2018-19 UGANDA MALARIA INDICATOR SURVEY WOMAN'S QUESTIONNAIRE

Uganda
NMCP/ UBOS

IDENTIFICATION

EA NAME

NAME OF HOUSEHOLD HEAD

CLUSTER NUMBER

HOUSEHOLD NUMBER

NAME AND LINE NUMBER OF WOMAN

INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT**

NEXT VISIT:
DATE
TIME

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT**

NEXT VISIT:
DATE
TIME

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT**

FINAL VISIT
DAY
MONTH
YEAR
INT. NO.
RESULT**

TOTAL NUMBER OF VISITS__

*RESULT CODES

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

LANGUAGE OF QUESTIONNAIRE

01 ENGLISH

LANGUAGE OF INTERVIEW**__

LANGUAGE OF RESPONDENT**___

**LANGUAGE CODES

01 ENGLISH
02 LUGANDA
03 LUO
04 LUGBARA
05 ATESO
06 RUNYANKOLE/ RUKIGA
07 RUNYORO/ RUTORO
96 OTHER__(SPECIFY)

TRANSLATOR USED

YES 1
NO 2

SUPERVISOR

NAME____
NUMBER__

INTRODUCTION AND CONSENT

Hello. My name is __. I am working with Ministry of Health/ UBOS. 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 to 20 minutes. All of the answers you give will be confidential and will not be shared with anyone other than the 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?

SIGNATURE OF INTERVIEWER_____________ DATE_________

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

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
NO 2 (SKIP TO 108)

105) What is the highest level of school you attended: primary, '0' level, 'A' level, tertiary or university?

PRIMARY 1
'O' LEVEL 2
'A' LEVEL 3
TERTIARY 4
UNIVERSITY 5

106) What is the highest (CLASS/ YEAR) you completed at that level?

IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

(CLASS/ YEAR)__

107) CHECK 105:

PRIMARY OR 'O' OR 'A' LEVEL (CONTINUE)
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 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) What is your religion?

NO RELIGION 10
ANGLICAN 11
CATHOLIC 12
MUSLIM 13
SEVENTH DAY ADVENTIST 14
ORTHODOX 15
PENTECOSTAL/ BORN AGAIN/ EVANGELICAL 16
BAHA'I 17
BAPTIST 18
JEWISH 19
PRESBYTERIAN 20
MAMMON 21
HINDU 22
BUDDHIST 23
JEHOVAH'S WITNESS 24
SALVATION ARMY 25
TRADITIONAL 26
OTHER__(SPECIFY) 96

110) What is your tribe?

TRIBE CODE__
OTHER__(SPECIFY) 996

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

YES 1
NO 2 (SKIP TO 201)

112) Have you heard or seen any of these messages:

a) On the radio?

YES 1
NO 2

b) On the television?

YES 1
NO 2

c) On a poster or billboard?

YES 1
NO 2

d) From a community health worker?

YES 1
NO 2

e) At a community event?

YES 1
NO 2

f) Interpersonal communication?

YES 1
NO 2

g) Flyers?

YES 1
NO 2

h) Social mobilization?

YES 1
NO 2

i) Social media?

YES 1
NO 2

j) Anywhere else?

YES 1
NO 2

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) IF NONE, RECORD '00'

a) How many sons live with you?

b) And how many daughters live with you?

204) Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?

YES 1
NO 2 (SKIP TO 206)

205) IF NONE, RECORD '00'

a) How many sons are alive but do not live with you?

b) And how many daughters are alive but do not live with you?

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, 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) ) IF NONE, RECORD '00'

a) How many boys have died?

b) And how many girls have died?

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

TOTAL 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 225)

211) Now I'd like to ask you about your more recent births. How many births have you had since 2013?

RECORD NUMBER OF LIVE BIRTHS SINCE 2013

TOTAL SINCE 2013__
NONE 00 (SKIP TO 225)

212) Now I would like to record the names of all your births since 2013, whether still alive or not, starting with the most recent one your had.

