Malaria Survey

AGE? *

SEX? *

MARRIED? *

Yes No

DO YOU HAVE CHILDREN? *

Yes No

STUDENT? *

Yes No

EMPLOYED? *

Yes No

HOW MANY TIMES DO YOU HAVE MALARIA IN A YEAR? *

WHERE DID YOU TREAT YOURSELF THE LAST TIME YOU HAD MALARIA? *

HOW MUCH DID YOU PAY (TOTAL) FOR THE TREATMENT? *

WRITE THE TOTAL MONEY SPENT ON TRANSPORTATION TO GET TREATMENT

HOW MANY DAYS DID YOU STAY AWAY FROM WORK WHEN YOU WERE SICK? *

DID YOU GET WELL? *

Yes No

WAS THE ABOVE THE FIRST PLACE YOU WENT FOR TREATMENT? *

Yes No

IF NO ABOVE,WHERE DID YOU GO TO FIRST FOR TREATMENT?

HOW MUCH DID YOU SPEND IN THIS FIRST PLACE? *

DID SOMEONE TAKE CARE OF YOU THE LAST TIME YOU HAD MALARIA? *

Yes No

IF YES TO THE ABOVE,GIVE AN ESTIMATE OF HOW MUCH SHE/HE EARNS PER MONTH....JUST ESTIMATE.

HOW MANY DAYS DID THE PERSON TAKE CARE OF YOU?

STATE OF RESIDENCE *

WHAT IS YOUR INCOME OR ALLOWANCE/MONTH *

DO YOU SLEEP UNDER A MOSQUITOE NET? *

Yes No

HOW DO YOU PREVENT MALARIA?