Household survey Household survey District North A Micheweni North A: Shehia Bandamaji Chaani Kubwa Kandwi Kendwa Kidoti Kijini Kivunge Matemwe Kaskazi Matemwe Kusini Mkokotoni Mkwajuni Nungwi Pita na zako Tumbatu Gomani Tumbatu Jongowe Tumbatu Uvivini Kijini 2 Micheweni: Shehia Shumba Mjini Konde Kifundi Konde Shumba Mihogoni Tumbe Mashariki Tumbe Magharibi Sizini Msuka Mashariki Shumba Vyamboni Wingwi Mtemani Micheweni Mjini Micheweni Majenzi Msuka Magharibi Wingwi Njuguni Wingwi Mijini Kiuyu Mbuyuni Household ID Head of household name First and Last Number of household members Currently living in the house Has your household been sprayed in the last 6 months? Yes No Don't know How many sleeping spaces are there in your house? i.e bed, sleeping mat, mattress How many mosquito nets do you use in your house? Household members Household member Name First and last Age If under 1 year, put 0.5 Present? If not present, return at a later date. Move onto next household member. Yes No Did you sleep under a net last night? Yes No In the last month, have you stayed overnight or longer outside of your own district? No Yes, within Zanzibar Yes, within Tanzania Yes, outside of Tanzania List travel locations within Zanzibar List travel locations within Tanzania List travel locations outside of Tanzania Have you had a fever within the last 2 days? Yes No Don't know Have you had malaria treatment in the last 2 weeks? Yes No Are you pregnant? Yes No Don't know Have you been taking IPTp? Yes No Don't know Are you willing to take part in the testing? Yes No Record temperature Use thermometer in armpit mRDT taken? Yes No Filter paper taken? Yes No Record barcode Scan barcode until you hear a beep Record barcode number Initials Record initials on filter paper Results of mRDT Positive Negative Which species? Falciparum Mixed Comments If no comments, move to next person in house or new household