RECORD IN 213 THE NAMES OF ALL THE BIRTHS BORN SINCE 2013. 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__

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

BOY 1
GIRL 2

215) Were any of these births twins?

SING 1
MULT 2

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

DAY__
MONTH__
YEAR____

217) Is (NAME) still alive?

YES 1
NO 2 (SKIP TO NEXT BIRTH)

IF ALIVE:

218) How old was (NAME) at (NAME's) last birthday?

RECORD AGE IN COMPLETED YEARS.

AGE IN YEARS__

219) Is (NAME) living with you?

YES 1
NO 2

220) RECORD HOUSEHOLD LINE NUMBER OF CHILD. RECORD '00' IF CHILD IS NOT LISTED IN HOUSEHOLD.

HOUSEHOLD LINE NUMBER__

221) Were there any other live births between (NAME) and (NAME OF PREVIOUS BIRTH), including any children who died after giving 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) CHECK 216: ENTER THE NUMBER OF BIRTHS IN 2013-2018

NUMBER OF BIRTHS__
NONE 0

225) Are you pregnant now?

YES 1
NO 2 (SKIP TO 227)
UNSURE 8 (SKIP TO 227)

226) How many months pregnant are you?

RECORD NUMBER OF COMPLETED MONTHS.

MONTHS__

227) CHECK 224:

ONE OR MORE BIRTHS SINCE 2013 (SKIP TO 301)
NO BIRTHS SINCE 2013 (SKIP TO 501)
Q. 224 IS BLANK (SKIP TO 501)

SECTION 3. PREGNANCY AND INTERMITTENT PREVENTATIVE TREATMENT

301) RECORD THE NAME AND SURVIVAL STATUS OF THE MOST RECENT BIRTH FROM 213 AND 217, LINE 01:

MOST RECENT BIRTH__

LIVING (CONTINUE)
DEAD (CONTINUE)

302) Now I would like to ask you some questions about your last pregnancy that resulted in a live birth.

When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?

YES 1 (SKIP TO 303)
NO 2

302A) What was the main reason why you did not see anyone for antenatal care?

FACILITY TOO FAR 1 (SKIP TO 304)
HAD NO MONEY 2 (SKIP TO 304)
HAD NO TIME 3 (SKIP TO 304)
NOT AWARE HAD TO ATTEND 4 (SKIP TO 304)
DID NOT WANT TO ATTEND 5 (SKIP TO 304)
OTHER__(SPECIFY) 6 (SKIP TO 304)
DON'T KNOW 8 (SKIP TO 304)

303) Whom did you see?

Anyone else?

PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEALTH PERSONNEL

DOCTOR A
NURSE/ MIDWIFE B
MEDICAL ASSISTANT/ CLINICAL OFFICER C
NURSING AIDE/ ASSISTANT D

OTHER PERSON

TRADITIONAL BIRTH ATTENDANT E
COMMUNITY/ VILLAGE HEALTH WORKER F

OTHER__(SPECIFY) X

303A) Where did you receive antenatal care for this pregnancy?

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__

HOME

HER HOME A
OTHER HOME B

PUBLIC SECTOR

GOVERNMENT HOSPITAL C
GOVERNMENT HEALTH CENTER D
OTHER PUBLIC SECTOR__(SPECIFY) E

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/ CLINIC F
OTHER PRIVATE MEDICAL SECTOR__(SPECIFY) G

OTHER__(SPECIFY) X

303B) How many months pregnant were you when you first received antenatal care for this pregnancy?

MONTHS__
DON'T KNOW 98

303C) How many times did you receive antenatal care during this pregnancy?

NUMBER OF TIMES__
DON'T KNOW 98

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

YES 1
NO 2 (SKIP TO 307)
DON'T KNOW 8 (SKIP TO 307)

305) How many times did you take SP/Fansidar during this pregnancy?

TIMES__

305A) CHECK 305:

TOOK SP ONLY 1 TIME DURING THIS PREGNANCY (CONTINUE)
OTHER (SKIP TO 306)

305B) Why did you take (SP/Fansidar) only one time during this pregnancy?

