Start time
End time
Data of interview
Province
District
Administrative Post
Locality
Community/village
Name of enumerator
Name of supervisor
Do you agree to be part of this study?
Respondent age in completed years
Respondent gender
What is your relationship with the head of household?
Age of household head
Gender of household head
What is the marital status of the household head/you?
What is the highest level of education achieved by the household head/you?
How many people live on your household?
Type of ownership of your housing
If Other type of housing ownership, please specify
Describe the characteristics of the roof of the HH main house
If Other type of roofing material, please specify
Describe the wall of your home, including the materials it is made of
If Other type of wall material, please specify
Describe the floor of your home, including the materials it is made of
If Other type of floor material, please specify
Do you have fruit trees or trees for different purposes in your backyard?
If yes, indicate the type of tree
Number of tree species in the yard?
Does your household have access to electricity?
What is the main occupation of the HH head
HH head occupation: Subsistence/commercial agriculture
HH head occupation: Employment in agriculture
HH head occupation: Employment outside agriculture
HH head occupation : Livestock rearing
HH head occupation: Public servant
HH head occupation: Works for private/NGOs
HH head occupation: Trade/run own business
HH head occupation: Small informal businesses
HH head occupation: Provision of informal services
HH head occupation: Government Transfer
HH head occupation: Formal/salaried employment
HH head occupation: Remittances
HH head occupation: Fishing
HH head occupation: Ganho-Ganho (informal/part time jobs)
HH head occupation: Pension
HH head occupation: Traditional healing practices
HH head occupation: Other
HH head occupation: Don't know
If Other type of household occupancy, please specify
Please could you tell me how much you earned (MZN) during the last 30 days
In recent times have you felt forced to abandon your house due to the frequent o
In recent times have you felt forced to abandon/reduce some livelihood activitie
What livelihood activities did you have to abandon due to extreme climatic event
Abandoned Livelihood due ECE: Subsistence/commercial agriculture
Abandoned Livelihood due ECE: Employment in agriculture
Abandoned Livelihood due ECE: Employment outside agriculture
Abandoned Livelihood due ECE: Livestock rearing
Abandoned Livelihood due ECE: Public servant
Abandoned Livelihood due ECE: Works for private/NGOs
Abandoned Livelihood due ECE: Trade/run own business
Abandoned Livelihood due ECE: Small informal businesses
Abandoned Livelihood due ECE: Provision of informal services
Abandoned Livelihood due ECE: Government Transfer
Abandoned Livelihood due ECE: Formal/salaried employment
Abandoned Livelihood due ECE: Remittances
Abandoned Livelihood due ECE: Fishing
Abandoned Livelihood due ECE: Ganho-Ganho (informal/part time jobs)
Abandoned Livelihood due ECE: Other
Abandoned Livelihood due ECE: Don't know
If Other type of livelihood/housing arrangement, please specify
What is the main and current source of water that the HH uses for consumption (d
If Other source of drinking water, please specify
Does your household usually treat the water it consumes?
What method do you use to treat water for consumption?
Water treatment method: Certainty/chlorine
Water treatment method: Pills
Water treatment method: Filter with cloth
Water treatment method: Let it settle
Water treatment method: Boil
Water treatment method: Moringa
Water treatment method: Solar disinfection
Water treatment method: Other
Water treatment method: Don't know
If Other type of drinking water treatment, please specify
Does your household have a latrine/flash toilet or access to it?
What type of latrine/toilet?
If Other type of latrine, please specify
Where do household members usually defecate?
Defecation place: Open field/forest
Defecation place: Nearby bush or river
Defecation place: Plastic bags/buckets (flying toilet\)
Defecation place: neighbour's latrine/house for defecation
Defecation place: Burial of faeces/digging holes for defecation
Defecation place: Use of communal/institutional latrine (e.g. church)
Defecation place: Other
Defecation place: Don't know
If Other practice related to open defecation, please specify
Is the latrine/toilet used by only your household or shared with others?
How far is the latrine/toilet from your house?
Does the latrine/toilet provide enough privacy and safety, especially for women
Is the latrine/toilet currently functional and usable?
What do household members usually use to wash their hands?
