with other households?
2 NO (Skip to 108)
107. Including your own household, how many households use this toilet?
95 10 OR MORE HOUSEHOLDS
98 DK
108. Where is this toilet located?
2 IN YOUR YARD/PLOT
3 ELSEWHERE
109. In this household, what kind of cookstove is usually used for cooking?
(01 - 05 SKIP TO 111)
02 SOLAR OVEN
03 LIQUID PROPANE GAS STOVE
04 STOVE CONNECTED TO NATURAL GAS
05 BIOGAS STOVE
06 LIQUID FUEL STOVE
07 MANUFACTURED SOLID FUEL STOVE
08 TRADITIONAL SOLID FUEL STOVE
09 THREE STONE FIREPLACE/OPEN HEARTH
95 NO COOKING IN HOUSEHOLD (Skip to 111)
96 OTHER (SPECIFY) ______
110. What kind of fuel or energy does this stove use?
02 GAS/DIESEL
03 PARAFFIN/OIL
04 COAL/LIGNITE
05 CHARCOAL
06 WOOD
07 STRAW/BRANCHES/GRASSES
08 AGRICULTURAL PRODUCTS
09 ANIMAL DUNG/WASTE
10 PROCESSED BIOMASS FUELS (PELLETS)/WOOD PELLETS
11 TRASH/PLASTIC
12 SAWDUST
96 OTHER (SPECIFY) ______
111. How many rooms are used for sleeping in this household?
112. Does your household own any livestock, herds, other farm animals, or poultry?
2 NO (Skip to 114)
113. How many of the following animals does your household own?
IF 95 OR MORE, MARK '95'.
IF DON'T KNOW, MARK '98'.
a) Milk cows or bulls?
b) Other livestock?
c) Horses, donkeys, or mules?
d) Camels?
e) Goats?
f) Sheep?
g) Chickens, guinea fowl, pigeons?
h) Ducks, geese?
i) Rabbits?
b) OTHER LIVESTOCK ______
c) HORSES, DONKEYS, OR MULES ______
d) CAMELS ______
e) GOATS ______
f) SHEEP ______
g) CHICKENS, GUINEA FOWL, PIGEONS ______
h) DUCKS, GEESE ______
i) RABBITS ______
114. Does any member of your household own any agricultural land?
2 NO (Skip to 116)
115. How many hectares of agricultural land is owned by household members?
HECTARES ______
950 95 HECTARES OR MORE
998 DK
116. In this household, do you have:
a) Electricity?
b) A radio set?
c) A television?
d) A landline telephone?
e) A computer?
f) A refrigerator?
g) A chair made out of traditional materials?
h) Wardrobe/Bookshelves?
i) A hot plate?
j) A gas or electric stove?
k) An improved stove?
l) An air conditioner?
m) Internet access at home?
n) A solar panel?
o) A generator?
p) A parabolic antenna?
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
117. Does any member of your household own:
a) A clock/a watch?
b) A cell phone?
c) A bicycle?
d) A motorcycle or a scooter?
e) An animal-drawn cart?
f) A car or van?
g) A motor boat or flat-bottomed boat?
h) A plow?
i) A dugout canoe?
j) A tractor?
k) A cultivator/tractor?
l) A motorized seeder?
m) A motorized tricycle?
n) A moped?
o) A motor pump?
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
2 NO
118. Does any member of the household have an account in a bank or in another financial institution?
2 NO
119. Does any member of this household use a cell phone to carry out financial transactions such as sending or receiving money, paying bills, buying goods or services, or receiving a salary?
2 NO
120. Does your household have any mosquito nets?
2 NO (Skip to 132)
121. How many mosquito nets does your household have?
IF SEVEN OR MORE MOSQUITO NETS, MARK '7'.
MOSQUITO NETS
ASK RESPONDENT TO SHOW YOU ALL THE MOSQUITO NETS IN THE HOUSEHOLD. OBSERVE AND ASK QUESTIONS ABOUT EACH MOSQUITO NET, ONE BY ONE.
122. ASSIGN A SEQUENTIAL NUMBER TO EACH MOSQUITO NET AND RECORD THE NUMBER HERE.
123. WAS THIS MOSQUITO NET OBSERVED?
2 NOT OBSERVED
124. How many months has your household had the mosquito net?
IF LESS THAN ONE MONTH, MARK '00'.
