NIGERIA MALARIA INDICATOR SURVEY
WOMAN'S QUESTIONNAIRE

NIGERIA
NATIONAL MALARIA ELIMINATION PROGRAMME
NATIONAL POPULATION COMISSION

IDENTIFICATION

STATE
LOCAL GOVERNMENT AREA
LOCALITY
ENUMERATION AREA
NAME OF HOUSEHOLD HEAD
CLUSTER NUMBER
HOUSEHOLD NUMBER
NAME AND LINE NUMBER OF WOMAN

INTERVIEWER VISITS

DATE
INTERVIEWER'S NAME
RESULT
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NO.
RESULT
RESULT CODES:

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7

TOTAL NUMBER OF VISITS
LANGUAGE OF QUESTIONNAIRE
LANGUAGE OF INTERVIEW
NATIVE LANGUAGE OF RESPONDENT
TRANSLATOR USED

YES 1
NO 2

LANGUAGE OF QUESTIONNAIRE: ENGLISH
LANGUAGE CODES:

ENGLISH 01
HAUSA 02
YORUBA 03
IGBO 04
OTHER 06

TEAM NUMBER__
TEAM SUPERVISOR
NAME__
NUMBER__

INTRODUCTION AND CONSENT

Greetings. My name is__. I am working with the National Malaria Elimination Program and the National Population Commission. We are conducting a survey about malaria all over Nigeria. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 30 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.

As part of this survey, we are also asking children 6 months through 4 years all over the country to take a combined malaria and anemia testing and give a few drops of blood from a finger or heel. Malaria is a serious illness caused by a parasite transmitted by a mosquito bite. Anemia is a serious health problem that usually results from poor nutrition, malaria and other infections, or chronic disease. The equipment used to take the blood is clean and completely safe. It has never been used before and will be thrown away after each test. The blood will be tested for malaria and anemia immediately, and the result will be told to you right away. A few blood drops will also be collected on slides and on filter paper and taken to a laboratory for malaria testing. You will not be told the results of the laboratory testing. We would like to ask you to allow for storing part of the blood sample at the laboratory for additional tests or research. The blood sample will not have any name or other data attached that could identify you. The results will be kept strictly confidential and will not be shared with anyone other than members of our survey team.

Lastly, we are taking measures to reduce the risk of transmission of COVID-19, including wearing face masks, keeping a distance of 2 meters from respondents to the survey, and washing our hands frequently.

In case you need more information about the survey, you may contact the following persons:

National Malaria Elimination Program Contact Person: Dr. Perpetua Uhomoibhi; Phone number: 08059121416
National Population Commission Contact Person: Mrs. Bintu Abba; Phone Number: 08033138277
National Health Research Ethics Committee Contact Person: NHREC Secretary; Email: secretary@nhrec.net
NHREC Desk Officer; Email: deskofficer@nhrec.net Phone Number: 095238367
Health Strategy and Delivery Foundation Contact Person: Dr. Ify Aniebo Phone Number: 09063727555

IF INTERESTED, ALLOW RESPONDENT TO COPY CONTACT INFORMATION

Do you have any questions? May I begin the interview now?

SIGNATURE OF INTERVIEWER__
DATE__

RESPONDENT AGREES TO BE INTERVIEWED 1 (CONTINUE)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME

HOURS__
MINUTES__

102. In what month and year were you born?

MONTH__
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.

AGE IN COMPLETED YEARS__

104. Have you ever attended school?

YES 1 (SKIP TO 105)
NO 2

104A. Have you had any informal education?

YES 1
NO 2 (SKIP TO 108)

104B. What type of informal education have you attended?

ADULT EDUCATION 1 (SKIP TO 108)
TSANGAYA 2 (SKIP TO 108)
QUARANIC 3 (SKIP TO 108)

105. What is the highest level of school you attended: primary, secondary, or higher?

PRIMARY 1
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'

CLASS/FORM/YEAR__

107. CHECK 105:

PRIMARY OR SECONDARY (CONTINUE)
HIGHER (SKIP TO 110)

108. Now I would like you to read this sentence to me. SHOW CARD TO RESPONDENT. IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PART OF THE SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) 4
BLIND/VISUALLY IMPAIRED 5

109. CHECK 108:

CODE '2', '3', OR '4' CIRCLED (CONTINUE)
CODE '1' OR '5' CIRCLED (SKIP TO 111)

