Copy of Ebola Survey Public

8/18/2019 Copy of Ebola Survey Public

1/14

QUESTION TEXT (ENGLISH)

ENTER COMMUNITY CODE

[ENTER RESPONDENT ID]

BACKGROUND

[SELECT RESPONDENT GENDER]

How old are you? [If don! "now# e$!%&a!e]

'(a! %$ !(e (%)(e$! le*el of edu+a!%on !(a! you (a*e +o&,le!ed?

'(a! %$ your rel%)%on?

'(ere d%d !(ey )o? [a$"ed !o rando& -./ of $a&,le]

T(e ,la+e w(ere you $lee, a! n%)(!# (ow &any ,eo,le ea! fro& your,o! and $lee, under your roof?

In !(e ,a$! 0 wee"$# d%d anyone %n your (ou$e(old lea*e !o )o ou!$%deMonro*%a? [a$"ed !o rando& -./ of $a&,le]

In !(e ,a$! 0 wee"$# d%d anyone %n your (ou$e(old re!urn fro& ou!$%deMonro*%a? [a$"ed !o rando& -./ of $a&,le]


2/14

'(ere d%d !(ey +o&e fro&? [a$"ed !o rando& -./ of $a&,le]

EBOLA AWARENESS-

1$ you &ay "now# ,eo,le are $ay%n) !(e E2ola %$ %n !own3 Now I wouldl%"e !o a$" you a2ou! w(a! you "now a2ou! !(e E2ola 2u$%ne$$ andw(a! you !(%n"3 Plea$e re&e&2er !(a! !(e $ur*ey %$ +on4den!%al and!(a! you +an 5u&, o*er any 6ue$!%on !(a! you do no! l%"e3

How you +an )e! E2ola? Plea$e !ell &e all !(e way$ !(a! you "now3 [DONOT RE1D OPTIONS7 SELECT 1LL TH1T 1PPLY]


3/14

E2ola +an 2e $,read !(rou)( !(e a%r3 True or fal$e?

Dr%n"%n) $al! wa!er +an (el, +ure E2ola3 True or fal$e?

HEALTH-

How +an you "now !(a! $o&eone (a$ E2ola? Can you +all !(e$y&,!o&$ !o &e now? [DO NOT RE1D OPTIONS7 SELECT 1LL TH1T1PPLY]

I&a)%ne a ,er$on w(o doe$ no! (a*e E2ola +o&e$ %n +on!a+! w%!($o&eone w(o (a$ E2ola# u, !o (ow &any day$ +an %! !a"e for !(e& !o"now w(e!(er !(e ,er$on (a$ E2ola?

'(a! %$ !(e E2ola (o!l%ne nu&2er? [DOES RESPONDENT CORRECTLYIDENTI8Y THE NUM9ER?]

O"# now I wan! !o $ay $o&e !(%n)$ a2ou! E2ola3 So&e are !rue and$o&e are fal$e3 I wan! you !o !ell &e w(e!(er !(ey are TRUE or 81LSE3

E2ola +an 2e $,read !(rou)( 2ody :u%d$ l%"e $wea! or 2lood3 True orfal$e?

If $o&eone (a$ E2ola# !(ey +an $,read %! e*en 2efore !(ey $(ow any$y&,!o&$3 True or fal$e?

O;# now I wan! !o a$" a2ou! !(e (eal!( of you and your fa&%ly dur%n)e2olaIn !(e ,a$! < &on!($# (ow of!en (a*e you or anyone %n your (ou$e(old)one w%!(ou! &ed%+%ne$ or &ed%+al !rea!&en!?


4/14

How &any +(%ldren under = are %n your (ou$e(old?

If ye$# d%d you )o !o a (o$,%!al or +l%n%+ or o!(er (eal!( fa+%l%!y?

If no# w(ere d%d you $ee" +are?

If ye$# d%d you.!(ey $ee" +are ou!$%de of your (o&e for !(%$ %llne$$?

If ye$# w(a! !y,e of (eal!( ,ro*%der d%d you *%$%!?

EBOLA VIGILANCE-

If any# w(o or)an%>ed !(e$e &ee!%n)$? [$ele+! all !(a! a,,ly]

If @# (a*e any of !(e +(%ldren %n your (ou$e(old (ad fe*er or +ou)( %n!(e ,a$! !wo wee"$?

If no# you !(%n" %! wa$ 2e+au$e of E2ola !(a! you were no! a2le !o 4nd+are?

