2018-19 UGANDA MALARIA INDICATOR SURVEY WOMAN'S QUESTIONNAIRE
EA NAME
NAME OF HOUSEHOLD HEAD
CLUSTER NUMBER
HOUSEHOLD NUMBER
NAME AND LINE NUMBER OF WOMAN
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
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER__(SPECIFY)
LANGUAGE OF INTERVIEW**__
LANGUAGE OF RESPONDENT**___
**LANGUAGE CODES
02 LUGANDA
03 LUO
04 LUGBARA
05 ATESO
06 RUNYANKOLE/ RUKIGA
07 RUNYORO/ RUTORO
96 OTHER__(SPECIFY)
TRANSLATOR USED
NO 2
SUPERVISOR
NAME____
NUMBER__
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 DOES NOT AGREE TO BE INTERVIEWED 2 (END OF INTERVIEW)
SECTION 1. RESPONDENT'S BACKGROUND
101) RECORD THE TIME
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, '0' level, 'A' level, tertiary or university?
'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'.
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?
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
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
OTHER__(SPECIFY) 996
111) In the past six months, have you seen or heard any messages about malaria?
NO 2 (SKIP TO 201)
112) Have you heard or seen any of these messages:
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
201) Now I would like to ask 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)
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)
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?
NO 2 (SKIP TO 208)
208) SUM ANSWERS TO 203, 205, 207, AND ENTER TOTAL. IF NONE, RECORD '00'.
Just to make sure that I have this right: you have had in TOTAL__ births during your life. Is that correct?
NO (PROBE AND CORRECT 201-208 AS NECESSARY.)
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
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.
214) Is (NAME) a boy or a girl?
GIRL 2
215) Were any of these births twins?
MULT 2
216) On what day, month, and year was (NAME) born?
MONTH__
YEAR____
NO 2 (SKIP TO NEXT BIRTH)
218) How old was (NAME) at (NAME's) last birthday?
RECORD AGE IN COMPLETED YEARS.
219) Is (NAME) living with you?
NO 2
220) RECORD HOUSEHOLD LINE NUMBER OF CHILD. RECORD '00' IF CHILD IS NOT LISTED IN HOUSEHOLD.
221) Were there any other live births between (NAME) and (NAME OF PREVIOUS BIRTH), including any children who died after giving birth?
NO 2 (NEXT BIRTH)
222) Have you had any live births since the birth of (NAME OF MOST RECENT BIRTH)?
NO 2
223) COMPARE 211 WITH NUMBER OF BIRTHS IN BIRTH HISTORY
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)
224) CHECK 216: ENTER THE NUMBER OF BIRTHS IN 2013-2018
NONE 0
NO 2 (SKIP TO 227)
UNSURE 8 (SKIP TO 227)
226) How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.
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:
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?
NO 2
302A) What was the main reason why you did not see anyone for antenatal care?
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)
Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
NURSE/ MIDWIFE B
MEDICAL ASSISTANT/ CLINICAL OFFICER C
NURSING AIDE/ ASSISTANT D
COMMUNITY/ VILLAGE HEALTH WORKER F
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.
OTHER HOME B
GOVERNMENT HEALTH CENTER D
OTHER PUBLIC SECTOR__(SPECIFY) E
OTHER PRIVATE MEDICAL SECTOR__(SPECIFY) G
303B) How many months pregnant were you when you first received antenatal care for this pregnancy?
DON'T KNOW 98
303C) How many times did you receive antenatal care during this pregnancy?
DON'T KNOW 98
304) During this pregnancy, did you take SP/Fansidar to keep you from getting malaria?
NO 2 (SKIP TO 307)
DON'T KNOW 8 (SKIP TO 307)
305) How many times did you take SP/Fansidar during this pregnancy?
OTHER (SKIP TO 306)
305B) Why did you take (SP/Fansidar) only one time during this pregnancy?
RECORD ALL MENTIONED.
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.
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6
NO LIVING CHILDREN BORN SINCE 2013 (SKIP TO 501)
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)
DEAD (SKIP TO 428)
404) Has (NAME) been ill with a fever at any time in the last 2 weeks?
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?
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 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).
GOVERNMENT HEALTH CENTER B
MOBILE CLINIC/ OUTREACH C
COMMUNITY HEALTH WORKER/ VHT D
OTHER PUBLIC SECTOR__(SPECIFY) E
PHARMACY/ DRUG SHOP G
PRIVATE DOCTOR H
MOBILE CLINIC I
FIELDWORKER J
OTHER PRIVATE MEDICAL SECTOR__(SPECIFY) K
TRADITIONAL PRACTITIONER M
MARKET N
HAWKER/ ITINERANT DRUG SELLER O
409) Where did you first seek advice or treatment?
USE LETTER CODE FROM 407.
410) How many days after the illness began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY RECORD '00'.
411) At any time during the illness, did (NAME) take any drugs for the illness?
NO 2 (SKIP TO 428)
DON'T KNOW 8 (SKIP TO 428)
412) What drugs did (NAME) take?
Any other drugs?