Handwashing material: Water only
Handwashing material: Water and soap
Handwashing material: Water and ash
Handwashing material: Water and detergent
Handwashing material: Other
Handwashing material: Don't know
If Other type of handwashing material, please specify
Is there a designated handwashing facility near the kitchen?
Is there a handwashing facility near your toilet/latrine?
What are the biggest challenges to regular handwashing in your household?
Handwashing challenge: Soap too expensive/unavailable
Handwashing challenge: Water is scarce
Handwashing challenge: Lack of awareness on importance
Handwashing challenge: Inconvenient location of station
Handwashing challenge: Children don't wash regularly
Handwashing challenge: No time / people forget
Handwashing challenge: Other
Handwashing challenge: Ther's no challenges
Handwashing challenge: Don't know
If Other handwashing challenge, please specify
How do you dispose of household waste?
HH waste disposal: Collected by municipality/waste service
HH waste disposal: Burnt in open areas
HH waste disposal: Buried in pits
HH waste disposal: Disposed in open fields/water bodies
HH waste disposal: Composted
HH waste disposal: In a corner or deposit locally
HH waste disposal: Rubbish pit/dustbin
HH waste disposal: Dumpsite/landfill
HH waste disposal: Household waste collected by neighbours/third parties
HH waste disposal: Other
HH waste disposal: Don't know
If Other type of household waste disposal, please specify
Have you ever heard of cholera?
What, in your opinion, causes cholera (i.e., how someone gets infected)?
Cholera Cause:  Contaminated/unsafe drinking water
Cholera Cause: Eating contaminated/uncovered food
Cholera Cause: Poor sanitation (lack of latrines/open defecation)
Cholera Cause: Poor hygiene practices (no hand washing after using latrines/toil
Cholera Cause: Poor hygiene practices (no hand washing before preparing food)
Using unclean utensils or food containers
Cholera Cause: Consuming food prepared in unclean conditions
Cholera Cause: Living in dirty surroundings
Cholera Cause: Poor sanitation or open defecation near the home
Cholera Cause: Being cursed or punished by spiritss
Cholera Cause: Bad air/bad smell (garbage/latrines)
Cholera Cause:  Environment/climate (rain, floods, wind)
Cholera Cause:  Vectors (flies, mosquitoes, contaminated water/fruit)
Cholera Cause:  Sociocultural beliefs (e.g. witchcraft)
Cholera Cause: Other
Cholera Cause: Don't know
If Other perceived cause of cholera, please specify
In your opinion, how do you think cholera is transmitted (i.e., how it spreads f
Transmission: Person-to-person contact
Transmission: Sharing contaminated food/drink
Transmission: Contaminated water sources
Transmission: Flies/insects on food or water
Transmission: Using same toilet as sick person
Transmission: Flooding/stagnant water carries germs
Transmission: Improper disposal of cholera waste
Transmission: Movement of infected people
Transmission: Touching objects handled by sick
Transmission:  Environment/nature (wind, location)
Transmission:  Poor sanitation (defecation, rubbish, smell)
Transmission:  Sociocultural beliefs
Transmission: Other
Transmission: Don't know
If Other perceived mode of cholera transmission, please specify
In your opinion, what are the common symptoms of cholera?
Cholera symptom: Diarrhea
Cholera symptom: Vomiting
Cholera symptom: Dehydration
Cholera symptom: Abdominal pain
Cholera symptom: Body weakness
Cholera symptom: Abdominal pain/stomach ache
Cholera symptom: Changes in the eyes
Cholera symptom: Other
Cholera symptom: Don't know
If Other cholera symptom, please specify
Do you know how cholera can be prevented?
In your opinion, what actions do you think can help protect yourself, your house
Preventive measures: Boil/treat drinking water
Preventive measures: Handwashing with soap/ash
Preventive measures: Proper food hygiene
Preventive measures: Avoid raw seafood
Prevention: Sanitation and waste management (cleaning, burying, covering)
Prevention: Construction/use of latrines
Prevention: Personal and collective hygiene
Prevention: Food and water safety practices
Prevention: Health care measures (hospital, pharmacy)
Prevention: Use of mosquito nets
Prevention: Traditional beliefs/other (rituals, nothing, forgotten)
Preventive measures: Other
Preventive Measures: Don't know
If Other prevention measure against cholera, please specify
How would you/your family treat cholera if someone in the household had it?
