Posted: April 11th, 2015
ebola
| QUESTION TEXT (ENGLISH) | varname | |
| ENTER COMMUNITY CODE | towncode | |
| [ENTER RESPONDENT ID] | respid | |
| BACKGROUND | ||
| [SELECT RESPONDENT GENDER] | gender | |
| How old are you? [If don’t know, estimate] | Numeric | age |
| The place where you sleep at night, how many people eat from your pot and sleep under your roof? | Numeric | hhsize |
| What is the highest level of education that you have completed? | 0-None 1-Some ABC 2-Completed ABC 3-Some junior high 4-Completed junior high 5-Some high school 6-Completed high school 7-Some university 8-Completed university 88-Other |
educ |
| What is your religion? | 1-Christian 2-Muslim 3-Traditional 88-Other |
religion |
| In the past 2 weeks, did anyone in your household leave to go outside Monrovia? [asked to random 1/4 of sample] | 0-No 1-Yes |
leavemonr2w |
| Where did they go? [asked to random 1/4 of sample] | 1-Bomi 2-Bong 3-Gbarpolu 4-Grand Bassa 5-Grand Cape Mount 6-Grand Gedeh 7-Grand Kru 8-Lofa 9-Margibi 10-Maryland 11-Montserrado 12-Nimba 13-Rivercess 14-Rivergee 15-Sinoe 88-Other |
leavemonr2wwhere |
| In the past 2 weeks, did anyone in your household return from outside Monrovia? [asked to random 1/4 of sample] | 0-No 1-Yes |
returnmonr2w |
| Where did they come from? [asked to random 1/4 of sample] | 1-Bomi 2-Bong 3-Gbarpolu 4-Grand Bassa 5-Grand Cape Mount 6-Grand Gedeh 7-Grand Kru 8-Lofa 9-Margibi 10-Maryland 11-Montserrado 12-Nimba 13-Rivercess 14-Rivergee 15-Sinoe 88-Other |
returnmonr2wwhere |
| EBOLA AWARENESS- | ||
| As you may know, people are saying the Ebola is in town. Now I would like to ask you about what you know about the Ebola business and what you think. Please remember that the survey is confidential and that you can jump over any question that you do not like. | eatxt1 | |
| How you can get Ebola? Please tell me all the ways that you know. [DO NOT READ OPTIONS; SELECT ALL THAT APPLY] | 1-Preparing or eating bush meat 2-Eating fruit bitten by bats 3-Bodily fluids of infected person 4-Man woman business 5-Touching dead bodies 6-Contact with infected surfaces 7-Mother breastfeeding her child 88-Other 97-Dont know |
ehowget |
| How can you know that someone has Ebola? Can you call the symptoms to me now? [DO NOT READ OPTIONS; SELECT ALL THAT APPLY] | 1-Vomiting 2-Fever 3-Diarrhea 4-Headache 5-Joint and muscle pain 6-Sore throat 7-Weakness 8-Stomach pain 9-Rash 10-Red eyes 11-Hiccups 12-Bleeding 13-Fatigue 14-Bruising 15-Chills 16-Weight loss 17-Chest pain 18-Cough 97-Does not know 88-Other |
esignsymptom |
| Imagine a person who does not have Ebola comes in contact with someone who has Ebola, up to how many days can it take for them to know whether the person has Ebola? | Numeric | eincubation |
| What is the Ebola hotline number? [DOES RESPONDENT CORRECTLY IDENTIFY THE NUMBER?] | 0-No 1-Yes |
ehotline |
| Ok, now I want to say some things about Ebola. Some are true and some are false. I want you to tell me whether they are TRUE or FALSE. | eatxt2 | |
| Ebola can be spread through the air. True or false? | 0-False 1-True 97-Don’t know |
spreadair |
| Ebola can be spread through body fluids like sweat or blood. True or false? | 0-False 1-True |
spreadfluids |
| If someone has Ebola, they can spread it even before they show any symptoms. True or false? | 0-False 1-True 97-Don’t know |
spreadearly |
| Drinking salt water can help cure Ebola. True or false? | 0-False 1-True 97-Don’t know |
saltcure |
| HEALTH- | ||
| OK, now I want to ask about the health of you and your family during ebola | htxt1 | |
| In the past 3 months, how often have you or anyone in your household gone without medicines or medical treatment? | 0-Never 1-Just once or twice 2-Several times 3-Many times 4-Always 97-Don’t know 98-Refused to answer |
notreatmentj26 |
| How many children under 5 are in your household? | Numeric | under5 |
| If >0, have any of the children in your household had fever or cough in the past two weeks? | 0-No 1-Yes |
childsick |
