NIGERIA MALARIA INDICATOR SURVEY
HOUSEHOLD 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 __
FIRST VISIT:
INTERVIEWER NAME __
RESULT* __
NEXT VISIT
TIME __
SECOND VISIT
INTERVIEWER NAME __
RESULT* __
NEXT VISIT:
TIME __
THIRD VISIT
INTERVIEWER NAME __
RESULT* __
FINAL VISIT
MONTH __
YEAR 2015
INT NO. __
RESULT* __
TOTAL NUMBER OF VISITS __
*RESULT CODES:
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 9 (SPECIFY) __
TOTAL PERSONS IN HOUSEHOLD __
TOTAL ELIGIBLE WOMEN __
TOTAL ELIGIBLE CHILDREN AGE 0-5 YEARS __
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE __
LANGUAGE OF QUESTIONNAIRE** ENGLISH
LANGUAGE OF INTERVIEW** __
NATIVE LANGUAGE OF RESPONDENT** __
TRANSLATOR USED (NOT AT ALL =1, SOMETIME =2, ALL THE TIME =3) __
*LANGUGAGE CODES:
YOURBA 2
IGBO 3
ENGLISH 4
OTHER 6 (SPECIFY) __
SUPERVISOR/EDITOR
NAME __
DATE __
NUMBER __
OFFICE EDITOR __
KEYED BY __
Greetings. My name is __________________________ and I am working with the National Population Commission (NPopC) and the National Malaria Elimination Program (NMEP). We are conducting a national survey that asks women and men about various health issues. 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 data collection period of September 2015 to November 2015. We would very much appreciate your participation in this survey. This information 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
NPopC CONTACT PERSON: Mr. Bolaji Akinsulie, Project Director; Email:; Phone: 08023307806
NHREC Contact Person(s): Secretary, NHREC; Email:; Phone: 095238367
Desk Officer, NHREC; Email:; Phone: --
As part of the survey we would first like to ask some questions about your household. All of the answers you give will be confidential. As part of this survey, we are asking that children all over the country take an anemia test. Anemia is a serious health problem that usually results from poor nutrition, infection, or disease. This survey will help the government to develop programs to prevent and treat anemia. As part of this survey, we are asking that children all over the country take a test to see if they have malaria. Malaria is a serious illness caused by a parasite transmitted by a mosquito bite. If the malaria test is positive, treatment will be offered. This survey will the government to develop programs to prevent malaria. Participation in the survey is completely voluntary. If we should come to any question you don't want to answer, just let me know and I will go onto the next question; or you can stop the interview at any time. However, we hope you will participate in the 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 __
LINE NO.
(1)
01
USUAL RESIDENTS AND VISITORS
(2) 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 LISTING THE NAMES, RELATIONSHIP, AND SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THE LISTING IS COMPLETE.
THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-14 FOR EACH PERSON.
__
2A) Jusre that I have a complete listing, are there any other persons 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, like 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
RELATIONSHIP
(3) What is the relationship of (NAME) to the head of the household?
SEE CODES BELOW.
CODES FOR Q.3: RELATIONSHIP TO HEAD OF HOUSEHOLD
WIFE = 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
NIECE/NEPHEW BY BLOOD = 09
NIECE/NEPHEW BY MARRIAGE = 10
OTHER = 11
ADOPTED/FOSTER/STEPCHILD = 12
NOT RELATED = 13
DON'T KNOW = 98
__
SEX
(4) Is (NAME) male or female?
FEMALE 2
RESIDENCE
(5) Does (NAME) usually live here?
NO 2
(6) Did (NAME) stay here last night?
NO 2
(7) How old was (NAME) at his/her last birthday?
WOMEN AGE 15-49
(8) CIRCLE LINE NUMBER OF ALL WOMEN AGE 15-49 YEARS
(9) Is (NAME) currently pregnant?
NO/DK 2
CHILDREN 0-5
(10) CIRCLE LINE NUMBER OF ALL CHILDREN AGE 0-5 YEARS
IF AGE 5 YEARS OR OLDER
EVER ATTENDED SCHOOL
(11) Has (NAME) ever attended school?
NO 2 (GO TO 13)
(12) What is the highest level of school (NAME) has attended?
SEE CODES BELOW.
What is the highest grade (NAME) completed at that level?
SEE CODES BELOW.