Treatment: Oral rehydration solution (ORS)
Treatment: Antibiotics
Treatment: Intravenous fluids
Treatment: Rest and hydration
Treatment: Hospital/health facility
Treatment: Home remedies (garlic, lemon, salt, ash, soap, coca cola, etc.)
Treatment: Traditional medicine or beliefs (healer, witchcraft)
Treatment: None/unspecified
Treatment: Other
Treatment: Don't know
If Other treatment of cholera, please specify
Source learned about cholera & prevention
Learned source: Mass Media & Technology
Learned source: Health System & Professionals
Learned source: Community & Social Networks
Learned source: Public Health Campaigns
Learned source: I don't remember
Learned source: School
Information source: Campaigns/activists (e.g. Red Cross, committees)
Information source: Personal experience or close contacts
Information source: Family/community
Information source: No knowledge
Learned source: Other
Learned source: Don't know
If Other source of cholera information, please specify
If learn about cholera and cholera prevention on Mass Media & Technology, please
MM&T type: Radio
MM&T type: Television
MM&T type: Social media (Facebook/WhatsApp/etc.)
MM&T type: Mobile text messages or apps
MM&T type: Newspapers or magazines
MM&T type: Internet websites/news platforms
MM&T type: Other
MM&T type: I don't remember
If Other mass media source of cholera information, please specify
If learn about cholera and cholera prevention from health authorities, please sp
Health auth.: Health worker at a clinic/hospital
Health auth.: Community health worker (APE)
Health auth.: Mobile health team/outreach campaign
Health auth.: During vaccination campaign/health screening
Health auth.: Other
Health auth.: I don't remember
If Other household source of cholera information, please specify
If learn about cholera and cholera prevention from Community & Social Networks,
Community & Social Networks source: Community leader (e.g., religious/chefe do b
Community & Social Networks source: Local/traditional healer
Community & Social Networks source: Neighbors or friends
Community & Social Networks source: Family members
Community & Social Networks source: School (teacher/clubs/materials)
Community & Social Networks source: Other
Community & Social Networks source: I don't remember
If Other community/social network source of cholera information, please specify
If learn about cholera and cholera prevention from Public Health Campaigns, plea
Public health campaign: Public announcements via megaphone
Public health campaign: Posters/leaflets in public places
Public health campaign: Community theaters/songs/dramas
Public healthcampaign: Village meetings/community dialogues
Public health campaign: NGO/humanitarian organization staff
Public health campaign: Other
Public health campaign: I don't remember
If Other health centre/professional source of cholera information, please specif
Which source do you trust the most for receiving information about cholera and c
Trusted source: Mass Media & Technology
Trusted source: Health System & Professionals
Trusted source: Community & Social Networks
Trusted source: Public Health Campaigns
Trusted source: I trust no source
Trusted source: Other
Trusted source: Don't know
If Other trusted information source, please specify
On your opinion, how serious do community members perceive cholera to be?
On your opinion, do community members believe they are at risk of contracting ch
On your opinion, how at risk are your community members?
Do you trust health authorities to manage cholera outbreaks?
How much trust do community members have in local health authorities ability to
Are there any stigmas related to cholera in the community?
What type of stigma do people with cholera suffer?
Stigma: No social contacts (people laugh/run away)
Stigma: No access to public services
Stigma: No access to jobs
Stigma: Don't know
How willing are community members to cooperate during cholera prevention efforts
How effective do community members believe handwashing is in preventing cholera
How effective do community members believe treating drinking water is in prevent
How effective do community members believe safe food handling (e.g., avoiding ra
How effective do community members believe using a latrine/toilet is in preventi
Why do community members believe some measures are less effective?
Overall, how confident are community members in the effectiveness of current cho
How do your family ensure they make water clean for consumption?
Water treatment: Boiling water
Water treatment: Using filters/purifiers (e.g., certeza)
Water treatment: Collecting & storing rainwater
Water treatment: No treatment
Water treatment: Appropriate storage/conservation
Water treatment: Other practices (wells, carrying, depth of well)
Water treatment: Don't know
If Other water and sanitation practice, please specify
When do household members usually wash their hands?
