NIGERIA MALARIA INDICATOR SURVEY
WOMAN'S QUESTIONNAIRE
NATIONAL MALARIA ELIMINATION PROGRAM
NATIONAL POPULATION COMMISSION
NATIONAL BUREAU OF STATISTICS
STATE __
LOCAL GOVT. AREA __
LOCALITY __
ENUMERATION AREA __
URBAN/RURAL (URBAN = 1, RURAL = 2) __
CLUSTER NUMBER __
BUILDING NUMBER __
HOUSEHOLD HEAD NAME/HOUSEHOLD NUMBER __
NAME AND LINE NUMBER OF WOMAN __
FIRST VISIT
INTERVIEWER'S NAME __
RESULT* __
NEXT VISIT:
TIME __
SECOND VISIT
INTERVIEWER'S NAME __
RESULT* __
NEXT VISIT:
TIME __
THIRD VISIT
INTERVIEWER'S NAME __
RESULT* __
FINAL VISIT
MONTH __
YEAR 2015
INT NO. __
RESULT* __
TOTAL NUMBER OF VISITS __
*RESULT CODES:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER 7 (SPECIFY) __
LANGUAGE OF QUESTIONNAIRE** ENGLISH
LANGUAGE OF INTERVIEW** __
NATIVE LANGUAGE OF RESPONDENT** __
TRANSLATOR USED (1 = NOT AT ALL, 2 = SOMETIME, 3 = ALL THE TIME) __
**LANGUAGE CODES
YORUBA 2
IGBO 3
ENGLISH 4
OTHER 6 (SPECIFY) __
SUPERVISOR/EDITOR
NAME __
DATE __
NUMBER __
OFFICE EDITOR __
KEYED BY __
SECTION 1. RESPONDENT'S BACKGROUND
INTRODUCTION AND CONSENT
INFORMED CONSENT
Greetings. My name is _____________________________ and I am working with National Population Commission (NPopC) and the National Malaria Elimination Program (NMEP). We are conducting a national survey about malaria all over Nigeria. This study has been reviewed and granted approval by the National Health Research Ethics Committee, assigned number NHREC/01/01/2007-11/05/2015, for the study period of September 2015 to November 2015. Your household was selected for this survey. We would very much appreciate your participation in this survey. This information you provide will help the government to plan health services. The survey usually takes between 20 and 30 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons. Should you have any questions, feel free to call any of the following contact person(s):
NMEP Contact Person: Dr. Nnenna Ezeigwe, National Coordinator; Email:; Phone: 08033000296
NPC CONTACT PERSON: Mr. Bolajj Akinsulie, Project Director, Email:; Phone: 08023307806
NHREC Contact Person(s): Secretary, NHREC; Email:; Phone: 09523867; Desk Officer, NHREC; Email:; Phone: -----
Participation in this survey is voluntary, and if we should come to 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. However, we hope that you will participate in this survey since your views are important.
At this time, do you want to ask me anything about the survey?
May I begin the interview now?
Signature of interviewer: ___________________________________ Date: _________________
Signature/thumb print of respondent: __________________________Date: _________________
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
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 (class/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 SENTENCES ON CARD TO RESPONDENT.
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE 4 (SPECIFY LANGUAGE) __
BLIND/VISUALLY IMPAIRED 5
ISLAM 2
TRADITIONAL RELIGION 3
NO RELIGION 4
OTHER 6 (SPECIFY) __
110. What is your ethnic group?
201. Now I would like to ask about all the births you have had during your life. Have you ever born a child?
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 children you born 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 born a child 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'.
Just to make sure that I have this right: you have had in TOTAL ________ births in your life. Is that correct?
NO (PROBE AND CORRECT 201-208 AS NECESSARY)
NO BIRTHS (SKIP TO 224)
210. Now I'd like to ask you about your more recent births. How many births have you had in the last 6 years?
RECORD ALL BIRTHS IN 2010 OR LATER
IF NONE, CIRCLE '00'.
NONE 00 (SKIP TO 224)
211. Now I would like to record the names of all your births in the last six years, whether still alive or not, starting with the most recent one you had.
RECORD NAMES OF ALL THE BIRTHS IN 2010 OR LATER IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. IF THERE ARE MORE THAN 5 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW.
212. What name was given to your (most recent/previous) baby?
RECORD NAME.
BIRTH HISTORY NUMBER
01__
213. Is (NAME) a boy or a girl?
GIRL 2
214. Were any of these births twins?
MULTIPLE 2
215. In what month and year was (NAME) born?
MONTH __
YEAR __
NO 2 (NEXT BIRTH)
217. IF ALIVE: How old was (NAME) at (NAME)'s last birthday?
RECORD AGE IN COMPLETED YEARS.