RECORD ALL MENTIONED.
SP/FANSIDAR B
CHLOROQUINE C
AMODIAQUINE D
INJECTION/ IV F
INJECTION/ IV H
INJECTION/ IV K
PANADOL/ ACETAMINOPHEN M
IBUPROFEN N
DON'T KNOW Z
413) CHECK 412: ANY CODE A-I CIRCLED?
NO (SKIP TO 428)
414) CHECK 412: ARTEMISININ COMBINATION THERAPY ('A') GIVEN
CODE 'A' NOT CIRCLED (SKIP TO 416)
415) How long after the fever started did (NAME) first take an artemisinin combination therapy?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
416) CHECK 412: SP/FANDISAR ('B') GIVEN
CODE 'B' NOT CIRCLED (SKIP TO 418)
417) How long after the fever started did (NAME) first take SP/Fandisar?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
418) CHECK 412: CHLOROQUINE ('C') GIVEN
CODE 'C' NOT CIRCLED (SKIP TO 420)
419) 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
420) CHECK 412: AMODIAQUINE ('D') GIVEN
CODE 'D' NOT CIRCLED (SKIP TO 422)
421) 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
422) CHECK 412: QUININE ('E' OR 'F') GIVEN
CODE 'E' OR 'F' NOT CIRCLED (SKIP TO 424)
423) 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
424) CHECK 412: ARTESUNATE ('G' OR 'H') GIVEN
CODE 'G' OR 'H' NOT CIRCLED (SKIP TO 426)
425) 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
426) CHECK 412: OTHER ANTIMALARIAL ('I') GIVEN
CODE 'I' NOT CIRCLED (SKIP TO 428)
427) How long after the fever started did (NAME) first take (OTHER ANTIMALARIAL)?
NET DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
428) GO BACK TO 403 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501.
SECTION 5. KNOWLEDGE AND BELIEFS
501) 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 in 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
DON'T KNOW 98
502) In your opinion, what causes malaria?
PROBE: Anything else?
RECORD ALL MENTIONED.
MOSQUITOES B
PARASITE C
EATING MAIZE D
EATING MANGOES E
EATING DIRTY FOOD F
DRINKING UNBOILED WATER G
GETTING SOAKED WITH RAIN H
COLD/ CHANGING WEATHER I
WITCHCRAFT J
CONTACT WITH INFECTED PERSON K
GERM L
STANDING WATER/BREEDING ENVIRONMENT M
POOR HYGIENE/ DIRTY ENVIRONMENT N
NOT SLEEPING UNDER MOSQUITO NET O
OTHER__(SPECIFY) X
DON'T KNOW Z
503) Are there any ways to prevent getting malaria?
NO 2 (SKIP TO 507)
504) What are the ways to avoid getting malaria?
PROBE: Anything else?
RECORD ALL MENTIONED.
SLEEP UNDER AN INSECTICIDE TREATED NET B
TAKING PREVENTATIVE MEDICATION C
USE MOSQUITO REPELLANT D
SPRAYING HOUSE WITH INSECTICIDE E
USING MOSQUITO COILS F
DESTROY MOSQUITO BREEDING SITES G
BOIL WATER H
GOOD HYGIENE/ KEEPING CLEAN ENVIRONMENT I
OTHER__(SPECIFY) X
DON'T KNOW Z
505) What medicine may be given to a pregnant woman to help her avoid getting malaria?
CHLOROQUINE B
CHLOROQUINE W/ FANSIDAR C
COARTEM/ACT D
OTHER__(SPECIFY) Z
DON'T KNOW Z
OTHER (SKIP TO 508)
507) How many times does a woman need to take SP/FANSIDAR during her pregnancy to avoid getting malaria?
DON'T KNOW 98
508) Now I am going to read some statements and I would like you to tell me whether you agree or disagree with it. If you don't know, say, don't know.
I sleep under a bed net every night beau case it is the best way to avoid getting malaria. Do you agree or disagree?
DISAGREE 2
DON'T KNOW/ UNCERTAIN 8
509) I can easily hang a mosquito net.
Do you agree or disagree?
DISAGREE 2
DON'T KNOW/ UNCERTAIN 8
510) Pregnant women should still take the medicine that is meant to keep them from getting malaria even if they sleep under nets every night.
Do you agree or disagree?
DISAGREE 2
DON'T KNOW/ UNCERTAIN 8
511) I take the entire course of malaria medicine to make sure the disease will be fully cured.
Do you agree or disagree?
DISAGREE 2
DON'T KNOW/ UNCERTAIN 8
512) It is important to take a child to a health provider the same or next day after the child gets a fever.
Do you agree or disagree?
DISAGREE 2
DON'T KNOW/ UNCERTAIN 8
513) My community is able to come together to take action to prevent malaria among its members.
Do you agree or disagree?
DISAGREE 2
DON'T KNOW/ UNCERTAIN 8
MINUTES__
TO BE FILLED IN AFTER COMPLETING INTERVIEW.
COMMENTS ABOUT INTERVIEW:
COMMENTS ON SPECIFIC QUESTIONS: