2014 UGANDA MALARIA INDICATOR SURVEY
WOMEN'S QUESTIONNAIRE
UGANDA
IDRC/MOH/UBOS
REGION ___
DISTRICT ___
COUNTY ___
SUBCOUNTY/TOWN ___
PARISH/LC2 NAME ____
EA NAME ____
UMIS NUMBER ___
PERI URBAN 2
RURAL 3
NAME AND LINE NUMBER OF WOMAN ___
HOUSEHOULD NUMBER ____
HOUSEHOLD SAMPLE NUMBER ___
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 ___
INT. NUMBER. ___
RESULT*___
TOTAL NUMBER OF VISITS ___
*RESULT CODES:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPCITATED 6
OTHER (SPECIFY) 7
LANGUAGE OF THE QUESTIONNAIRE 7
LANGUAGE USED IN THE INTERVIEW ___
NATIVE LANGUAGE OF RESPONDENT ___
TRANSLATOR USED (NOT AT ALL =1, SOMETIMES = 2, ALL THE TIME = 3)
LANGUAGE OF QUESTIONNAIRE ENGLISH
LANGUAGE USED:
LUGANDA 2
LUGBARA 3
LUO 4
RUNYANKORE-RUKIGA 5
RINYORO-RUTORO 6
ENGLISH 7
OTHER 8 (SPECIFY)
SUPERVISOR
NAME ___
OFFICE EDITOR ___
KEYED BY ___
SECTION 1: RESPONDENT'S BACKGROUND
INTRODUCTION AND CONSENT
Hello. My name is ____________________. I am working with MOH. We are conducting a survey about malaria all over UGANDA The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 10-20 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 person listed on the card that has already been given to your household.
Do you have any questions? May I begin the interview now?
SIGNATURE OF INTERVIEWER: _________________________ DATE: ________________
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
MINUTES ___
102. In what month and year were you born?
DIDN'T KNOW MONTH 98
YEAR ___
DON'T KNOW YEAR 0008
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, 'O' level 'A' level or university or tertiary?
'O' LEVEL 2
'A' LEVEL 3
UNIVERSITY/TERITARY 4
106. What is the highest (class/year) you completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL RECORD '00.'
SECONDARY OR HIGHER (SKIP TO 109)
108. Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT.
IF RESPONDENT CANNOT READ WHOLE SETNENCE, 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 LANGAUGE 4 (SPECIFY LANGUAGE)
BLIND/VISUALLY IMPAIRED 5
ANGLICAN/PROTESTANT 02
SDA 03
ORTHODOX 04
PENTECOSTAL 05
OTHER CHRISTIAN 06
MOSELM 07
BAHAI 08
TRADITIONAL 09
HINDU 10
NONE 11
OTHER 99 (SPECIFY)
110. What is your ethnic group?
BANYANKORE 02
ITESO 03
LUGBARA/MADI 04
BASOGA 05
LANGI 06
BAKIGA 07
KARIMOJONG 08
ACHOLI 09
BAGISU/SABINY 10
ALURI/JOPADHOLA 11
BANYORO 12
BATORO 13
OTHER 14 (SPECIFY)
111. In the past six months, have you seen or heard any messages about malaria?
NO 2 (SKIP TO 201)
112. Have you seen or heard these messages:
b) On the television?
c) On a poster or billboard?
d) From a community health worker?
e) At a community event?
f) Anywhere else?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
201. Now I would like to ask you about all the births you have had during your life. Have you ever given birth?
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)
b) And how many daughters live with you?
b) 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 you?
NO 2 (SKIP TO 206)
b) And how many daughters are alive but do not live with you?
b) DAUGHTERS ELSEWHERE ___
206. Have you ever given birth to a boy or a girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?
NO 2 (SKIP TO 208)
b) And how many girls have died?
b) GIRLS ___
208. SUM, ANSWERS TO 20, 203, AND 207, AND ENTER TOTAL. IF NON, RECORD '00'.
Just to make sure that I have this right: you have had in TOTAL ___ births during your life. Is that correct?
NO 2 (PROBE AND CORRECT 201-208 AS NECESSARY.)
210. Now I'd like to ask you about your more recent births. How many births have you gad in the last 6 years?
IF NONE, CIRCLE '00'.
NONE 00 (SKIP TO 224)
211. Now I would like to record the name 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 THE LAST 6 YEARS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS.
212. What name was given to your (most recent/previous) baby?
RECORD NAME.