Handwashing moment: After using toilet/latrine
Handwashing moment: Before preparing food
Handwashing moment: Before eating
Handwashing moment: After handling children's feces
Handwashing moment: After cleaning the house
Handwashing moment: After returning from outside
Handwashing: Occasional or not frequent
Handwashing: As part of daily routine (e.g. in the morning)
Handwashing moment: Other
Handwashing moment: Don't know
If Other handwashing practice, please specify
How frequently do your members wash their hands especially before meals?
How frequently do your HH members wash their hands especially after using latrin
How frequently, do household members wash hands with soap after using the latrin
How often is your latrine/toilet cleaned?
How is waste from your latrine/toilet disposed of?
Latrine waste disposal: Septic tank
Latrine waste disposal: Open pit (not emptied)
Latrine waste disposal: Pit latrine with emptying service
Latrine waste disposal: Flushed to open area/surface water
Latrine waste: No latrine available
Latrine waste: Disposal in the bush/open spaces
Latrine waste: Burial
Latrine waste disposal: Other
Latrine waste disposal: Don't know
If Other latrine waste disposal practice, please specify
Where do community members seek medical help if they suspect cholera symptoms?
Seek care (suspected cholera): Local health center
Seek care (suspected cholera): Community Health Worker (CHW)
Seek care (suspected cholera): Traditional healer
Seek care (suspected cholera): Self-medication
Seek care (suspected cholera): Use of APES
Seek care (suspected cholera): Multiple sources
Seek care (suspected cholera): Other
Seek care (suspected cholera): Don't know
If Other health-seeking behaviour, please specify
Have you or any household members had diarrhea in the past 12 months?
Have you or any household members had cholera in the past 12 months?
If yes, did they seek medical care?
If yes, where did they seek care?
Sought care at: Health Center
Sought care at: Community Health Worker
Sought care at: Traditional Healer
Sought care at: Self-Medication
How do community members support each other during cholera outbreaks?
Preventive action: Sharing information
Preventive action: Assisting with hygiene promotion
Preventive action: Providing emotional support
Preventive action: Transporting the patient
Preventive action: Occasional assistance or contributions
Preventive action: There's no preventive measure
Preventive action: Other
Preventive action: Don't know
If Other type of community cooperation/outbound support, please specify
Do community members follow health guidelines during cholera outbreaks?
What preventive actions do you/households/affected communities take to reduce th
Community support: Boil or treat drinking water
Community support: Handwashing with soap/ash
Community support: Proper food hygiene
Community support: Avoid raw seafood
Previous measures: Infrastructure/sanitation (latrine, yard, water)
Previous measures:  Individual/collective hygiene
Previous measures: Medication/health care
Previous measures: Awareness/information sessions
Previous measures: None
Community support: Don't know
If Other previous measures taken, please specify
Has your household been affected by flooding or cyclones in the past year?
Have extreme weather events such as flooding, cyclone, windy, affected your acce
Has anyone from your Household been diagnosed with cholera or had diarrhea sympt
Was this the first time anyone in your household experienced cholera or diarrhea
How many people in this household were affected by cholera?
If you or someone from your HH has been diagnosed or had symptom of cholera, did
If yes, where did you seek care?
Are there early warning systems or alerts for cholera outbreaks in your communit
What community-led actions are taken to prepare for cholera outbreaks?
Community-led action: WASH activities
Community-led action: Awareness & Education
Community-led action: Planning & Coordination
Community-led action: None / No community-led actions observed
Community-led action: Other
Community-led action: Don't know
If Other early action taken, please specify
Water, Sanitation, and Hygiene (WASH) Activities
WASH: Clean/disinfect communal latrines & public spaces
WASH: Organize handwashing promotion campaigns
WASH: Community clean-up days (trash, stagnant water)
WASH: Distribute soap/chlorine/water purification tablets
WASH: Rehabilitate/protect water sources
WASH: Other
If Other WASH-related early action, please specify
Awareness & Education
Awareness/Education: Community talks or awareness sessions
Awareness/Education: Door-to-door sensitization
Awareness/Education: Megaphone/posters/community radios
Awareness/Education: School-based health education
Awareness/Education: Drama/music/theatre on prevention
Awareness/Education: infrastructure/sanitation (latrines, toilets)
Awareness/Education:  institutional assurances/guarantees
Awareness/Education: Other
If Other education/awareness early action, please specify
Planning & Coordination
Planning/Coord.: Form/activate community health committees
Planning/Coord.: Develop emergency preparedness plans
Planning/Coord.: Stockpile emergency supplies (ORS, etc.)