In !(e ,a$! < &on!($# (a*e you or anyone el$e %n your (ou$e(old fel!$%+" enou)( !o need &ed%+al !rea!&en!?

If no# you !(%n" %! wa$ 2e+au$e of E2ola !(a! you were no! a2le !o 4nd+are?

Now I wan! !o a$" a2ou! $o&e of !(e !(%n)$ your +o&&un%!y &ay 2edo%n) !o ,ro!e+! %!$elf a)a%n$! E2ola3 Re&e&2er now# e*ery!(%n) !o $ay%$ $e+re! and no for+e %n !(%$ $ur*ey3

Now now# doe$ your +o&&un%!y (a*e an awarene$$ )rou, !o $,readnew$ a2ou! E2ola? T(%$ +an 2e a )rou, fro& nor&al !%&e$ !(a! doe$!(%$# or !(%$ +an 2e a new )rou,3

Now now# doe$ your +o&&un%!y (a*e a +o&&un%!y )rou, !(a! +an(el, w%!( +on!a+! !ra+%n) or enfor+e 6uaran!%ne$ of $u$,e+!ed +a$e$?

T(%$ +an 2e a )rou, fro& nor&al !%&e$ !(a! doe$ !(%$# or !(%$ +an 2e anew )rou,3In !(e ,a$! !wo wee"$# (ow &any +o&&un%!y &ee!%n)$ a2ou! E2olad%d you a!!end?


5/14

Do you u$e (and $an%!%>er da%ly?

Now now you $(a"%n) (and$ !(e L%2er%an way?

ECONOMIC IMPACTS-

My +o&&un%!y %$ wellAor)an%>ed %n !(e 4)(! !o "ee, E2ola ou! of &y+o&&un%!y3 1)ree or d%$a)ree?

My +o&&un%!y $u,,or!$ $afe 2ur%al ,ra+!%+e$ for E2ola *%+!%&$ 2yallow%n) (eal!( wor"er$ !o 2ury !(e 2od%e$3 1)ree or d%$a)ree?

Now I wan! !o a$" a2ou! $o&e of !(e $!e,$ you &ay (a*e !a"en !o,ro!e+! your$elf a)a%n$! !(e d%$ea$e

Do you (a*e a 2u+"e! w%!( wa!er and +(lor%ne for (andwa$(%n) a! your(o&e?

Now I wan! !o a$" you $o&e 6ue$!%on$ a2ou! !(%n)$ !(a! &%)(! (a*e(a,,ened %n !(e la$! !wo wee"$# or -/ day$3 Your an$wer$ are $e+re!#$o you $(ould feel free !o 2e !ru!(ful w%!( &e3 9u! no for+e %n !(%$$ur*ey3So&e!%&e$ ,eo,le wan! !o 2ury dead 2od%e$ %n !(e !rad%!%onal way# $o!(ey do !(e 2ur%al$ %n $e+re!3 In !(e ,a$! -/ day$# (a*e you (eard of

any $e+re! 2ur%al$ %n your +o&&un%!y?

So&e!%&e$ ,eo,le are $+ared of w(a! w%ll (a,,en %f !(ey re,or! E2ola+a$e$ !o !(e au!(or%!%e$# $o !(ey (%de !(e& %n$!ead3 In !(e ,a$! -/day$# (a*e you (eard of anyone (%d%n) ,o!en!%al E2ola +a$e$ %n your+o&&un%!y?

So&e!%&e$ %! +an 2e (ard !o $!ay %n$%de a! n%)(!# e$,e+%ally for ,eo,lew(o )o! !o wor" a! n%)(!3 In !(e ,a$! -/ day$# (ow &any day$ d%d youyour$elf )o ou! a! n%)(!?So&e!%&e$ %! +an 2e (ard no! !o )o ou! and en5oy your$elf3 In !(e ,a$!-/ day$# (ow &any day$ d%d you your$elf a!!end a ,u2l%+ )a!(er%n)

l%"e *%deo +lu2$# en!er!a%n&en! +en!er$# or o!(er +rowded area$?1$ you "now# $o&e!%&e$ %! +an 2e (ard !o )e! !ran$,or! %n !(%$ +%!y3 In!(e ,a$! -/ day$# (ow &any day$ d%d you (a*e !o r%de a$ < on a&o!or2%"e?