BIRTH HISTORY NUMBER
213. Is (NAME) a boy or a girl?
GIRL 2
214. Where any of these births twins?
MULT 2
215. In what month and year was (NAME) born?
PROBE: When is his/her birthday?
YEAR ___
NO 2 (NEXT BIRTH) (CONTINUE TO 220)
How old was (NAME) at his/her last birthday?
RECORD AGE IN COMPLETED YEARS.
If (NAME) living with you?
NO 2
219. IF ALIVE: RECORD HOUSE-HOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSE-HOLD).
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)?
NO 2
222. COMPARE 210 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:
NUMBERS ARE DIFFERENT ___ (PROBE AND RECONCILE)
ENTER THE NUMBER OF BIRTHS IN 2008 OR LATER
NONE 0
NO 2 (SKIP TO 226)
UNSURE (SKIP TO 226)
225. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.
NO BIRTHS IN 2008 OR LATER (SKIP TO 426)
Q. 223 IS BLANK (SKIP TO 426)
SECTION 3. PREGNANCY AND INTERMITTENT PREVENTATIVE TREATMENT
301. CHECK 215: 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.
301A. FROM 212 AND 216 IN BIRTH HISTORY NUMBER 01:
MOST RECENT BIRTH
LIVING ___
DEAD ___
302.When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?
NO 2 (SKIP TO 303A)
303. Whom did you see?
Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED
NURSE/MIDWIFE B (SKIP TO 304)
MEDICAL ASSISTANT/CLINCAL OFFICER C (SKIP TO 304)
NURSING AIDE D (SKIP TO 304)
303A. What was the main reason why you did not see anyone for antenatal care?
HAD NO MONEY 2
HAD NO TIME 3
NOT AWARE HAD TO ATTEND 4
DID NOT WANT TO ATTEND 5
OTHER (SPECIFY) 6
DIDN'T KNOW 8
304. During this pregnancy, did you take any drugs to keep you from getting malaria?
NO 2
DIDN'T KNOW 8 (SKIP TO 310)
304A. What was the main reason why you did not take any drugs to keep you from getting malaria during this pregnancy?
HAD NO MONEY 2 (SKIP TO 310)
SIDE EFFECTS 3 (SKIP TO 310)
NOT AWARE HAD TO TAKE ANY 4 (SKIP TO 310)
DID NOT WANT TO TAKE 5 (SKIP TO 310)
OTHER (SPECIFY) 6 (SKIP TO 310)
DIDN'T KNOW 8 (SKIP TO 310)
RECORD ALL MENTIONED.
IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.
CHLOROQUINE B
OTHER X (SPECIFY)
DIDN'T KNOW Z
SP/FANSIDAR TAKEN FOR MALARIA PREVENTION
CODE 'A' NOT CIRCLED (SKIP TO 301)
307. How many times did you take (SP/Fansidar) during this pregnancy?
TOOK SP ONLY 1 TIME DURING THIS PREGNANCY
OTHER ___ (SKIP TO 308)
307B. Why did you take (SP/Fansidar) only one time during this pregnancy?
HAD NO MONEY 2
SIDE EFFECTS 3
NOT AWARE HAD TO TAKE MORE 4
DID NOT WANT TO TAKE 5
OTHER (SPECIFY) 6
DIDN'T KNOW 8
ANTENATAL CARE FROM HELATH PERSONNEL DURING THIS PREGNANCY
OTHER ___ (SKIP TO 301)
309. Did you get the (SP/Fansidar) during any antenatal care visit, during another visit to a health facility or from another source?
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6
NO LIVING CHILDREN BORN IN 2008 OR LATER ___ (SKIP TO 426)
401. CHECK 215: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2008 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE MOST RECENT BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE)
Now I would like to ask some questions about the health of your children born since January 2008. (We will talk about each separately.)
402. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY
MOST RECENT BIRTH
LIVING ___
DEAD ___ (GO TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 426)
404. Has (NAME) been ill with fever at any time in the last 2 weeks
NO 2 (GO TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 426)
DON'T KNOW 8 (GO TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 426)
405. At any time during the illness, did (NAME) have blood taken from his/her finger or heel for testing?
NO 2
DON'T KNOW 8
406. Did you seek advice or treatment for the illness from any source?
NO 2
406A. Why have you not sought advice or treatment from any source?