218. IF ALIVE: Is (NAME) still living with you?
NO 2
RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD).
220. Were there any other live births between (NAME) and (NAME OF PREVIOUS BIRTH), including any children who died after birth?
NO 2 (NEXT BIRTH)
221. Have you had any live births since the birth of (NAME OF MOST RECENT BIRTH)?
IF YES, RECORD BIRTH(S) IN BIRTH TABLE.
NO 2
222. COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY:
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)
223. CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2010 OR LATER.
NONE 0
NO 2 (SKIP TO 226)
UNSURE 8 (SKIP TO 226)
225. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.
NO BIRTHS IN 2010 OR LATER (GO TO 501)
Q. 223 IS BLANK (GO TO 501)
SECTION 3. PREGNANCY AND INTERMITTENT PREVENTIVE TREATMENT
300. CHECK 212: ENTER IN THE TABLE THE NAME AND SURVIVAL STATUS OF THE MOST RECENT BIRTH.
Now I would like to ask some questions about your last pregnancy that resulted in a live birth.
301. FROM 212 AND 216, LINE 01:
MOST RECENT BIRTH
LIVING (CONTINUE)
DEAD (CONTINUE)
302. When you were 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
AUXILIARY MIDWIFE C
COMMUNITY HEALTH EXTENSION WORKER (CHEW) D
VILLAGE HEALTH WORKER (VHW) F
RURAL MODEL CAREGIVER (RMC) G
COMMUNITY DIRECTED DISTRIBUTOR (CDD) H
304. During this pregnancy, did you SP/Fansidar to keep you from getting malaria?
NO 2 (SKIP TO 311)
DON'T KNOW 8 (SKIP TO 311)
307. How many times did you take SP/Fansidar during this pregnancy?
ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY
OTHER (SKIP TO 311)
309. CHECK 304: ANTENATAL CARE FROM HEALTH PROFESSIONAL RECEIVED DURING THIS PREGNANCY?
OTHER (SKIP TO 312)
310. Did you get the SP/Fansidar during an 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
COMMUNITY HEALTH EXTENSION WORKER 3
OTHER SOURCE 6
310. Did you receive a mosquito net during an antenatal care visit?
NO 2
NO LIVING CHILDREN BORN IN 2010 OR LATER (SKIP TO 501)
401. CHECK 212: RECORD THE BIRTH HISTORY NUMBER IN 402 AND THE NAME AND SURVIVAL STATUS IN 403 FOR EACH BIRTH IN 2010-2015. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS, BEGIN WITH THE LAST BIRTH.
Now I would like to ask some questions about the health of your children born since January 2010. (We will talk about each separately.)
402. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY
MOST RECENT BIRTH
LIVING (CONTINUE)
DEAD (GO TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 425)
404. Has (NAME) been ill with a fever at any time in the last 2 weeks?
NO 2 (GO TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 425)
DON'T KNOW 8 (GO BACK TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 425)
404A. Did you suspect that (NAME) had malaria?
NO 2
DON'T KNOW 8
405. At any time during the illness, did (NAME) have a drop of blood taken from his/her finger or heel for testing?
NO 2
DON'T KNOW 8
405A. Was (NAME) tested for malaria?
NO 2 (SKIP TO 406)
DON'T KNOW 8 (SKIP TO 406)
405B. What was the result of the malaria test?
NEGATIVE 2
DON'T KNOW 8
406. Did you seek advice or treatment for the fever from any source?
NO 2 (SKIP TO 410)
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.
_______________________________
(NAME OF PLACE)
GOVT HEALTH CENTER B
GOVT HEALTH POST C
FREE MOBILE CLINIC D
ROLE MODEL CAREGIVER/COMMUNITY WORKER E
OTHER PUBLIC F (SPECIFY) __
PHARMACY H
CHEMIST/PMV I
PVT DOCTOR J
PVT MOBILE CLINIC K
OTHER PRIVATE L (SPECIFY) __
TRADITIONAL PRACTITIONER N
DRUG HAWKER O
OTHER X (SPECIFY) __
OTHER (SKIP TO 409A)
409. Where did you first seek advice or treatment?
USE LETTER CODE FROM 407.
409A. How many days after the illness began did you first seek advice or treatment for (NAME)?
IF SAME DAY, RECORD '00'.
410. At any time during this illness, did (NAME) take any drugs for the illness?
NO 2 (GO BACK TO 403 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 425)
DON'T KNOW 8 (GO BACK TO 403 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 425)
411. What drugs did (NAME) take?
Any other medicine?
RECORD ALL MENTIONED.
CHLOROQUINE B
AMODIAQUINE C
ARTESUNATE RECTAL D
INJECTION/IV E
QUININE PILLS F
INJECTION/IV G
ARTEMISININ COMBINATION THERAPY (ACT) H
OTHER ANTIMALARIAL I (SPECIFY) __
INJECTION K
ASPIRIN M
ACETAMINOPHEN N
IBUPROFEN O
DON'T KNOW Z
412. CHECK 411: ANY CODE A-I CIRCLED?
NO (GO BACK TO 315 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 425)
413. CHECK 411: SP/FANSIDAR/AMALAR/MALOXINE ('A') GIVEN
CODE 'A' NOT CIRCLED (SKIP TO 415)
414. How long after the fever started did (NAME) first take (SP/Fansidar)?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
415. CHECK 411: CHLOROQUINE ('B') GIVEN
CODE 'B' NOT CIRCLED (SKIP TO 417)
416. How long after the fever started did (NAME) first take chloroquine?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
417. CHECK 411: AMODIAQUINE ('C') GIVEN
CODE 'C' NOT CIRCLED (SKIP TO 418A)
418. How long after the fever started did (NAME) first take amodiaquine?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
418A. CHECK 411: ARTESUNATE ('D' OR 'E') GIVEN
CODE 'D' OR 'E' NOT CIRCLED (SKIP TO 419)
418B. 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
419. CHECK 332: QUININE ('F' OR 'G') GIVEN
CODE 'F' OR 'G' NOT CIRCLED (SKIP TO 336)
420. 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
ARTEMISININ COMBINATION THERAPY ('H') GIVEN
CODE 'H' NOT CIRCLED (SKIP TO 423)
422. How long after the fever started did (NAME) first take (ARTEMISININ COMBINATION THERAPY)?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
OTHER ANTIMALARIAL ('I') GIVEN
CODE 'I' NOT CIRCLED (GO BACK TO 403 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 425)
424. How long after the fever started did (NAME) first take the (OTHER ANTIMALARIAL)?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
425. GO BACK TO 403 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501.
SECTION 5. KNOWLEDGE OF MALARIA
501. Have you ever heard of an illness called malaria?
NO 2 (SKIP TO 516)
502. How can you tell if you have malaria?
CIRCLE ALL MENTIONED
CHILLS/SHIVERING B
HEADACHE C
JOINT PAIN D
POOR APPETITE E
VOMITTING F
CONVULSION G
COUGH H
CATARRH/NASAL CONGESTION I
OTHER X (SPECIFY) __
DON'T KNOW Z
503. Who are most at risk to get malaria?
CIRCLE ALL MENTIONED.
PREGNANT WOMEN B
ADULTS C
ELDERLY D
EVERYONE E
DON'T KNOW Z
CIRCLE ALL MENTIONED.
STAGNANT WATER B
DIRTY SURROUNDINGS C
BEER D
CERTAIN FOODS E
OTHER X (SPECIFY) __
DON'T KNOW Z
505. Are there ways to avoid getting malaria?
NO 2 (SKIP TO 509)
506. What are the ways to avoid getting malaria?
SLEEP INSIDE AN ITN/LLIN B
USE INSECTICIDE SPRAY C
USE MOSQUITO COILS D
KEEP DOORS AND WINDOWS CLOSED E
USE INSECT REPELLANT F
KEEP SURROUNDINGS CLEAN G
CUT THE GRASS H
ELIMINATE STAGNANT WATER AROUND LIVING AREA I
OTHER X (SPECIFY) __
DON'T KNOW Z
507. What can you do to prevent yourself from getting malaria?
CIRCLE ALL MENTIONED.
SLEEP INSIDE AN ITN/LLIN B
USE INSECTICIDE SPRAY C
USE MOSQUITO COILS D
KEEP DOORS AND WINDOWS CLOSED E
USE INSECT REPELLANT F
KEEP SURROUNDINGS CLEAN G
CUT THE GRASS H
ELIMINATE STAGNANT WATER AROUND LIVING AREA I
SHUT DOORS/WINDOWS J
OTHER X (SPECIFY) __
DON'T KNOW Z
508. What can a pregnant woman do to prevent malaria?
CIRCLE ALL MENTIONED.
SLEEP INSIDE AN ITN/LLIN B
KEEP ENVIRONMENT CLEAN C
TAKE SP/FANSIDAR GIVEN DURING ANTENATAL CARE D
TAKE DARAPRIM TABLETS (SUNDAY-SUNDAY MEDICINE) E
OTHER X (SPECIFY) __
DON'T KNOW Z
NO 2 (SKIP TO 512)
DON'T KNOW 8 (SKIP TO 512)
510. What medicines are used to treat malaria?
CIRCLE ALL MENTIONED.
