#	Question	Response	Skip pattern
	How many people usually live in your household?	Number of people |____|_____|
	How many insecticide treated mosquito nets (LLIN) does your household have?	Number of nets |____|_____|	If "0" then skip to 7
	Did you sleep under an LLIN last night?	YES…………………………1 NO…………………………0.2
	How many children under 5 slept in your household last night?	Number of children |____|_____|	If "0" then skip to 7
	How many of those children slept under a net last night?	Number of children |____|_____|
	Is this your first pregnancy?	YES…………………………1 NO…………………………0.2	If YES then END
	How many prior pregnancies have you had?	Number of pregnancies |____|_____|
	How many children under 5 do you have?	NUMBER OF CHILDREN |____|____|	If "0" then END
	Have any of your children who are under 5 years old been ill with a fever at any time in the last 2 weeks?	YES…………………………1 NO…………………………0.2	If NO then END
	For each child aged < 5 years with fever in the past 2 weeks: at any time during the illness, did you seek any advice or treatment for the illness from any source?	YES…………………………1 NO…………………………0.2	If NO then END
	Where did you seek treatment?	GOVERNMENT HOSPITAL……………………01 GOVERNMENT HEALTH CENTER…………0.02 GOVERNMENT HEALTH POST………………03 MOBILE CLINIC ……………………………………04 FIELDWORKER ……………………………………05 OTHER PUBLIC SECTOR………………………0.06 PRIVATE HOSPITAL/CLINIC…………………0.07 PHARMACY ……………………………………….0.08 PRIVATE DOCTOR ………………………………09 MOBILE CLINIC ………………………………….0.10 FIELDWORKER ……………………………………11 OTHER PRIVATE MEDICAL SECTOR…….0.12 SHOP …………………………………………………13 TRADITIONAL PRACTITIONER ……………14 MARKET ……………………………………………15 ITINERANT DRUG SELLER……………………16 OTHER……………………………………………………97
	How many days after the illness began did you first seek advice or treatment for this child?	NUMBER OF DAYS
	Did this child have blood taken from his/ her finger or heel for malaria testing?	YES…………………………1 NO…………………………0.2
	At any time during the illness, did this child take any drugs for the illness?	YES…………………………1 NO…………………………0.2	Continue END
	What drugs did this child take?	ANTIMALARIAL DRUGS ORAL ARTEMISININ COMBINATION THERAPY (ACT). …………………………………01 SP/FANSIDAR ……………………………………02 CHLOROQUINE……………………………………03 AMODIAQUINE……………………………………04 QUININE…………………………………………….0.05 OTHER (specify) ___________________06 INJECTION/RECTAL ARTESUNATE INJECTION…………………0.07 QUININE INJECTION…………………………08 RECTAL ARTESUNATE………………………09 ANTIBIOTIC DRUGS PILL/SYRUP …………………………….0.10 INJECTION/IV……………………………11 DON'T KNOW…………………………………………12