QUESTIONNAIRE

Tittle: The Causes and effects of Cholera among children in Mubi North
Local government

SECTION A: Social Demographics Factors

1. Sex: Female ( ) Male ( )
2. How old are you?
1.15-24 ( )
2. 25-34 ( )
3. 35-44 ( )
4. ≥ 45 ( )

2. Marital status: Single ( ) Married ( ) Separated/divorced ( ) Windowed.

3. What is your high level of education achieved?
a)No formal education ( )
b)Primary level ( )
c)Secondary level ( )
d)Tertiary ( )

SECTION B: RESAERCH QUESTIONS

4. Have you ever heard about cholera?
a) Yes ( )
b) No ( )
5. Do you usually take any child who has fallen sick due to cholera to health care
facility?

a) Yes ( )
b) No ( )
6. How soon after suspecting cholera would you seek for treatment?
1. One day. (Within 24 hours). ( )
2. 2-3 days. ( )
3. 4-6 days. ( )
4. 7 days or more. ( )
7. Do you think cholera is serous and threatening disease?
a) Yes ( )
b) No ( )
8. Do you think the best way to prevent myself from getting cholera is to avoid
dirty water?
a) Yes ( )
b) No ( )
9. Am sure that I can treat the child if he or she gets cholera?
a) Yes ( )
b) No ( )
10. Children and pregnant mothers are at greater risk of getting cholera.
a) Yes ( )
b) No ( )
11. Do you think that one can recover from cholera without any treatment?
a) Yes ( )
b) No ( )
12. Do you think that it is dangerous if cholera medicine is not taken completely?
a) Yes ( )
b) No ( )
13. Do you have good water drainage system around your house?
a) Yes ( )
b) No ( )
14. Do you usually clear stagnant waters in broken pots, containers and ditches
around your house?

a) Yes ( )
b) No ( )
15. Do you have garbage heaps very close to your home?
a) Yes ( )
b) No ( )

Thank you for your participation.