95 MORE THAN 36 MONTHS
98 NOT SURE
125. OBSERVE OR ASK THE BRAND/TYPE OF MOSQUITO NET. IF BRAND IS NOT KNOWN AND YOU CANNOT SEE THE MOSQUITO NET, SHOW RESPONDENT SOME PHOTOS OF COMMON BRANDS AND TYPES OF MOSQUITO NET.
12 DURANET
13 INTERCEPTOR G2
14 OLYSET NET
15 PERMANET 2.0
16 ROYAL SENTRY
17 SAFENET
18 LIFE NET
19 YORKOOL LN
26 OTHER/DON'T KNOW BRAND (LLIN)
96 OTHER TYPE (NOT LLIN)
98 DON'T KNOW TYPE
126. Did you get the mosquito net during an LLIN distribution campaign, during an antenatal visit, or during a vaccination visit?
2 YES, ANTENATAL VISIT
3 YES, VACCINATION VISIT (Skip to 128)
4 NO (Skip to 128)
[translator's note: skip directions not clear]
127. Where did you get the mosquito net?
02 PRIVATE HEALTH FACILITY
03 PHARMACY
04 SHOP/MARKET
05 COMMUNITY HEALTH AGENT
06 RELIGIOUS INSTITUTION
07 SCHOOL
08 NGO
96 OTHER
98 DK
128. Did anyone sleep under this mosquito net last night?
2 NO (Skip to 130)
8 NOT SURE (Skip to 131)
129. Who slept under this mosquito net last night?
RECORD PERSON'S NAME AND LINE NUMBER FROM HOUSEHOLD SCHEDULE.
(Repeat for up to 4 people)
LINE NUMBER ______ (Skip to 131)
130. What is the main reason that this mosquito net was not used last night?
03 DON'T LIKE SHAPE OF MOSQUITO NET
04 DON'T LIKE COLOR OF MOSQUITO NET
05 DON'T LIKE SIZE OF MOSQUITO NET
06 DON'T LIKE SMELL OF MOSQUITO NET
07 UNABLE TO HANG IT UP
08 SLEPT OUTSIDE
09 USUAL PERSON TO USE IT DID NOT SLEEP HERE LAST NIGHT
10 NO MOSQUITOS/NO MALARIA
11 EXTRA MOSQUITO NET/KEEPING IT FOR LATER
96 OTHER (SPECIFY) ______
131. RETURN TO 122 FOR THE NEXT MOSQUITO NET; IF NO MORE MOSQUITO NETS, CONTINUE TO 132
.
OTHER CHARACTERISTICS OF DWELLING
132. OBSERVE THE MAIN MATERIAL OF FLOOR OF DWELLING.
RECORD OBSERVATION.
12 DUNG
22 PALMS/BAMBOO
32 VINYL/ASPHALT STRIPS
33 TILE
34 CEMENT
35 CARPETING
96 OTHER (SPECIFY) ______
133. OBSERVE THE MAIN MATERIAL OF DWELLING'S ROOF.
RECORD OBSERVATION.
12 THATCH/PALMS/LEAVES
13 CLUMPS OF EARTH
22 PALMS/BAMBOO
23 WOOD PLANKS
24 CARDBOARD
32 WOOD
33 ZINC/CEMENT FIBER
34 TILES
35 CEMENT
36 SHINGLES
96 OTHER (SPECIFY) ______
RECORD OBSERVATION.
12 BAMBOO/CANE/PALM/TRUNK
13 EARTH
22 STONES WITH MUD
23 UNFINISHED ADOBE
24 PLYWOOD
25 CARDBOARD
26 SALVAGED WOOD
32 STONES WITH LIME/CEMENT
33 BRICKS
34 CEMENT BLOCKS
35 FINISHED ADOBE
36 WOOD PLANKS/SHINGLES
96 OTHER (SPECIFY) ______
MINUTES ______
INTERVIEWER'S OBSERVATIONS
TO BE FILLED OUT ONCE INTERVIEW IS COMPLETED
______
COMMENTS ABOUT PARTICULAR QUESTIONS:
______
OTHER COMMENTS:
______