110. Do you read a newspaper or magazine at least once a week, less than once a week, or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

111. Do you listen to the radio at least once a week, less than once a week, or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

112. Do you watch television at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

113. Do you own a mobile phone?

YES 1
NO 2 (SKIP TO 115)

114. Is your mobile phone a smart phone?

YES 1
NO 2

115. Have you ever used the internet from any location on any device?

YES 1
NO 2 (SKIP TO 118)

116. In the last 12 months, have you used the internet? IF NECESSARY, PROBE FOR USE FROM ANY LOVATION, WITH ANY DEVICE.

YES 1
NO 2 (SKIP TO 118)

117. During the last one month, how often did you use the internet: at least once a week, less than once a week, or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

118. What is your religion?

CATHOLIC 01
OTHER CHRISTIAN 02
ISLAM 03
TRADITIONALIST 04
OTHER (SPECIFY) 96

119. What is your ethnic group?

ETHNIC GROUP__

SECTION 2. REPRODUCTION

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

YES 1
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?

YES 1
NO 2 (SKIP TO 204)

203. How many sons live with you? And how many daughters live with you? IF NONE, RECORD '00'.

SONS AT HOME__
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

YES 1
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'.

SONS ELSEWHERE__
DAUGHTERS ELSEWHERE__

206. Have you ever given birth to a boy or girl 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?

YES 1
NO 2 (SKIP TO 208)

207. How many boys have died? And how many girls have died? IF NONE, RECORD '00'.

BOYS DEAD__
GIRLS DEAD__

208. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'.

TOTAL LIVE BIRTHS__

209. CHECK 208: Just to make sure that I have this right: you have had in TOTAL__ births during your life. Is that correct?

YES (CONTINUE)
NO (PROBE AND CORRECT 201-208 AS NECESSARY)

210. CHECK 208:

ONE OR MORE BIRTHS (CONTINUE)
NO BIRTHS (SKIP TO 224)

211. Now I'd like to ask you about your more recent births. How many births have you had in 2016-2021? RECORD NUMBER OF LIVE BIRTHS IN 2016-2021

TOTAL IN 2016-2021__
NONE 00 (SKIP TO 224)

212. Now I would like to record the names of all your births in 2016-2021, whether still alive or not, starting with the most recent one you had. RECORD IN 213 THE NAMES OF ALL THE BIRTHS BORN IN 2016-2021. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS. IF THERE ARE MORE THAN 5 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE STARTING WITH THE SECOND ROW.

213. What name was given to your (most recent/previous) baby? RECORD NAME. BIRTH HISTORY NUMBER

NAME__
NUMBER__

214. Is (NAME) a boy or a girl?

BOY 1
GIRL 2

215. Was that a single or multiple pregnancy?

SINGLE 1
MULTIPLE 2

216. On what day, month, and year was (NAME) born?

DAY__
MONTH__
YEAR__

217. Is (NAME) still alive?

YES 1
NO 2 (NEXT BIRTH)

218. IF ALIVE: How old was (NAME) at (NAME)'s last birthday? RECORD AGE IN COMPLETED YEARS

AGE IN YEARS__

219. IF ALIVE: Is (NAME) living with you?

YES 1
NO 2

220. IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD. RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD

HOUSEHOLD LINE NUMBER__ (NEXT BIRTH)

221. Were there any other live births between (NAME) and (NAME OF PREVIOUS BIRTH), including any children who died after birth?

YES 1 (ADD BIRTH)
NO 2 (NEXT BIRTH)

222. Have you had any live births since the birth of (NAME OF MOST RECENT BIRTH)?

YES 1 (RECORD BIRTH(S) IN TABLE)
NO 2

223. COMPARE 211 WITH NUMBER OF BIRTHS IN BIRTH HISTORY

NUMBERS ARE THE SAME (CONTINUE)
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224. Are you pregnant now?

YES 1
NO 2 (SKIP TO 301)
UNSURE 8 (SKIP TO 301)

225. How many weeks or months pregnant are you? RECORD NUMBER OF COMPLETED WEEKS OR MONTHS.

WEEKS__ 1
MONTHS__ 2

SECTION 3. PREGNANCY AND INTERMITTENT PREVENTIVE TREATMENT

301. CHECK 216 AND 218:

ONE OR MORE BIRTHS 0-35 MONTHS BEFORE THE SURVEY (CONTINUE)
NO BIRHTS 0-35 MONTHS BEFORE THE SURVEY (SKIP TO 401)

302. RECORD THE NAME OF THE MOST RECENT BIRTH FROM 213, LINE 01:

NAME__

303. Now I would like to ask you some questions about your last pregnancy that resulted in a live birth. While you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?

