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[PLEASE ENCIRCLE ALPHABET/NUMBER TO THE RESPECTIVE ANSWER]

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District: Block: Grampanchayat Village and Ward

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%
 Male-1, Female-2
 Hindu-1, Christian-2, Muslim-3, 0ther-99
  SC-1, ST-2, OBC-3, Other-99
#
    APL-1, BPL-2, No Cards- 3
)
 Joint-1, Nuclear-2, Nuclear family with Elder in household-3
* " 
 Agricultural daily wage labour-1, Non agricultural daily wage labour-2,
Farming-3, Craft-4, Petty trade-5,Forest produce-6, Hawker-7,
MGNREGA-8, Other-99
#
  Illiterate-1, Literate-2, Elementary education-3 ,Medium (6th &7th )-4,
High School Education ± 5, Up to 12th standard-6, College-7, Others-99
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   1,2,3,4,5,6,7,8,9,10




   c a)Yes b) No

 
  a) Village Level Health Worker
 b) AWW
c) ANM
d) ASHA
e) PRI members
f) GKS
g) Teacher

 1,2,3,4,5,6,7,8,9,10
 
 


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3. Have you heard of LLIN Before?

a) Yes b) No

4. From whom did you get information on LLIN in village?

a) Village Level Health Worker

b) AWW
c) ANM
d) ASHA
e) PRI members
f) GKS
g) Teacher
h) Village educated person
i) Dakua (Drum bitter)
j) Other_______

5. Have you heard about LLIN from any other channel in your village?

a. News paper
b. Mobile
c. Local haat
d. Video shows
e. TV
f. Radio
g. Wall paintings
h. Evening social interactions
i. Posters
j. Street plays
k. Dance
l. Songs
m. Miking
n. Swasthyakanth

6. When did you hear about LLIN first in your village?

a) Within one month

b) 1-2 months
c) 3 months above

7. What kind of information did you receive?


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8. Where did you receive LLIN?

a. Govt. Medical
b. Sub center
c. School
d. AWC
e. PRI building
f. Village community center
g. NGO
h. Any other specify

9. If yes, did you go and watch demonstration?

a) Yes b) No

·If No go to the Q No-14)

10. If yes, what did you observe in demonstration?

11. If yes, who demonstrated about the maintenance of Net?

a. Village Level Health Worker

b. AWW
c. ANM
d. ASHA
e. PRI members
f. GKS
g. Teacher
h. Village educated person
i. MTS
j. Other_______

12. During Demonstration, did they inform about usage and maintenance of net?

13. What did they inform?

a. Advantages of treated and untreated nets.

b. Cleaning of LLIN
c. Side effects of LLIN and care to be taken to avoid side effects.
 

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14. Have you seen Nidhirath in your village?

a) Yes b) No

15. When did you see Nidhirath in your village?

a) 7AM-10AM
b) 10AM-1PM
c) 2PM-5PM
d) 5PM-7PM

16. Was Nidhirath attractive?

a) Yes b) No

17. If yes, what was attractive?

18. If yes, what did you like?

(Multiple answers expected)

a. Colorful decoration
b. Album song
c. Message on the poster
d. Message through pamphlet.

19. If answer is b, c or d then ask

Can you recall any message or information you heard or read, while Nidhirath was moving?

20. If he/she does not mention any thing about malaria, Please ask them to sing two lines of the
album song or any two message from poster/pamphlets.

21. Were any announcements made in your village during Nidhirath?

 a) Yes b) No

22. If yes what was the announcement?

23. Was there any Jatra/ video show after Nidhirath?

a) Yes b) No

(If no skip to Section-E)

24. If yes, did you watch jatra/ video?

a) Yes b) No

(If no skip to Section-E)

25. What was performed in your village?

a) Jatra
b) Video

26. Can you brief us about the story?

27. If the respondent does not talk about malaria, ask specifically what they remembered about
malaria related messages during the Jatra and video.

28. Do you remember any character in the Jatra/vedio

a) Yes b) No

29. If yes, what character did you like?

30. Why did you like these characters?

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(Distribution strategy: _

  _

 

  
 

  

 

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31. Do you sleep under the net every day?

a) Yes b) No

32. If No, what is the reason?

33. Do all your family members sleep under the net?

a) Yes b) No

34. If yes

Who all slept under the net yesterday?

35. If No,

Why do all of them, not sleep under the net?

36. Give reason?

37. Did you wash the net in this one year?

38. How many times

a) once
b) 3 times
c) More than three times

+ c!

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