RECORD ALL MENTIONED.

FACILITY TOO FAR A
HAD NO MONEY B
SIDE EFFECTS C
NOT AWARE HAD TO TAKE MORE D
DID NOT WANT TO TAKE E
NOT GIVEN F
NOT AVAILABLE G
OTHER__(SPECIFY) X
DON'T KNOW Z

306) 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 ONE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST.

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

307) CHECK 216 AND 217:

ONE OR MORE LIVING CHILDREN BORN SINCE 2013 (GO TO 401)
NO LIVING CHILDREN BORN SINCE 2013 (SKIP TO 501)

SECTION 4. FEVER IN CHILDREN

401) CHECK 213: RECORD THE BIRTH HISTORY NUMBER IN 402 AND THE NAME AND SURVIVAL STATUS IN 403 FOR EACH BIRTH SINCE 2013. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE MOST RECENT BIRTH. IF THERE ARE MORE THAN 2 BIRTHS, USE ADDITIONAL QUESTIONNAIRE(S).

Now I would like to ask some quesitons about the health of your children born since January 2013. (We will talk about each separately.)

402) BIRTH HISTORY NUMBER FROM 213 IN BIRTH HISTORY.

(MOST RECENT/ NEXT MOST RECENT BIRTH)

BIRTH HISTORY NUMBER__

403) FROM 213 AND 217:

NAME__

LIVING (CONTINUE)
DEAD (SKIP TO 428)

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

YES 1
NO 2 (SKIP TO 428)
DON'T KNOW 8 (SKIP TO 428)

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

YES 1
NO 2
DON'T KNOW 8

406) Did you seek advice or treatment for the illness from any source?

YES 1 (SKIP TO 407)
NO 2

406A) Why have you not sought advice or treatment from any source?

CHILD JUST FELL ILL A (SKIP TO 411)
CHILD NOT VERY ILL B (SKIP TO 411)
CLINIC TOO FAR C (SKIP TO 411)
HAVE NO MONEY D (SKIP TO 411)
WAITING FOR CHILD'S FATHER E (SKIP TO 411)
DON'T KNOW WHAT TO DO F (SKIP TO 411)
ALREADY HAD MEDICINE AT HOME G (SKIP TO 411)
OTHER__(SPECIFY) X (SKIP TO 411)

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(S).

NAME OF PLACE __

PUBLIC SECTOR

GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
MOBILE CLINIC/ OUTREACH C
COMMUNITY HEALTH WORKER/ VHT D
OTHER PUBLIC SECTOR__(SPECIFY) E

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/ CLINIC F
PHARMACY/ DRUG SHOP G
PRIVATE DOCTOR H
MOBILE CLINIC I
FIELDWORKER J
OTHER PRIVATE MEDICAL SECTOR__(SPECIFY) K

OTHER SOURCE

SHOP L
TRADITIONAL PRACTITIONER M
MARKET N
HAWKER/ ITINERANT DRUG SELLER O

OTHER__(SPECIFY) X

409) Where did you first seek advice or treatment?

USE LETTER CODE FROM 407.

FIRST PLACE__

410) How many days after the illness began did you first seek advice or treatment for (NAME)?

IF THE SAME DAY RECORD '00'.

DAYS__

411) At any time during the illness, did (NAME) take any drugs for the illness?

YES 1
NO 2 (SKIP TO 428)
DON'T KNOW 8 (SKIP TO 428)

412) What drugs did (NAME) take?

Any other drugs?

RECORD ALL MENTIONED.

ANTIMALARIAL DRUGS

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 DRUGS

PILLS/ SYRUP J
INJECTION/ IV K

OTHER DRUGS

ASPIRIN L
PANADOL/ ACETAMINOPHEN M
IBUPROFEN N

OTHER__(SPECIFY) X
DON'T KNOW Z

413) CHECK 412: ANY CODE A-I CIRCLED?

YES (CONTINUE)
NO (SKIP TO 428)

414) CHECK 412: 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?