THE STOP MALARIA PROJECT
Evaluation of the Test and Treat
Campaign
Client Exit Interview Questionnaire
1. Facility Identification
ID NUMBER: ___________________________________
301
302
303
304
305
NAME OF FACILITY
DISTRICT
SUB-COUNTY
FACILITY NUMBER
TYPE OF FACILITY
306
OWNERSHIP
REGIONAL REFERRAL HOSPITAL ........ 01
GENERAL HOSPITAL ............................. 02
OTHER HOSPITAL .................................. 03
HEALTH CENTER IV ............................... 04
HEALTH CENTER III ............................... 05
HEALTH CENTER II ................................ 04
OTHER__________________________ . 96
(specify)
GOVERNMENT........................................01
PRIVATE NOT FOR PROFIT(PNFP)........02
OTHER __________________________ 96
2. Information about Interview
307
INTERVIEW DATE
308
NAMES OF THE INTERVIEWER
309
CLIENT CODE
310. DATE
311. TEAM LEADER NAME
312
RESULT CODES
COMPLETED
1
RESPONDENT NOT AVAILABLE
2
REFUSED
3
PARTIALLY COMPLETED
4
OTHER
5
313
Sex [Please interviewer observe]
Stop Malaria Evaluation of Test and Treat Campaign:
Male
Female
1
2
PI: Marc Boulay, PhD, V1 February 20, 2014 Page 1 of 12
NO.
QUESTIONS
CODING CLASSIFICATION
VERIFY THAT RESPONDENT PROVIDED CONSENT
314
May I begin the interview?
315
RECORD THE TIME THE INTERVIEW STARTED
316
GO TO
CLIENT AGREES ......................................... 1
CLIENT REFUSES ....................................... 2
STOP
MONTH .........................................
In what month and year were you born?
DON’T KNOW MONTH ....................... ...........98
IF RESPONDENT IS NOT SURE, PROBE TO
DETERMINE HER YEAR OF BIRTH
317
YEAR ........................................ 19
How old are you now?
AGE
DON’T KNOW AGE
318
Have you ever attended school?
319
What is the highest level of school you attended: primary,
secondary, or post – secondary?
98
YES .......................................................................................1
NO ..........................................................................................2
NONE......................................................................................1
SOME PRIMARY ....................................................................2
COMPLETED PRIMARY.........................................................3
O Level....................................................................................4
A LEVEL .................................................................................5
UNIVERSITY/TERTIARY .......................................................6
320
321
Have you ever participated in a literacy program or any
other program that involves learning to read or write, (not
including primary school)?
Do you read a newspaper or magazine almost every day,
at least once a week, less than once a week or not at all?
NO..........................................................................................0
YES........................................................................................1
ALMOST EVERYDAY ..........................................................1
ATLEAST ONCE A WEEK ...................................................2
LESS THAN ONCE A WEEK ...............................................3
NOT AT ALL ........................................................................4
CANNOT READ ...................................................................8
322
320
Do you listen to the radio almost every day, at least once
a week, less than once a week or not at all?
ALMOST EVERYDAY ...........................................................1
ATLEAST ONCE A WEEK ....................................................2
LESS THAN ONCE A WEEK ................................................3
NOT AT ALL ........................................................................4
Stop Malaria Evaluation of Test and Treat Campaign:
PI: Marc Boulay, PhD, V1 February 20, 2014 Page 2 of 12
2→Q320
32
3
321
Do you watch television almost every day, at least once a
week, less than once a week or not at all?
ALMOST EVERYDAY ...............................................1
ATLEAST ONCE A WEEK .........................................2
LESS THAN ONCE A WEEK ......................................3
NOT AT ALL ...............................................................4
324
325
326
As you know, some women/ men take up jobs for
which they are paid in cash or kind .Others sell
things, have a small business or work on the
family farm or in the family business. In the last
seven days, have you done any of these things or
any other work?