YES 1
NO 2 (SKIP TO 308)

304. Whom did you see? Anyone else? PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEALTH PERSONNEL

DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
COMMUNITY EXTENTION HEALTH WORKER D

OTHER PERSON

TRADITIONAL BIRTH ATTENDANT E
COMMUNITY HEALTH WORKER/FIELD WORKER F

OTHER (SPECIFY) X

305. Where did you receive antenatal care for this pregnancy? Anywhere else? PROBE TO IDENTIFY THE TYE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC, PRIVATE, OR NGO SECTOR, RECORD 'X' AND WEITE THE NAME OF THE PLACE(S).

HOME

HER HOME A
OTHER HOME B

PUBLIC SECTOR

GOVERNMENT HOSPITAL C
GOVERNMENT HEALTH CENTER D
GOVERNMENT HEATH POST E
OTHER PUBLIC SECTOR (SPECIFY) F

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL G
PRIVATE CLINIC H
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) I

NGO MEDICAL SECTOR

NGO HOSPITAL J
NGO CLINIC K
OTHER NGO MEDICAL SECTOR (SPECIFY) L

OTHER (SPECIFY) X

306. How many weeks or months pregnant were you when you first received antenatal care for this pregnancy?

WEEKS__ 1
MONTHS__ 2
DON'T KNOW 98

307. How many times did you receive antenatal care during this pregnancy?

NUMBER OF TIMES__
DON'T KNOW 98

308. During this pregnancy, did you take SP/Fansidar to keep you from getting malaria?

YES 1
NO 2 (SKIP TO 401)
DON'T KNOW 8 (SKIP TO 401)

309. How many times did you take SP/Fansidar during this pregnancy?

TIMES__

310. Did you get the SP/Fansidar during any antenatal care visit, during another visit to a health facility or from another source? IF MORE THAN ONCE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST.

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
COMMUNITY HEALTH EXTENSION WORKER 3
OTHER SOURCE 6

SECTION 4. FEVER IN CHILDREN

401. CHECK 216, 217, AND 218 IN THE BIRTH HISTORY: ANY SURVIVING CHILDREN BORN 0-59 MONTHS BEFORE THE SURVEY?

ONE OR MORE SURVIVING CHILDREN BORN 0-59 MONTHS BEFORE THE SURVEY (CONTINUE)
NO SURVIVING CHILDREN BORN 0-59 MONTHS BEFORE THE SURVEY (SKIP TO 501)

402. Now I would like to ask some questions about the health of your children born in the last 5 years. (We will talk about each separately, starting with the youngest.)

403. RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 213 OF THE SURVIVING CHILDREN BORN 0-59 MONTHS BEFORE THE SURVEY, STARTING WITH THE LAST ONE.

NAME OF CHILD__
BIRTH HISTORY NUMBER___

404. Has (NAME) been ill with a fever at any time in the last 2 weeks?

YES 1
NO 2 (SKIP TO 416)
DON'T KNOW 8 (SKIP TO 416)

405. At any time during the illness, did (NAME) have blood taken from (NAME)'s finger or heel for testing?

YES 1
NO 2
DON'T KNOW 8

406. Were you told by a healthcare provider that (NAME) had malaria?

YES 1
NO 2
DON'T KNOW 8

407. Did you seek advice or treatment for the illness from any source?

YES 1
NO 2 (SKIP TO 412)

408. Where did you seek advice or treatment? Anywhere else? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC, PRIVATE, OR NGO SECTOR, RECORD 'X' AND WRITE THE NAME OF THE PLACE(S).

PUBLIC SECTOR

GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
COMMUNITY HEALTH WORKER/FIELDWORKER E
OTHER PUBLIC SECTOR (SPECIFY) F

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL G
PRIVATE CLINIC H
PHARMACY I
PRIVATE DOCTOR J
MOBILE CLINIC K
COMMUNITY HEALTH WORKER/FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) M

NGO MEDICAL SECTOR

NGO HOSPITAL N
NGO CLINIC O
OTHER NGO MEDICAL SECTOR (SPECIFY) P

OTHER SOURCE

CHEMIST SHOP/PPM Q
TRADITIONAL PRACTITIONER R
MARKET S
ITINERANT DRUG SELLER T
COMMUNITY ORIENTED RESOURCE PERSON U

OTHER (SPECIFY) X

409. CHECK 408:

TWO OR MORE CODES CIRCLED (CONTINUE)
ONLY ONE CODE CIRCLED (SKIP TO 411)

410. Where did you first seek advice or treatment? USE LETTER CODE FROM 408.

FIRST PLACE__

411. How many days after the illness began did you first seek advice or treatment for (NAME)? IF THE SAME DAY RECORD '00'.