CHLOROQUINE B
ARTESUNATE C
QUININE D
ACT E
ASPRIRIN, PANADOL, PARACETAMOL F
ANTIMALARIAL (UNKNOWN COMPONENTS) G
OTHER X (SPECIFY) __
DON'T KNOW Z
511. What medicines are used to treat children with malaria?
CIRCLE ALL MENTIONED.
CHLOROQUINE B
ARTESUNATE
QUININE C
ACT D
ASPIRIN/PANADOL/PARACETAMOL E
ANTIMALARIAL (UNKNOWN COMPONENTS)
OTHER X (SPECIFY) __
DON'T KNOW Z
512. In the past 6 months, have you seen or heard any messages about malaria?
NO 2 (SKIP TO 515)
513. What messages about malaria have you seen or heard?
CIRCLE ALL MENTIONED.
MALARIA CAN KILL B
MOSQUITOES SPREAD MALARIA C
SLEEPING INSIDE A MOSQUITO NET IS IMPORTANT D
WHO SHOULD SLEEP INSIDE A MOSQUITO NET E
SEEK TREATMENT FOR FEVER F
SEEK TREATMENT FOR FEVER PROMPTLY (WITHIN 24 HOURS) G
IMPORTANCE OF HOUSE SPRAYING H
ENVIRONMENTAL SANITATION ACTIVITIES I
SEEK TESTING BEFORE TREATMENT FOR MALARIA J
EARLY REGISTRATION FOR ANC K
PREGNANT WOMEN SHOULD TAKE SP/FANSIDAR L
OTHER X (SPECIFY)__
DON'T KNOW Z
514. Where did you hear or see these messages?
CIRCLE ALL MENTIONED.
TELEVISION B
COMMUNITY HEALTH EXTENSION WORKER (CHEW) C
VILLAGE HEALTH WORKER (VHW) D
ROLE MODEL CAREGIVER (RMC) E
COMMUNITY DIRECTED DISTRIBUTOR (DCC) F
MOSQUE/CHURCH G
TOWN ANNOUNCER H
COMMUNITY EVENT I
BILLBOARD J
POSTER K
T-SHIRT L
LEAFLET/FACT SHEET/BROCHURE M
RELATIVE/FRIEND/NEIGHBOR/SCHOOL N
SOCIAL MEDIA (FACEBOOK, TWITTER, ETC) O
ANTENATAL CARE VISIT P
HEALTH CTR OR HOSPITAL Q
OTHER X (SPECIFY) __
515. I am going to ask you about your opinion of malaria. Please tell me whether you agree or disagree with the following statements:
B. The medicine given to pregnant women to prevent malaria works well to keep the mother healthy.
C. The malaria tests are a good way to know if someone really has malaria or not.
D. ACTs work quickly to treat malaria.
DISAGREE 2
DON'T KNOW 8
DISAGREE 2
DON'T KNOW 8
DISAGREE 2
DON'T KNOW 8
DISAGREE 2
DON'T KNOW 8
515A. Did you sleep inside a mosquito net last night?
NO 2
516. What would encourage you to sleep inside a mosquito net?
HAD A DIFFERENT SHAPE/SIZE B
HAD A DIFFERENT COLOR C
IF NET WERE NOT ITCHY/IRRITATING D
IF NET WERE BIGGER/NOT CLOSTROPHOBIC F
OTHER G (SPECIFY)__
DON'T KNOW X
516A. If you have a choice, what color of mosquito net do you prefer?
DARK BLUE 02
LIGHT BLUE 03
RED 04
BLACK 05
WHITE 06
OTHER 96 (SPECIFY)__
DK/NO PREFERENCE 98
516B. If you have a choice, what shape of mosquito net do you prefer?
RECTANGLE 2
OTHER 6 (SPECIFY)__
DK/NO PREFERENCE 8
516C. If you have a choice, what size of mosquito net do you prefer?
SINGLE 2
DOUBLE 3
TRIPLE 4
OTHER 6 (SPECIFY)__
DK/NO PREFERENCE 8
516D. If you have a choice, what brand of mosquito net do you prefer?
OLYSET 02
ICONLIFE 03
DURANET 04
NETPROTECT 05
BASF INTERCEPTOR 06
OTHER 96 (SPECIFY)__
DK/NO PREFERENCE 98
MINUTES __
INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ON SPECIFIC QUESTIONS:__
ANY OTHER COMMENTS:__
NAME OF SUPERVISOR__
DATE__