Although you did not work in the last seven days,
do you have any job or business from which you
were absent for leave, illness, vacation, maternity
leave or any other such reason?
Have you done any work in the last 12 months?
What is your occupation, that is, what kind of
work do you mainly do?
327
INTERVIEWER PROBE TO OBTAIN
DETAILED INFORMATION ON THE
KIND OF WORK RESPONDENT DOES
328
329
330
What is your tribe?
To confirm, did you bring a child today for
treatment of fever or malaria?
Yes .............................................................................1
No ...............................................................................2
1,→Q327
Yes .............................................................................1
No ...............................................................................2
1,→Q327
Yes ..............................................................................1
No ...............................................................................2
2,→Q328
Subsistence Farmer (produces mainly for own consumption)..................1
Commercial Farmer (produces mainly for sale).......................................2
Fisherman................................................................................................3
Labourer..................................................................................................4
Domestic Worker / Maid / Char / House help..........................................5
Petty Trader / Hawker / Vendor/Boda boda...........................................6
Owns Business with 3 or more employees.............................................7
Professional Worker (lawyer, accountant, nurse, engineer, teacher,
administrator, etc. ....................................................................................8
Armed Services/ Police / Security Personnel...................................9
Artisan (skilled carpenter, builder, mechanic, etc)...........................10
Politician...................................................................................................11
Broker....................................................................................................12
Student....................................................................................................13
Other___________________________________________________97
(SPECIFY)
Don’t Know ............................................................................................98
___________________________________________
BAGANDA .........................................................................1
BANYANKORE ..................................................................2
ITESO ................................................................................3
BAGUNGU .......................................................................4
BANYARWANDA ................................................................5
BASOGA .............................................................................7
LANGI ................................................................................8
BAKIGA ..............................................................................9
KARIMOJONG .................................................................10
ACHOLI ............................................................................11
BAGISU/SABINY ..............................................................12
ALUR ...............................................................................13
JOPADHOLA ....................................................................14
BANYORO .......................................................................15
BATORO ...........................................................................16
OTHER ______________________________________97
(SPECIFY)
Yes .....................................................................1
No........................................................................2
How old is the child you bought for fever or
Stop Malaria Evaluation of Test and Treat Campaign:
PI: Marc Boulay, PhD, V1 February 20, 2014 Page 3 of 12
2, →STOP THE
INTERVIEW
malaria treatment today?
CHILD’S AGE
IF CHILD IS LESS THAN ONE YEAR OLD,
INDICATE AGE IN MONTHS.
YEAR………………………..
MONTHS…………………….
How long after the fever started did you
bring the child for treatment at this facility?
Hours
IF LESS THAN ONE DAY INDICATE TIME
IN HOURS.
331
332
333
Days
Is this the first place you sought treatment
for your child when she/he was not feeling
well?
Where was the first place you sought
medical advice/treatment for your child’s
fever/malaria symptoms?
How long after the fever started did you seek
treatment at the place you first visited?
Yes……………………………………………………………….1
No………………………………………………………………..2
1,→Q340
Another public health facility…………………………………1
A private clinic ………………………………………………….2
Community Health worker …………………………………….3
Drug shop……………………………………………………….4
Pharmacy ……………………………………………………….5
Other _________________________________________97
(SPECIFY)
Hours
334
Days
335
Did the child you brought for care today
have blood taken from his/her finger or heel
for testing at the place you sought treatment
before coming to this facility?
336
What was the result of the blood test?
337
Was the child given treatment at the place
you took him/her before coming here?
338
What medications/drugs was the child given
at the place you first visited?
Stop Malaria Evaluation of Test and Treat Campaign:
Yes………………………………………………………………1
No………………………………………………………………...2
POSITIVE FOR MALARIA……………………………………1
NEGATIVE FOR MALARIA …………………………………..2
INCONCLUSIVE ………………………………………………3
DON’T KNOW/DON’T REMEMBER ………………………96
YES………………………………………………………………1
NO ……………………………………………………………….2
DON’T REMEMBER ………………………………………….96
ORAL QUININE....................................................................1
ATERSUNATE......................................................................2
COARTEM ...........................................................................3
OTHER ____________________________96
(SPECIFY)
PI: Marc Boulay, PhD, V1 February 20, 2014 Page 4 of 12
2,→Q337
2/96,→Q339
ANTIBIOTIC DRUGS
PILL/SYRUP ....................................................................4
OTHER DRUGS
PANADOL .........................................................................5
ASPIRIN ...................................................................... .....6
IBUPROFEN ......................................................................7
OTHER ______________________________________97
(SPECIFY)
DON’T KNOW…………………………………………….98
339
Why did you decide to seek additional
treatment?
340
Did you provide any remedies/medications
to the child at home before you first sought
treatment for the child?
DID NOT BELIEVE THE RESULT …………………………1
CHILD’S CONDITION GOT WORSE ………………………2
TO GET ADDITIONAL DRUGS …………………………….3
OTHER
_________________________________________97
(SPECIFY)
YES .....................................................................................1
NO .......................................................................................2
ORAL QUININE....................................................................1
ATERSUNATE......................................................................2
COARTEM ...........................................................................3
OTHER ____________________________96
(SPECIFY)
ANTIBIOTIC DRUGS
PILL/SYRUP ........................................................................4
341
What medications/drugs/remedies did you
give the child before you bought him/her to
the place you first sought treatment
OTHER DRUGS
PANADOL ...........................................................................5
ASPIRIN ...................................................................... .......6
IBUPROFEN ........................................................................7
HERBS ..............................................................................8
OTHER ______________________________________97
(SPECIFY)
DON’T KNOW…………………………………………….98
342
Did these medications/remedies improve the
child’s condition?
INTERVIEWER INSTRUCTION
CHECK Q331 AND 334
343
Why did you not seek treatment for the child
as soon as the fever started?
Stop Malaria Evaluation of Test and Treat Campaign:
YES.................................................................................1
NO.....................................................................................2
IF TREATMENT WAS NOT SOUGHT WITHIN 24 HOURS,
ASK QUESTION 343. IF TREATMENT WAS SOUGHT
WITHIN 24 HOURS BUT OTHER FACILITY VISITED
FIRST, ASK QUESTION 344. IF TREATMENT SOUGHT
AT THIS FACILITY WITHIN 24 HOURS, GO TO
QUESTION 345
DID NOT THINK IT WAS
SERIOUS......................................1
BOUGHT DRUGS FROM A PHARMACY/DRUG
SHOP................................................................................2
GAVE THE CHILD HERBS ..............................................3
DID NOT HAVE MONEY FOR TRANSPORT ...................4
PI: Marc Boulay, PhD, V1 February 20, 2014 Page 5 of 12
2,→Q343
INTERVIEWER CHECK Q332
Why didn’t you bring the child to this facility
for treatment as soon as the fever started?
344
CHECK ALL THAT APPLIES
DONOT PROMPT
OTHER _______________________________________96
(SPECIFY)
IF THIS FACILITY WAS NOT THE FIRST PLACE CARE
WAS SOUGHT, ASK QUESTION 344
DIDNOT THINK IT WAS SERIOUS.....................................1
BOUGHT DRUGS FROM A PHARMACY/DRUG
SHOP...................................................................................2
GAVE THE CHILD HERBS .................................................3
DIDNOT HAVE MONEY FOR TRANSPORT ......................4
FACILITY IS TOO FAR/WENT ELSE WHERE ...................5
OTHER _______________________________________97
(SPECIFY)
INTERVIEWER
345
346
347
348
349
ALL RESPONDENTS SHOULD BE ASKED
THIS QUESTION REGARDLESS OF
WHERE OR WHEN CARE WAS SOUGHT
Did the provider at THIS FACILITY offer or
suggest testing/ have blood taken from the
child’s finger or heel to test for malaria?
Did you request the provider at this facility to
test your child for malaria/have blood taken
from his/her finger or heel to test for malaria?
Did the child you brought for care today have
blood taken from his/her finger or heel to test
for malaria during this visit?
Did the provider explain that it was
important to get tested for malaria before
providing treatment?
Did the provider explain that it was
important to seek testing and treatment for a
child with fever within 24 hours?
INTERVIEWER CHECK Q347
350
351
352
Did the provider EXPLAIN to you the
RESULTS OF THE TEST?
What was the result of the blood test?
What did the provider say was causing the
fever?
INTERVIEWER CHECK Q351
353
[If test result was negative]: Did the provider
Stop Malaria Evaluation of Test and Treat Campaign:
YES .....................................................................................1
NO .......................................................................................2
DON’T REMEMBER.............................................................3
YES .....................................................................................1
NO .......................................................................................2
DON’T REMEMBER.............................................................3
YES.....................................................................................1
NO.......................................................................................2
YES.....................................................................................1
NO.......................................................................................2
YES.....................................................................................1
NO.......................................................................................2
YES.....................................................................................1
NO.......................................................................................2
YES ....................................................................................1
NO ......................................................................................2
DON’T KNOW .....................................................................3
POSITIVE FOR MALARIA……………………………………1
NEGATIVE FOR MALARIA …………………………………..2
INCONCLUSIVE ………………………………………………3
DON’T KNOW/DON’T REMEMBER ………………………96
MALARIA
PNEUMONIA.......................................................................1
URINARY TRACT INFECTIONS.........................................2
DEHYDRATION...................................................................3
MEASLE...............................................................................4
EAR INFECTIONS...............................................................5
MENINGTIS ........................................................................6
TYPHOID ............................................................................7
CHICKEN POX ...................................................................8
SORE THROAT .................................................................9
INFLUENZA ......................................................................10
OTHER _______________________________________97
(SPECIFY)
POSITIVE FOR MALARIA……………………………………1
NEGATIVE FOR MALARIA …………………………………..2
INCONCLUSIVE ………………………………………………3
DON’T KNOW/DON’T REMEMBER ………………………96
YES....................................................................................1
PI: Marc Boulay, PhD, V1 February 20, 2014 Page 6 of 12
2→Q352
1/3/96→Q357
explain that it was not necessary for the child
to take anti-malarials?
354
In your opinion, how likely is it that your child
has malaria?
355
Did the provider explain to you how to
reduce the fever/control symptoms?
356
What did the provider say you should do to
reduce the fever?
357
Did the child you brought for care today
receive treatment for malaria?
NO .....................................................................................2
VERY LIKELY ....................................................................1
SOMEWAHT LIKELY .........................................................2
VERY UNLIKELY.................................................................3
SOMEWHAT UNLIKELY.....................................................4
YES………………………………………………………………1
NO………………………………………………………………..2
UNCOVER THE CHILD………………………………………..1
BATHE CHILD WITH WARM SPONGE/CLOTHE…………2
GIVE CHILD SOME WATER………………………………….3
GIVE PARACETAMOL…………………………………………4
CONTINUE BREASTFEEDING……………………………….5
OTHER _______________________________________97
(SPECIFY)
YES....................................................................................1
NO .....................................................................................2
2,→357
2,→Q358b
ANTI-MALARIAL DRUGS
What drugs were you or the person you
brought for care given today?
358
Any other drugs?
RECORD ALL MENTIONED
Coartem.............................................................................1
Oral Quinine.......................................................................2
Injectable quinine .............................................................3
Atersunate..........................................................................4
Other ____________________________........................96
(SPECIFY)
ANTIBIOTIC DRUGS
Pill/Syrup ...........................................................................5
Injection .............................................................................6
OTHER DRUGS
Panadol .............................................................................7
Aspirin ...................................................................... ........8
Ibuprofen ...........................................................................9
OTHER _______________________________________97
(SPECIFY)
Don’t know ......................................................................98
ANTIMALARIAL PROVIDED...........................................1
358b
INTERVIEWER CHECK 358
NO ANTI-MALARIA PROVIDED......................................2
359
360
361
362
[If prescribed anti-malarials]: Did the
provider explain to you HOW TO TAKE THE
ANTI-MALARIAL TABLETS given to your
child?
Did the provider inquire WHETHER CHILD
is able or unable to drink or breastfeed at
all?
Did the provider give you advice on how to
feed the child you brought to care during this
episode?
Did the provider inquire or did you mention
whether the child you bought to care today
had the following symptoms?
TICK ALL MENTIONED
363
Did the provider take the temperature of the
Stop Malaria Evaluation of Test and Treat Campaign:
YES ...................................................................................1
No......................................................................................2
YES ..................................................................................1
NO ....................................................................................2
YES ..................................................................................1
NO ....................................................................................2
NO
YES
COUGH
0
1
DIARRHOEA
0
1
FEVER OR BODY HOTNESS
0
1
VOMITING
0
1
CONVULSIONS WITH THIS SICKNESS 0
1
YES ..................................................................................1
PI: Marc Boulay, PhD, V1 February 20, 2014 Page 7 of 12
2,→Q360
364
365
366
child you brought for care today with a
thermometer?
Did the provider describe the signs in the
child that will require you to bring the child
back to the facility?
Was the child you brought for care today
referred to another facility or did the provider
tell you to take the child somewhere else?
Did the child you brought for care sleep
under a net last night?
NO ....................................................................................2
YES ..................................................................................1
NO ....................................................................................2
YES ..................................................................................1
NO ....................................................................................2
YES ..................................................................................1
NO ....................................................................................2
KNOWLEDGE OF MALARIA
367
Are there other causes of fever in
children apart from malaria?
YES........................................................................................................1
NO.........................................................................................................2
368
What other illnesses cause fever?
.
2,→Q369
PNEUMONIA.......................................................................1
URINARY TRACT INFECTIONS.........................................2
DEHYDRATION...................................................................3
MEASLE..............................................................................4
EAR INFECTIONS..............................................................5
MENINGTIS .......................................................................6
TYPHOID ...........................................................................7
CHICKEN POX ..................................................................8
SORE THROAT .................................................................9
INFLUENZA ........................................................................10
OTHER
__________________________________________97
(SPECIFY)
369
How soon after the on-set of malaria
should somebody suspected of having
malaria be taken for treatment?
370
What are the signs that show a person
may have malaria?
RECORD ALL MENTIONED
THE SAME DAY...................................................................................1
ONE DAY AFTER FEVER STARTED................................................ 2
TWO DAYS AFTER FEVER STARTED............................................. 3
THREE OR MORE DAYS AFTER...................................................... 4
WHEN THE FEVER IS TOO HIGH/TOO HOT.....................................5
DON’T KNOW / NOT SURE .............................................................96
OTHER ______________________________________________97
(SPECIFY)
CONVULSIONS /FITS ..............................................................................1
FEVER/HIGH TEMPEARTURE ................................................................2
TOO WEAK TO SIT UP.............................................................................3
SEVERE VOMITING .................................................................................4
SEVERE DIARRHEA .............................................................................. 5
SICK WITH FEVER FOR TWO OR MORE DAYS ....................................6
NOT BEING ABLE TO EAT OR DRINK ....................................................7
DIFFICULTY BREATHING.........................................................................8
CHILLS AND SHIVERS..............................................................................9
SEVERE PALLOR
SEVERE DEHYDRATION.........................................................................11
LETHARY, DROWSINESS, UNCONCIOUSNESS OR CONFUSION
DON’T KNOW/NOT SURE……………………………………….................96
OTHER ___________________________________________97
(SPECIFY)
371
Are there benefits for testing children for
malaria before treatment?
YES..............................................................................................,1
NO.................................................................................................2
372
What are the benefits of testing children
for malaria before treatment?
CAN GIVE THE CHILD CORRECT TREATMENT........................1
DO NOT WASTE
MEDICATION.....................................................2
CHILD RECOVERS QUCIKLY.......................................................3
Stop Malaria Evaluation of Test and Treat Campaign:
PI: Marc Boulay, PhD, V1 February 20, 2014 Page 8 of 12
2,→Q373
DONT KNOW ................................................................................4
ATTITUDES TOWARDS MALARIA TESTING/TREATMENT
Please let me know if you strongly agree, somewhat agree, somewhat disagree or strongly disagree with
the statements below
Strongly
Agree
Somewhat
Agree
Somewhat
Disagree
Strongly
Disagree
373
Children who test negative for malaria
may still have malaria
1
2
3
4
373b
It is easy to tell whether a fever is
malaria or not
1
2
3
4
374
The health care provider is better than
the test at diagnosing malaria, so I
rely on the provider to tell me whether
the fever is caused by malaria.
1
2
3
4
375
I believe I was given the correct
treatment for my child’s illness
1
2
3
4
376
I would give my child an anti-malarial
drug even if the malaria test showed
he/she was negative for malaria
1
2
3
4
377
A person should only take malaria
medicine if a health provider says that
a fever really is malaria
1
2
3
4
378
The health provider is always the best
person to talk to when you think your
child may have malaria
1
2
3
4
378b
Many people will go to a second
health provider for malaria medicine if
the first provider says that the fever is
not due to malaria
1
2
3
4
378c
Even if the malaria test says that the
fever was not caused by malaria,
many caregivers will still seek out
malaria treatment from a health
provider because they don't believe
the result
1
2
3
4
378d
Providers often give malaria medicine
even when the malaria test says that
the fever was not caused by malaria
1
2
3
4
Stop Malaria Evaluation of Test and Treat Campaign:
PI: Marc Boulay, PhD, V1 February 20, 2014 Page 9 of 12
INTERVIEWER INSTRUCTION
379
ALL RESPONDENTS SHOULD BE
ASKED THIS QUESTION
1
2
3
4
I intend to seek a second opinion
about my child’s illness after this visit
379b
What treatment do you plan to give
your child when you leave this health
facility
EXPOSURE TO THE TEST AND TREAT CAMPAIGN THROUGH THE MEDIA
In the past 6 months, have you had any
malaria prevention message?
Where did you hear about this campaign?
YES ……………………………………………………………….1
NO………………………………………………………………….2
RADIO …………………………………………………………….1
POSTER…………………………………………………………..2
BILLBOARD………………………………………….................3
HEALTH CARE WORKER (IN PERSON, NOT RADIO SHOW)
FRIEND OR FAMILY MEMBER
OTHER _________________________________97
(SPECIFY)
2,→Q380
Have you heard about the “ DON’T
GUESS, FIRST TEST ON DAY ONE”
Malaria campaign ?
Where did you hear about this campaign?
YES ……………………………………………………………….1
NO………………………………………………………………….2
2,→Q387
382
How many times have you heard /seen
these messages?
383
What are the key messages for this
campaign?
DAILY ………………………………………………………………1
SEVERAL TIMES A WEEK………………………………………2
ONCE A WEEK…………………………………………………….3
SEVERAL TIMES A MONTH……………………………………..4
ONCE A MONTH…………………………………………………..5
LESS THAN ONCE A MONTH…………………………………..6
GET TESTED FOR MALARIA WHEN YOU HAVE A
FEVER ……………………………………………………………..1
TEST FOR MALARIA WITHIN THE FIRST DAY OF FEVER
ONSET……………………………………………………………...2
SEE A HEALTHCARE WORKER WHEN YOU HAVE A
FEVER …………………………………………………………..…3
ALL FEVERS MAY NOT BE MALARIA ………………………...4
TAKE ANTI-MALARIA DRUGS WHEN YOU HAVE A
FEVER ……………………………………………..5
YES…………………………………………………………………1
379c
379d
380
381
CHECK ALL THAT APPLIES
INTERVIEWER; DO NOT PROMPT
384
Did you take any actions as a result of
RADIO …………………………………………………………….1
POSTER…………………………………………………………..2
BILLBOARD………………………………………….................3
HEALTH CARE WORKER (IN PERSON, NOT RADIO SHOW)
FRIEND OR FAMILY MEMBER
OTHER _________________________________97
(SPECIFY)
Stop Malaria Evaluation of Test and Treat Campaign:
PI: Marc Boulay, PhD, V1 February 20, 2014 Page 10 of 12
2,→Q386
hearing/seeing the above messages
NO…………………………………………………………………..2
385
What actions did you take?
TOOK A CHILD FOR IMMEDIATE
TREATMENT………………………………………………………1
ASKED FOR A BLOOD TEST FOR A CHILD WHO WAS
SICK ………………………………………………………………..2
TALKED TO SOMEONE ABOUT MALARIA TESTING……….3
TALKED TO SOMEONE ABOUT THE DIFFERENT CAUSES
OF FEVER………………………………………………………….4
TALKED TO SOMEONE ABOUT MALARIA
TREATMENT……………………………………………………….5
OTHER
________________________________________________97
(SPECIFY)
NO
GO TO
QUESTIONS
CODING CLASSIFICATION
Now I am going to ask you questions about the services you received today. I would like to have your honest
opinion about the things that we will talk about. This information will help improve malaria prevention and
treatment services.
386
How long did you wait between the time
you arrived at this facility and time you
were able to see a provider for the
consultation?
Information About Client’s Satisfaction
HOURS: ........................................................ \
MINUTES:.......................................................
SAW PROVIDER IMMEDIATELY ................. 000
DON’T KNOW ............................................... 998
387
Would you return to see this provider for
fever/malaria related care for your child
YES……………………………………………………………..1
NO……………………………………………………………….2
388
Why wouldn’t you return to this provider?
PROVIDERS WAS NOT KIND………………………………..1
MY CHILD DID NOT RECEIVE THE RIGHT
DIAGNOSIS………………………………………………………2
MY CHILD DID NOT RECEIVE THE RIGHT
TREATMENT…………………………………………………….3
OTHER _______________________________________97
(SPECIFY)
389
2,→389
Now I am going to ask about some common problems clients have at health facilities. As I mention each one,
please tell me whether any of these were problems for you today, and if so, whether they were large or small
problems for you.
NO
LARGE SMALL PROBDK
LEM
01
Time you waited
Stop Malaria Evaluation of Test and Treat Campaign:
1
2
3
8
PI: Marc Boulay, PhD, V1 February 20, 2014 Page 11 of 12
02
Ability to discuss problems or concerns about
your health with the provider
1
2
3
8
03
Quality of the physical examination conducted
1
2
3
8
1
2
3
8
1
2
3
8
1
2
3
8
1
2
3
8
1
2
3
8
04
05
06
Amount of explanation you received about the
diagnosis
Amount of explanation you received about
the treatment you received
The treatment you received from this facility
09
Privacy from having others see the
examination
Privacy from having others hear your
consultation discussion
Availability of malaria medicines at this facility
10
The hours of service at this facility
1
2
3
8
11
The number of days services are available to
you
1
2
3
8
07
08
THANK YOU FOR YOUR RESPONSE!!!!
390
RECORD THE TIME THE INTERVIEW ENDED
Stop Malaria Evaluation of Test and Treat Campaign:
PI: Marc Boulay, PhD, V1 February 20, 2014 Page 12 of 12