| If yes, did you go to a hospital or clinic or other health facility? | 0-No 1-Yes |
childsickcareclinic |
| If no, where did you seek care? | 1-Clinic 2-Hospital 3-Traditional healer 4-At home doctor or nurse 5-Midwife 6-Traditional midwife 7-Family or self 88-Other |
childsickcarewhereelse |
| If no, you think it was because of Ebola that you were not able to find care? | 0-No 1-Yes |
childsicknocareebola |
| In the past 3 months, have you or anyone else in your household felt sick enough to need medical treatment? | 0-No 1-Yes |
hhmemsick |
| If yes, did you/they seek care outside of your home for this illness? | 0-No 1-Yes |
hhmemsickcare |
| If yes, what type of health provider did you visit? | 1-Clinic 2-Hospital 3-Traditional healer 4-At home doctor or nurse 5-Midwife 6-Traditional midwife 7-Family or self 88-Other |
hhmemsickcarewhere |
| If no, you think it was because of Ebola that you were not able to find care? | 0-No 1-Yes |
hhmemsicknocareebola |
| EBOLA VIGILANCE- | ||
| Now I want to ask about some of the things your community may be doing to protect itself against Ebola. Remember now, everything to say is secret and no force in this survey. | evtxt1 | |
| Now now, does your community have an awareness group to spread news about Ebola? This can be a group from normal times that does this, or this can be a new group. | 0-No 1-Yes |
egroupa |
| Now now, does your community have a community group that can help with contact tracing or enforce quarantines of suspected cases? This can be a group from normal times that does this, or this can be a new group. | 0-No 1-Yes |
egroupct |
| In the past two weeks, how many community meetings about Ebola did you attend? | Numeric | emtgs |
| If any, who organized these meetings? [select all that apply] | 1-Community leaders 2-Religious leaders 3-Community members 4-NGOs 5-Government agency 6-Community group 88-Other |
emtgswho |
| My community is well-organized in the fight to keep Ebola out of my community. Agree or disagree? | 0-Disagree 1-Agree 97-Don’t know 98-Refuse to answer |
corganizedae |
| My community supports safe burial practices for Ebola victims by allowing health workers to bury the bodies. Agree or disagree? | 0-Disagree 1-Agree 97-Don’t know 98-Refuse to answer 99-N/A |
csafeburial |
| Now I want to ask about some of the steps you may have taken to protect yourself against the disease | evtxt2 | |
| Do you have a bucket with water and chlorine for handwashing at your home? | 0-No 1-Yes 97-Don’t know 98-Refuse to answer |
bucket |
| Do you use hand sanitizer daily? | 0-No 1-Yes 97-Don’t know 98-Refuse to answer |
handsanitizer |
| Now now you shaking hands the Liberian way? | 0-No 1-Yes 97-Don’t know 98-Refuse to answer |
shakehands |
| Now I want to ask you some questions about things that might have happened in the last two weeks, or 14 days. Your answers are secret, so you should feel free to be truthful with me. But no force in this survey. | evtxt3 | |
| Sometimes people want to bury dead bodies in the traditional way, so they do the burials in secret. In the past 14 days, have you heard of any secret burials in your community? | 0-No 1-Yes 97-Don’t know 98-Refuse to answer |
secretburials |
| Sometimes people are scared of what will happen if they report Ebola cases to the authorities, so they hide them instead. In the past 14 days, have you heard of anyone hiding potential Ebola cases in your community? | 0-No 1-Yes 97-Don’t know 98-Refuse to answer |
hidecases |
| Sometimes it can be hard to stay inside at night, especially for people who got to work at night. In the past 14 days, how many days did you yourself go out at night? | Numeric | breakcurfew |
| Sometimes it can be hard not to go out and enjoy yourself. In the past 14 days, how many days did you yourself attend a public gathering like video clubs, entertainment centers, or other crowded areas? | Numeric | havefun |
| As you know, sometimes it can be hard to get transport in this city. In the past 14 days, how many days did you have to ride as 3 on a motorbike? | Numeric | ride3 |