CODES FOR Q.10B: EDUCATION
EDUCATION LEVEL:
PRIMARY = 1
SECONDARY = 2
HIGHER = 3
DON'T KNOW = 8
EDUCATION YEAR:
YEARS AT PRE-PRIMARY/KINDERGARTEN LEVEL = 01-03
YEARS 1-6 AT PRIMARY LEVEL = 01-06
YEARS 1-6 AT SECONDARY LEVEL = 01-06
TOTAL NUMBER OF YEARS AT HIGHER LEVEL* = 01
LESS THAN 1 YEAR COMPLETED = 00
DON'T KNOW = 98
*FOR "HIGHER", TOTAL THE NUMBER OF YEARS AT THE POST-SECONDARY LEVEL
CLASS/YEAR __
FOR EVERYONE FEVER AND TREATMENT
(13) In the last 2 weeks, has (NAME) been sick with a fever at any time?
NO 2 (NEXT LINE NUMBER)
DON'T KNOW 8 (NEXT LINE NUMBER)
(14) Did (NAME) get any treatment for the fever in the last 2 weeks?
NO 2 (NEXT LINE NUMBER)
DON'T KNOW 8 (NEXT LINE NUMBER)
(15) Where did (NAME) first seek treatment?
USE CODES BELOW.
CODES FOR Q.15: PLACE OF TREATMENT
GOVERNMENT HEALTH CENTER = 02
GOVERNMENT HEALTH CLINIC = 03
PRIVATE HOSPITAL/CLINIC = 04
PHARMACY = 05
PRIVATE DOCTOR = 06
MOBILE CLINIC = 07
CHEMIST/PMV = 08
SHOP = 09
TRADITIONAL PRACTITIONER = 10
ROLE MODEL CAREGIVER/COMMUNITY WORKER = 11
DRUG HAWKER = 12
SELF TREATMENT AT HOME = 13
OTHER = 96
DOES NOT KNOW = 98
__
(16) How much did the treatment cost?
INCLUDE COST OF DOCTOR, NURSE, DRUGS, TESTS.
IF > 99990, WRITE '99990'.
IF FREE, CIRCLE COE 99995.
IF DON'T KNOW CODE '99998'.
FREE 99995
101. What is the main source of drinking water for members of your household?
PIPED TO YARD/PLOT 12 (SKIP TO 104)
PIPED TO NEIGHBOR 13 (SKIP TO 104)
UNPROTECTED WELL 32 (SKIP TO 102)
UNPROTECTED SPRING 42 (SKIP TO 102)
TANKER TRUCK 61 (SKIP TO 102)
CART WITH SMALL TANK 71 (SKIP TO 102)
SURFACE WATER (RIVER/DAM/LAKE/POND/STREAM/CANAL/IRRIGATION CHANNEL) 81 (SKIP TO 102)
BOTTLED WATER 91
SACHET WATER/PURE WATER 92
OTHER 96 (SPECIFY) __ (SKIP TO 102)
101A. What is the main source of water used by your household for other purposes such as cooking and handwashing?
PIPED TO YARD/PLOT 12 (SKIP TO 104)
PIPED TO NEIGHBOR 13 (SKIP TO 104)
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
BOTTLED WATER 9
SACHET WATER/PURE WATER 92
OTHER 96 (SPECIFY) __
102. Where is that water source located?
IN OWN YARD/PLOT 2 (SKIP TO 104)
ELSEWHERE 3
103. How long does it take to go there, get water, and come back?
DON'T KNOW 998
104. 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 107)
OTHER 96 (SPECIFY) __
105. Do you share this toilet facility with other households?
NO 2 (SKIP TO 107)
106. Including your own household, how many households use this toilet facility?
10 OR MORE HOUSEHOLDS 95
DON'T KNOW 98
107. Does your household have:
b) A radio?
c) A television?
d) A mobile telephone?
e) A non-mobile telephone?
f) A refrigerator?
g) A cable TV?
h) A generating set?
i) Air conditioner?
j) A computer?
k) Electric iron?
l) A fan?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
108. What type of fuel does your household mainly use for cooking?
LIQUID PROPANE GAS/CYLINDER 02
NATURAL GAS 03
BIOGAS 04
KEROSENE 05
COAL, LIGNITE 06
CHARCOAL 07
WOOD 08
STRAW/SHRUBS/GRASS/SAWDUST 09
AGRICULTURAL CROP 10
ANIMAL DUNG 11
NO FOOD COOKED IN HOUSEHOLD 95
OTHER 96 (SPECIFY) __
109. MAIN MATERIAL OF THE FLOOR.
DUNG 12
PALM/BAMBOO 22
VINYL OR ASPHALT STRIPS 32
CERAMIC TILES 33
CEMENT 34
CARPET 35
110. MAIN MATERIAL OF THE ROOF
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
111. MAIN MATERIAL OF THE EXTERIOR WALLS.
RECORD OBSERVATION
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
112. How many rooms in total are in your household, including rooms for sleeping and all other rooms?
INCLUDE ALL STRUCTURES BELONGING TO THE HOUSEHOLD DWELLING.
112A. How many rooms in this household are used for sleeping?
112B. How many sleeping facilities are currently in use in this household, including any beds, mattresses, mats, or rugs?
ASK FOR BOTH INSIDE AND OUTSIDE OF DWELLING.
113. Does any member of this household own:
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 a motor?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
114. Does any member of this household own agricultural land?
NO 2 (SKIP TO 116)
115. How many hectares of agricultural land do members of this household own?
STANDARD PLOT = 60 FT X 120 FT (18M X 36M)
1 HECTARE = 6 PLOTS
IF 95.0 OR MORE PLOTS RECORD HECTARES
IF 95.0 OR MORE HECTARES, CIRCLE '9950.'
HECTARES 2 __
95 OR MORE HECTARES 9950
DON'T KNOW 9998
116. Does this household own any livestock, herds, other farm animals, or poultry?
NO 2 (SKIP TO 118)
117. How many of the following animals does this household own?
IF NONE, ENTER '00'.
IF 95 OR MORE, ENTER '95'.
IF UNKNOWN, ENTER '98'.
Other cattle?
Horses, donkeys, or mules?
Goats?
Sheep?
Chickens or other poultry?
OTHER CATTLE __
HORSES/DONKEYS/MULES __
GOATS __
SHEEP __
CHICKENS/POULTRY __
118. Does any member of this household have a bank account?
NO 2
119. At any time in the past 12 months, has anyone come into your dwelling to spray the interior walls against mosquitoes?
NO 2 (SKIP TO 121)
DON'T KNOW 8 (SKIP TO 121)
120. Who sprayed the dwelling?
PRIVATE COMPANY B
NONGOVERNMENTAL ORGANIZATION (NGO) C
OTHER X (SPECIFY) __
DON'T KNOW Z
121. Does your household have any mosquito nets?
NO 2 (SKIP TO 122)
121A. Did you sleep inside a mosquito net last night?
NO 2
121B. What would encourage you to sleep inside a mosquito net?
CIRCLE ALL MENTIONED.
HAS A DIFFERENT SHAPE/SIZE B (SKIP TO 125)
HAD A DIFFERENT COLOR C (SKIP TO 125)
IF NET WERE NOT ITCHY/IRRITATING D (SKIP TO 125)
IF NET WERE BIGGER/NOT CLAUSTROPHOBIC E (SKIP TO 125)
DON'T KNOW Z (SKIP TO 125)
122. Why doesn't your household have any mosquito nets?
CIRCLE ALL MENTIONED.
NOT AVAILABLE B
DON'T LIKE TO USE NETS C
TOO EXPENSIVE D
OTHER X (SPECIFY) __
123. Has your household ever owned a mosquito net?
NO 2 (SKIP TO 139)
DON'T KNOW 8 (SKIP TO 139)
124. Why does your household no longer have a mosquito net?
CIRCLE ALL MENTIONED.
NOT AVAILABLE B (SKIP TO 139)
DON'T LIKE TO USE NETS C (SKIP TO 139)
TOO EXPENSIVE D (SKIP TO 139)
NET WAS OLD E (SKIP TO 139)
THREW AWAY NET F (SKIP TO 139)
HAVE WINDOW NETS G (SKIP TO 139)
OTHER X (SPECIFY) __
125. How many mosquito nets does your household have?
IF 7 OR MORE NETS, RECORD '7'.
126. ASK RESPONDENT TO SHOW YOU THE NETS. IF MORE THAN 3, USE ADDITIONAL QUESTIONNAIRE(S).
NET #1
OBSERVED, DOES NOT HAVE HOLES 2
NOT OBSERVED 3
127. OBSERVER OR ASK IF NET IS HANGING.
NOT HANGING 2
NOT HANGING 4
127A. OBSERVE (OR ASK) THE COLOR OF THE MOSQUITO NET
DARK BLUE 02
LIGHT BLUE 03
RED 04
BLACK 05
WHITE 06
OTHER 96 (SPECIFY) __
127B. OBSERVE (OR ASK) THE SHAPE OF THE MOSQUITO NET
RECTANGLE 2 (SPECIFY) __
127C. OBSERVE (OR ASK) THE SIZE OF THE MOSQUITO NET
SINGLE 2
DOUBLE 3
TRIPLE 4
OTHER 6 (SPECIFY) __
128. How many months ago did your household obtain the mosquito net?
IF LESS THAN ONE MONTH, WRITE '00'.
MORE THAN 36 MONTHS AGO 95
NOT SURE 98
128A. Did you get the net through a mass distribution campaign, antenatal care visit, or during an immunization visit?
YES, ANC 2 (SKIP TO 130)
YES, IMMUNIZATION 3 (SKIP TO 130)
NO 4
129. Where did you obtain this mosquito net?
GOVERNMENT HOSPITAL 02
PRIVATE HOSPITAL 03
NGO CLINIC 04
MISSION CLINIC 04
MOSQUE/CHURCH 06
PHARMACY 07
PATENT MEDICINE STORE 08
SHOP/SUPERMARKET 09
OPEN MARKET 10
HAWKER 11
SCHOOL 12
COMMUNITY DIRECTED DISTRIBUTORS (CDD) 13
OTHER 96 (SPECIFY) __
DON'T KNOW 98
130. Did you buy the net or was it given to you free?
FREE 2 (SKIP TO 132)
DON'T KNOW 8 (SKIP TO 132)
131. How much did you pay for the net?
IF DK, WRITE '99998'.
132. OBSERVE OR ASK THE TYPE AND BRAND OF MOSQUITO NET.
IF BRAND IS UNKNOWN, AND YOU CANNOT OBSERVE THE NET, SHOW PICTURES OF TYPICAL NET TYPES/BRANDS OF RESPONDENT.
OLYSET 12 (SKIP TO 135)
ICONLIFE 13 (SKIP TO 135)
DURANET 14 (SKIP TO 135)
NETPROTECT 15 (SKIP TO 135)
BASF INTERCEPTOR 16 (SKIP TO 135)
OTHER/DK BRAND 17 (SKIP TO 135)
DK BRAND 98
133. Since you got the mosquito net, was it ever soaked or dipped in a liquid to kill or repel mosquitoes?
NO 2 (SKIP TO 135)
NOT SURE 8 (SKIP TO 135)
134. How many months ago was the net last soaked or dipped?
IF LESS THAN ONE MONTH, RECORD '00' MONTHS. IF LESS THAN 2 YEARS AGO, RECORD MONTHS AGO. IF '12 MONTHS AGO' OR '1 YEAR AGO.' PROBE FOR EXACT NUMBER OF MONTHS.
NOT SURE 98
135. Did anyone sleep inside this mosquito net last night?
NO 2
NOT SURE 8 (SKIP TO 138)
136. Why didn't anyone sleep inside this net?
NO MALARIA 02 (SKIP TO 138)
TOO HOT 03 (SKIP TO 138)
DIFFICULT TO HANG 04 (SKIP TO 138)
DON'T LIKE SMELL 05 (SKIP TO 138)
FEEL 'CLOSED IN' OR CONSTRAINED 06 (SKIP TO 138)
NET TOO OLD OR TORN 07 (SKIP TO 138)
NET TOO DIRTY 08 (SKIP TO 138)
NET NOT AVAILABLE LAST NIGHT (WASHING) 09 (SKIP TO 138)
FEEL ITN CHEMICALS ARE UNSAFE 10 (SKIP TO 138)
ITN PROVOKES COUGHING 11(SKIP TO 138)
USUAL USER(S) DID NOT SLEEP HERE LAST NIGHT 12 (SKIP TO 138)
NET NOT NEEDED LAST NIGHT 13 (SKIP TO 138)
NO SPACE TO HANG 14 (SKIP TO 138)
OTHER 96 (SPECIFY) (SKIP TO 138)
DON'T KNOW 98 (SKIP TO 138)
137. Who slept inside this mosquito net last night?
RECORD THE PERSON'S LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.
NET #1
LINE NUMBER __
LINE NUMBER __
LINE NUMBER __
138. GO BACK TO 126 FOR NEXT NET; OR, IF NO MORE NETS, GO TO 201.
MINUTES __