O;# now I would l%"e !o a$" a2ou! !(e 5o2 2u$%ne$$ and !(e food2u$%ne$$3


6/14

'(a! %$ your ,r%&ary o++u,a!%on?

In !(e la$! $%B &on!($# (a*e you lo$! your 5o2?

In !(e la$! $%B &on!($# (a$ anyone el$e %n your fa&%ly lo$! !(e%r 5o2?

FOOD SECURITY-

O;# now I wan! !o a$" a2ou! !(e food 2u$%ne$$3

S%n+e uly !(%$ year# (ow of!en (a*e you or anyone %n your fa&%ly )onew%!(ou! &oney fro& 2u$%ne$$ or 5o2$?

In !(e ,a$! wee" day$F# a2ou! (ow &u+( &oney d%d you &a"e? [INLD]9efore E2ola# %n a nor&al wee"# (ow &u+( &oney do you !y,%+ally&a"e? [IN LD]

Do you feel !(a! you lo$! !(%$ 5o2 2e+au$e of E2ola or for d%eren!rea$on?

Co&,ared !o nor&al !%&e$# are you wor"%n) le$$ 2e+au$e !(ere %$ no!enou)( wor" !o do?

Doyou feel !(a! you are wor"%n) le$$ 2e+au$e of E2ola or for d%eren!rea$on?

Do you feel !(a! !(%$ ,er$on lo$! !(%$ 5o2 2e+au$e of E2ola or ford%eren! rea$on?

Co&,ared !o nor&al !%&e$# %$ anyone el$e %n your fa&%ly wor"%n) le$$2e+au$e !(ere %$ no! enou)( wor" !o do?

Do you feel !(a! !(%$ ,er$on %$ wor"%n) le$$ 2e+au$e of E2ola or ford%eren! rea$on?

S%n+e uly !(%$ year# (ow of!en# %f e*er# (a*e you or anyone %n yourfa&%ly )one w%!(ou! enou)( food !o ea!?

In !(e ,a$! wee"# d%d you worry !(a! your fa&%ly would no! (a*eenou)( food !o ea!?

In !(e ,a$! wee"# (ow &any day$ d%d you or $o&eone %n your(ou$e(old (a*e !o S;IP ME1LS 2e+au$e you +ould no! aord food?


7/14

CONCLUSION-

T%&e %n!er*%ew end$3

'ere !(ere any d%$!ra+!%on$ or %n!erru,!%on$ dur%n) !(e %n!er*%ew?

END OF SURVEY

In !(e ,a$! wee"# (ow &any day$ d%d you or $o&eone %n your(ou$e(old (a*e !o LIMIT THE PORTION SIE dur%n) &eal$?

In !(e ,a$! wee"# (ow &any day$ d%d you or $o&eone %n your(ou$e(old (a*e !o 9ORRO' 8OOD 8ROM 1 8RIEND OR REL1TIE?

In !(e ,a$! wee"# (ow &any day$ d%d you (a*e !o ea! food !(a! wa$NOT 1S GOOD 1S YOU '1NTED 2e+au$e you +ould no! aord %!?

In !(e ,a$! wee"# a2ou! (ow &any &eal$ d%d your +(%ldren ea! ea+(day? [JJ K no +(%ldren]

In a nor&al wee"# !(a! %$# 2efore E2ola# (ow &any &eal$ d%d your+(%ldren ea! ea+( day? [JJ K no +(%ldren]

In !(e ,a$! wee"# (ow &any !%&e$ (a$ a +(%ld of your$ )one !o 2ed(un)ry? [JJ K no +(%ldren]

O;# !(an" you for your ,ar!%+%,a!%on !oday3 'e )rea!ly a,,re+%a!e your!%&e39RIE8LY 1NS'ER 1NY UESTIONS TH1T THE RESPONDENT 1S;S#

THEN COMPLETE THE REST O8 THE SUREY ONCE THE RESPONDENTH1S LE8T3

D%d you feel !(a! !(e re$,onden! wa$ w%ll%n) !o $(are %nfor&a!%on andeB,er%en+e$ w%!( you?

D%d !(e re$,onden! )e! %rr%!a!ed or an)ry a! any !%&e dur%n) !(e$ur*ey?


8/14

*arna&e

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9/14

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10/14

e$%)n$y&,!o&

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11/14

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12/14

+or)an%>edae

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13/14

no+a$(5uly

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o++u,a!%on

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14/14

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