Table 1 Questionnaire description
Block | Information |
|---|---|
(A) Interviewee demographic data | Name |
Address | |
Birth date and age | |
Gender | |
Race/color | |
Birth place | |
Residence time in the current address | |
(B) Dwellers demographic data | Name |
Age | |
Gender | |
Relationship with the interviewee | |
Residence time > 12 months in the address | |
Schooling | |
School’s name and location | |
(C) Malaria episodes reported by the interviewee | If remembers the 1st malaria |
Self-reported malaria in the last 12 months | |
Inactivity and days lost due to malaria | |
If needed health care in the last 12 months | |
Places sought for health care | |
Hospitalization due to malaria | |
(D) Interviewee’s last episode of malaria | How he/she discovered he/she had malaria |
Date of the last malaria episode (self-report) | |
If he/she had malaria symptoms | |
Type of malaria (falc, vivax) | |
Access and adherence to treatment | |
(E) Malaria information for each dweller | If they had malaria in the last 12 months (as reported by the interviewee) |
Hospitalization to treat malaria | |
(F) Household goods | Ownership of goods and animals |
(G) Occupation and income of the household | Types of occupation of the householders |
Number of dwellers contributing for the household income | |
If the income received is considered sufficient | |
(H) Characteristics of household | Material used for the wall, roof, ceiling and floor |
Presence of crevices in the walls | |
Number of rooms | |
(I) Household access | Type of access to the household (river, road, trail) |
If household is accessible by vehicle on a rainy day | |
If access is paved | |
If you would like the street, road or trail to be paved | |
If the access to the house floods | |
If flooding reaches the door of the house | |
Presence of natural or artificial water bodies in the vicinity of the house and the neighborhood | |
(J) Water supply | Type of access to water |
Source of water used in the kitchen and for drinking | |
How water is stored | |
If water is treated before consumption | |
Frequency at which water is missing at home | |
Place where the households shower | |
Place where the households wash dishes and clothes | |
Place where the households go to tend to their physiological needs | |
(L) Garbage disposal | How waste is disposed |
Frequency of garbage collection by public service, if available | |
(M) Access to electricity | If there is electricity in the household |
If available: its source, installation date, if time-restricted or fails, cost | |
If not available: source of energy used | |
(N) Mobility and potential exposure to malaria | Routine activities from 6 p.m. to 9 p.m. |
Frequency and motivation to go close to water bodies and the forest | |
Frequency of sleeping in the wild | |
Frequency, motivation, and length of stay in farms | |
If needs to travel to receive social benefits, frequency and length of stay | |
If needs to travel for working, frequency and length of stay | |
If traveled for any other reason in the last 12 months, frequency and length of stay | |
(O) Use of bednet and other protections | Ownership of impregnated and standard bednets and quantity |
General usage, usage in the last night | |
Problems with bednet usage | |
If the households use other methods for mosquito protection | |
Recommendations or suggestions for improving the health of the family and community |