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