No

Question

Answer

A.DEMOGRAPHIC DATA

A1

Hospital

1= Kibirizi hospital

2 = CHUB

A2

Patient ID

…………………

A3

Gender

0=Male 1=Female

A4

Age (years)

A5

Occupation

1 = Farmer

2 = Student

3 = Office agent

4 = Other……………….

5=Unemployed

A6

Address of participant

1. Sector………………

2. District…

3. Province:…………

A7

Marital status

1 = Single

2 = Married

3 = Widower

4 = Divorced

A8

Ubudehe category (Rwandan financial status category)

1 = Category I (poorest)

2 =Category II

3 = Category III

4 = Category IV (Richest)

A9

Health insurance

1 = Community Based Health Insurance (CBHI)

2 = Rwanda Social Security Board (RSSB) insurance

3 = Others

4 = No insurance

B. CLINICAL DATA

B1

Episodes of malaria in the last 5 years

0 = never

1 = once

2 = two times

3 = three times

4 = four times

5 = five times

6 = above 5 times

When was the last episode of malaria

B2

Stage of splenomegaly (on physical exam)

1 = Stage II

2 = Stage III

3 = Stage IV

4=Stage V