| ECONOMIC IMPACTS- | ||
| OK, now I would like to ask about the job business and the food business. | ectxt1 | |
| Since July this year, how often have you or anyone in your family gone without money from business or jobs? | 0-Never 1-Just once or twice 2-Several times 3-Many times 4-Always 97-Don’t know, 98-Refused to answer |
nocashjuly |
| In the past week (7 days), about how much money did you make? [IN LD] | Numeric | income7d |
| Before Ebola, in a normal week, how much money do you typically make? [IN LD] | Numeric | income7dnormal |
| What is your primary occupation? | 0-None 1-Professional/technical 2-Clerical 3-Sales and services 4-Skilled manual 5-Unskilled manual 6-Domestic service 7-Agriculture 88-Other |
occupation |
| In the last six months, have you lost your job? | 0-No 1-Yes |
losejob |
| Do you feel that you lost this job because of Ebola or for different reason? | 0-Different reason 1-Because of ebola |
losejobebola |
| Compared to normal times, are you working less because there is not enough work to do? | 0-No 1-Yes |
workless |
| Doyou feel that you are working less because of Ebola or for different reason? | 0-Different reason 1-Because of ebola |
worklessebola |
| In the last six months, has anyone else in your family lost their job? | 0-No 1-Yes |
famlosejob |
| Do you feel that this person lost this job because of Ebola or for different reason? | 0-Different reason 1-Because of ebola |
famlosejobebola |
| Compared to normal times, is anyone else in your family working less because there is not enough work to do? | 0-No 1-Yes |
famworkless |
| Do you feel that this person is working less because of Ebola or for different reason? | 0-Different reason 1-Because of ebola |
famworklessebola |
| FOOD SECURITY- | ||
| OK, now I want to ask about the food business. | fstxt1 | |
| Since July this year, how often, if ever, have you or anyone in your family gone without enough food to eat? | 0-Never 1-Just once or twice 2-Several times 3-Many times 4-Always 97-Don’t know, 98-Refused to answer |
nofoodjuly |
| In the past week, did you worry that your family would not have enough food to eat? | 0-No 1-Yes |
nofoodworry7d |
| In the past week, how many days did you or someone in your household have to SKIP MEALS because you could not afford food? | Numeric | skipmeals |
| In the past week, how many days did you or someone in your household have to LIMIT THE PORTION SIZE during meals? | Numeric | limitmealsize |
| In the past week, how many days did you or someone in your household have to BORROW FOOD FROM A FRIEND OR RELATIVE? | Numeric | borrowfood |
| In the past week, how many days did you have to eat food that was NOT AS GOOD AS YOU WANTED because you could not afford it? | Numeric | badfood |
| In the past week, about how many meals did your children eat each day? [99 = no children] | Numeric | childmeals |
| In a normal week, that is, before Ebola, how many meals did your children eat each day? [99 = no children] | Numeric | childmealsnormal |
| In the past week, how many times has a child of yours gone to bed hungry? [99 = no children] | Numeric | bedhungry2w |
| CONCLUSION- | ||
| OK, thank you for your participation today. We greatly appreciate your time. | conctxt3 | |
| BRIEFLY ANSWER ANY QUESTIONS THAT THE RESPONDENT ASKS, THEN COMPLETE THE REST OF THE SURVEY ONCE THE RESPONDENT HAS LEFT. | conctxt4 | |
| Time interview ends. | TIME | endtime |
| Did you feel that the respondent was willing to share information and experiences with you? | 1-Willing to share 2-Not willing to share |
willshare |
| Were there any distractions or interruptions during the interview? | 0-None 1-Rain 2-Child present 3-Spouse present 4-Friend present 5-Bossman present 88-Other |
distractions |
| Did the respondent get irritated or angry at any time during the survey? | 1-Yes 0-No |
angry |
| END OF SURVEY |
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