CHILD NOT VERY ILL B (SKIP TO 410)
CLINC TOO FAR C (SKIP TO 410)
HAVE NO MONEY D (SKIP TO 410)
WAITING FOR CHILD'S FATHER E (SKIP TO 410)
DIDN'T KNOW WHAT TO DO F (SKIP TO 410)
ALREADY HAD MEDICINE AT HOME G (SKIP TO 410)
OTHER X (SPECIFY) (SKIP TO 410)
407. Where did you seek advice or treatment?
Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE
IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. ____ (NAME OF PLACE(S))
GOVT HEALTH CENTER B
GOVT HEALTH POST C
MOBILE CLINIC D
COMMUNITY HEALTH WORKER (VHT) E
OTHER PUBLIC SECTOR F (SPECIFY)
HEALTH CENTER H
PHARMACY J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MED. SECTOR M (SPECIFY)
TRADITIONAL PRACTITIONER O
MARKET P
OTHER X (SPECIFY)
ONLY ONE CODE CIRCLED ____ (SKIP TO 410)
409. Where did you first seek advice or treatment?
USE LETTER CODE FROM 407.
FIRST PLACE ____
410. At any time during the illness, did (NAME) take any drugs for the illness?
NO 2 (GO TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 426)
DON'T KNOW 8 (GO TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 426)
411. What drugs did (NAME) take?
Any other drugs?
RECORD ALL MENTIONED.
CHLOROQUINE B
AMODIAQUINE C
QUININE D
COARTEM/ACT E
PANADOL J
IBUPROFEN K
DON'T KNOW Z
412. CHECK 411:
ANY CODE A-F CIRCLED?
NO _____ (GO TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 426)
SP/FANSIDAR ('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
CHOLOROQUINE ('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
AMODIAQUINE ('C') GIVEN
CODE 'C' NOT CIRCLED ___ (SKIP TO 419)
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
QUININE ('D') GIVEN
CODE 'D' NOT CIRCLED ____ (SKIP TO 421)
420. How long after the fever stated did (NAME) first take quinine?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
COMBINATION WITH COARTEM/ACT ('E') GIVEN
CODE 'E' NOT CIRCLED ___ (SKIP TO 423)
422. How long after the fever started did (NAME) first take COARTEM/ACT?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
422A. For how many day did (NAME) take COATREM/ACT?
DON'T NOW 98
OTHER ANTIMALARIAL ('F') GIVEN
CODE 'F' NOT CIRCLED ___ (GO TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 426)
424. How long after the fever started did (NAME) first take (OTHER ANTIMALARIAL)?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
GO TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 426
426. I would like to ask you a few questions about fever in children.
When a child is sick with fever, how long after the fever begins should the child be taken for treatment?
NEXT DAY 02
TWO DAYS AFTER ONSET OF FEVER 03
THREE OR MORE DAYS AFTER ONSET OF FEVER 04
FEVER IS NORMAL IN CHILDREN, NO TREATMENT NECESSARY 05
DEPENDS ON HOW SERIOUS THE FEVER IS 06
OTHER 96 (SPECIFY)
DON'T KNOW 98
427. In your opinion, what causes malaria?
PROBE: Anything else?
RECORD ALL MENTIONED
PARASITE B
EATING MAIZE C
EATING MANGOES D
EATING DIRTY FOOD E
RECORD ALL MENTIONED DRINKING UNBOILED WATER F
GETTING SOAKED WITH RAIN G
COLD/CHANGING WEATHER H
WITCHCRAFT I
CONTACT WITH INFECTED PERSON J
GERM K
OTHER X (SPECIFY)
428. Are there ways to avoid getting malaria?
NO 2 (SKIP TO 431)
429. What are the ways to avoid getting malaria?
PROBE: Anything else?
RECORD ALL MENTIONED
SLEEP UNDER AN INSECTICIDE TREATED NET B
TAKING PREVENTIVE MEDICATION C
USE MOSQUITO REPELLANT D
SPRAYING HOUSE WITH INSECTICIDE E
USING MOSQUITO COILS F
DESTROY MOSQUITO BREEDING SITES G
OTHER X (SPECIFY)
DON'T KNOW Z
431. CHECK 430 SP/FANSIDAR MENTIONED
CODE 'A' NOT CIRCLED ____ (SKIP TO 433)
432. How many times does a woman need to take SP/FANSIDAR during her pregnancy to avoid getting malaria?
DON'T KNOW 98
MINUTES ___
INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT REPONSDENT: _____
COMMENTS ON SPECIFC QUESTIONS: ____
ANY OTHER COMMENTS: ______
SUPERVISOR'S OBSERVATIONS
NAME OF SUPERVISOR: _____ DATE: _______