| No. | Variables | Terms | Answer |
| HOUSEHOLD INFORMATION | |||
| Presence of an adult aged at least 18 in the household | 1. Yes 2. No If not, come back and visit the household. Chooseanotherhousehold | /__/ | |
| 2. | Sanitary zone | 1. Pak 2. Sakif | /__/ |
| Municipality | 1. Pobè 2. Kétou 3. Adja-Ouèrè 4. Sakété 5. Ifangni | /__/ | |
| Borough | Choose the district | ||
| Village | Choose the village | ||
| 6. | Place of residence | 1. Urban 2. Rural | /__/ |
| 7. | Type of habitat | 1. Individual 2. Collective | /__/ |
| 8. | Household size | Enter the number of people living in the household | /__/__/ |
| 9. | Monthly household income | Enter the average monthly income in F CFA | ……….F |
| INFORMATION ON THE SUBJECT SURVEYED | |||
| 10. | Does the household agree to participate in the study? | 1. Yes 2. No If no, choose another household | /__/ |
| 11. | Position of the respondent in the household | 1. Head of household 2. Head of household's wife 3. Child of the head of the household 4. Other | /__/ |
| 12. | Age of respondent | Enter your age in years | /__/__/ |
| 13. | Gender of respondent | 1. Male 2. Feminine | /__/ |
| 14. | Educational level | 1. Uneducated 2. Primary 3. Secondary 4. Superior | /__/ |
| If not educated, specify whether literate or not in local language | 1. Literate 2. Not Literate | /__/ | |
| 15. | Religion | 1. Endogenous 2. Christianity 3. Islam 4. No religion | /__/ |
| 16. | Are there veterinary centers in your area? | 1. Yes 2. No 3. I don’t know | /__/ |
| KNOWLEDGE OF HUMAN RABIES INVESTIGATION | |||
| 17. | What do you think human rage is? | 1. Do not know 2. Disease transmitted from dogs to humans 3. Brain-related disease 4. Poisoning 5. Diseases caused by spirits 6. Diseasesinduced by witchcraft 7. Otherto specify | Check all true answers |
| 18. | How is rabies transmitted? | 1. Do not know 2. Disease transmitted from dogs to humans 3. Disease transmitted from one dog to another 4. Disease transmitted from man to dog 5. Disease transmitted from man to man | Check all trueanswers |
| 19. | How could rabies be transmitted from a dog to a human? | 1. Do not know 2. Bite 3. Scratch 4. Licking | Check all true answers |
| 20. | What do you think are the signs of animal rabies? | 1. Do not know 2. Lack of appetite/difficulty eating 3. Barks or meowsdifferently 4. Saliva excessively 5. Bites the wound site where it was exposed to the rabies virus 6. Reacts excessively to touch, noise or light 7. Stagger or fall 8. Is partially or completely paralyzed 9. Disappearance of the animal 10. Behaviour change 11. Hustle 12. Photophobia 13. Other signs to specify | Check all true answers |
| 21. | What do you think are the signs of rabies in humans? | 1. Do not know 2. Irritability 3. Tingling from the wound 4. Hydrophobia 5. Bark 6. Sweat 7. Aggressiveness 8. Hustle 9. Leak 10. Other signs to specify | Check all true answers |
| 22. | How do you think rabies can be prevented? | 1. Do not know 2. Vaccination of dogs 3. Slaughter of stray dogs 4. Cat vaccination 5. Vaccination of other pets 6. Human vaccination regardless of any bite 7. Human vaccination after bite 8. Other to specify | Check all true answers |
| 23. | What is the minimum age for dog vaccinations? | 1. Do not know 2. Before the age of three months 3. At threemonthsold 4. After three months of age | /__/ |
| ATTITUDE AND PRACTICES | |||
| 24. | In your opinion, why is the presence of a dog important in a home? | 1. Do not know 2. The dog provides security and keeps thieves away from the house 3. The dog protects against evil spirits 4. The dog receives bad luck instead of its master 5. Eating dog meat protects against rabies 6. Eating dog meat protects against witchcraft 7. The dog is a good companion 8. Otherto specify | /__/ |
| 25. | Do you think a dog bite can cause rabies? | 1. Yes 2. No | /__/ |
| 26. | Do you think that declared human rabies is fatal, that is, incurable? | 1. Yes 2. No | /__/ |
| 27. | Do you think vaccinating your dog can protect it against rabies? | 1. Yes 2. No | /__/ |
| 28. | Do you have a dog at home here? | 1. Yes 2. No | /__/ |
| If so, is your dog vaccinated against rabies? | 1. Yes 2. No 3. Do not know | /__/ | |
| If the dog is vaccinated, what do you think about the cost of the vaccine given to the dog? | 1. Free 2. Cheaper 3. Acceptable, affordable cost 4. Dear 5. Very expensive | /__/ | |
| If Not Vaccinated, why haven’t you vaccinated your dog? | 1. High cost of vaccines 2. Vaccine not available in the locality 3. No veterinary practice in the area 4. Veterinary office very far from home 5. Absence/insufficiency of financialresources 6. Don't know where dog vaccinations are done 7. No need to vaccinate a dog 8. Vaccines killdogs 9. Vaccines cause rabies in dogs 10. Didn’t know you need to vaccinate a dog 11. Otherto specify | Check all true answers | |
| 29. | Does one of your neighbors have a dog? | 1. Yes 2. No 3. Do not know | /__/ |
| 30. | If yes, have the dog(s) been vaccinated against rabies? | 1. Yes 2. No 3. Do not know | /__/ |
| 31. | Have you ever been bitten by a dog? | 1. Yes 2. No | /__/ |
|
| If yes, after the bite, what was the action taken? | 1. Consultation in a health center 2. Identification of the dog’s vaccination status 3. Consultation of the dog with a veterinarian 4. Consultation with a traditionaltherapist 5. Consultation with a religious leader 6. Home care by family 7. Otherto specify | /__/ |
| Are you vaccinated against rabies? | 1. Yes 2. No | /__/ | |
| 32. | Do you have a loved one who has been bitten by a dog? | 1. Yes 2. No | /__/ |
| 33. | Has anyone close to you or a member of your family been diagnosed with rabies in the past? | 1. Yes 2. No | /__/ |
| What was the evolution of rabies? | 1. Deceased 2. Cured without after-effects 3. Cured with after-effects | /__/ | |
| 34. | If you or a loved one are bitten by a dog, in which case will you go to the hospital? | 1. Systematically 2. If there are worrying signs 3. If there is money 4. If there is injury 5. If the one who was bitten accepts 7. If the traditional practitioner does not succeed | /__/ |
| 35. | What will you do if in the near future you or a loved one is bitten by a dog? | 1. Consultation in a health center 2. Identification of the dog's vaccination status 3. Consultation of the dog with a veterinarian 4. Consultation with a traditionaltherapist 5. Consultation with a religious leader 6. Home care by family 7. Otherto specify | Check all true answers |
| 36. | Have you already participated in or benefited from awareness raising on rabies prevention in your locality? | 1. Yes 2. No | /__/ |
| If Yes, which structure organized this awareness? | 1. Ministry of Health 2. Local NGOs 3. Other 4. I do not remember | /__/ | |