DAYS__

411A. While (NAME) was sick with this fever were you referred to go to a higher level of care?

YES 1
NO 2

412. At any time during the illness, did (NAME) take any medicine for the illness?

YES 1
NO 2 (SKIP TO 416)
DON'T KNOW 8 (SKIP TO 416)

413. What medicine did (NAME) take? Any other medicine? RECORD ALL MENTIONED. IF MEDICINE NOT KNOWN, ASK TO SEE THE PACKAGE OR PRESCRIPTION.

ANTIMALARIAL MEDICINE

ARTEMISININ COMBINATION THERAPY (ACT) A
SP/FANSIDAR B
CHLOROQUINE C
AMODIAQUINE D
QUININE

PILLS E
INJECTION/IV F

ARTESUNATE

RECTAL G
INJECTION/IV H

OTHER ANTIMALARIAL (SPECIFY) I

ANTIBIOTIC MEDICINE

AMOXICILLIN J
COTRIMOXAZOLE K
OTHER PILL/SYRUP L
OTHER INJECTION/IV M

OTHER MEDICINE

ASPIRIN N
PERACETAMOL/PANADOL/ACETAMINOPHEN O
IBUPROFEN P

OTHER (SPECIFY) X
DON'T KNOW Z

414. CHECK 413: ARTEMISININ COMBINATION THERAPY ('A') GIVEN

CODE 'A' CIRCLED (CONTINUE)
CODE 'A' NOT CIRCLED (SKIP TO 416)

415. How long after the fever started did (NAME) first take an artemisinin combination therapy?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8

415A. After (NAME) took an artemisinin combination therapy, did the fever go away?

YES 1
NO 2

416. CHECK 216 AND 217 IN BIRTH HISTORY. ANY MORE SURVIVING CHILDREN BORN 0-59 MONTHS BEFORE THE SURVEY?

NO MORE SURVIVING CHILDREN BORN 0-59 MONTHS BEFORE THE SURVEY (CONTINUE)
MORE SURVIVING CHILDREN BORN 0-59 MONTHS BEFORE (SKIP TO 403)

SECTION 5. MALARIA KNOWLEDGE AND BELIEFS

501. In the past six months, have you seen or heard any messages about malaria?

YES 1
NO 2 (SKIP TO 503)

502. Where did you see or hear these messages? PROBE: Anywhere else? RECORD ALL MENTIONED.

RADIO A
TELEVISION B
POSTER/BILLBOARD C
NEWSPAPER/MAGAZINE D
LEAFLET/BROCHURE E
HEALTHCARE PROVIDER F
COMMUNITY HEALTH WORKER G
SOCIAL MEDIA H
TOWN ANNOUNCER I
INTER-PERSONAL COMMUNICATION AGENT/COMMUNITY VOLUNTEER J
FAMILY/FRIENDS K
OTHER (SPECIFY) X
DON'T REMEMBER Z

503. Are there ways to avoid getting malaria?

YES 1
NO 2 (SKIP TO 505)
DON'T KNOW 8 (SKIP TO 505)

504. What are the things that people can do to prevent themselves from getting malaria? RECORD ALL MENTIONED.

SLEEP INSIDE A MOSQUITO NET A
SLEEP INSIDE AN INSECTICIDE-TREATED MOSQUITO NET B
USE MOSQUITO REPELLANT OR COIL C
TAKE PREVENTATIVE MEDICATIONS D
SPRAY HOUSE WITH INSECTICIDE E
FILL IN STAGNANT WATERS (PUDDLES) F
KEEP SURROUNDINGS CLEAN G
PUT MOSQUITO SCREEN ON WINDOWS H
OTHER (SPECIFY) X
DON'T KNOW Z

505. Now I am going to read some statements and I would like you to tell me whether you agree or disagree with each statement. If you don't know, say, don't know. People in this community only get malaria during the rainy season. Do you agree or disagree?