Planning/Coord.: Map vulnerable HHs/high-risk areas
Planning/Coord.: Other
If Other protection/coordination early action, please specify
What are the biggest obstacles to cholera preparedness in your household?
Obstacle: Lack of money (soap, purifiers, safe containers)
Obstacle: Lack of information/awareness about cholera
Obstacle: Lack of access to clean water
Obstacle: Lack of sanitation facilities (toilets/latrines)
Obstacle: Inadequate health services/support nearby
Obstacle: Long distance to health facilities/suppliers
Obstacle: Cultural beliefs/practices affect prevention
Obstacle: Poor infrastructure (drainage, waste disposal)
Obstacle: Lack of support from leaders/institutions
Obstacle: No early warning/alert systems
Obstacle: Low risk perception ('won't happen to us')
Obstacle: Household too busy with work/survival needs
Obstacle: Past outbreaks—no perceived benefit
Obstacle: No challenges
Obstacle:  Weak alternative practices (e.g. ash when soap is lacking)
Obstacle: Other
Obstacle: Don't know
If Other observed preparedness measure, please specify
How willing are community members to cooperate in cholera prevention efforts?
Do community members receive emergency health support during cholera outbreaks?
What role do local leaders play in cholera outbreak response?
Leader role: Mobilize for hygiene/sanitation campaigns
Leader role: Share health messages/outbreak updates
Leader role: Coordinate with health workers/authorities
Leader role: Distribute emergency supplies (soap, ORS)
Leader role: Support building/cleaning community latrines
Leader role: Organize public meetings/awareness sessions
Leader role: Guidance on cultural/traditional practices
Leader role: Encourage cooperation/compliance
Leader role: Mediate conflicts on health/sanitation access
Leader role: Take no role / Not involved
Leader role: Other
Leader role:  Don't know what role they play
If Other role of local leaders, please specify
What emergency response services are available during outbreaks or disaster?
Emergency service: Local health center/clinic support
Emergency service: District/provincial hospital
Emergency service: Mobile health clinics/outreach teams
Emergency service: Community health workers (APEs)
Emergency service: Red Cross/other humanitarian orgs
Emergency service: NGOs providing WASH/health services
Emergency service: ORS/chlorine/certeza/hygiene kits
Emergency service: Health education/info campaigns
Emergency service: Temporary cholera treatment units (CTUs)
Emergency service: Hotline/emergency contact for cases
Emergency service: Water tankers/emergency supply points
Emergency service: Emergency food/water rations
Emergency service: No services available
Emergency service: Support from INGD
Emergency service: Other
Emergency service: Don't know
If Other type of emergency experienced, please specify
What immediate actions does your household take when a cholera outbreak starts?
Immediate action: Seek medical care at a health facility
Immediate action: Contact a community health worker (APEs)
Immediate action: Isolate sick from household members
Immediate action: Increase handwashing frequency
Immediate action: Drink only safe/boiled water
Immediate action: Clean/disinfect latrines & surroundings
Immediate action: Avoid raw or uncovered foods
Immediate action: Prepare/use ORS at home
Immediate action: Reduce contact with neighbors/visitors
Immediate action: Listen to radio/community alerts
Immediate action: Use chlorine/certeza/other disinfectants
Immediate action: Avoid unsafe water sources
Immediate action: Avoid gatherings (funerals, markets, etc.)
Immediate action: Do nothing / No action taken
Immediate action: Traditional practices/remedies
Immediate action: Other
Immediate action: Don't know
If Other household action during emergency, please specify
What actions does your household take to ensure water hygiene practices are safe
Water action: Use purifiers/certeza/chlorine or cloth to strain water
Water action: Use bottled/mineral water for drinking
Water action: Use boiled/treated water for drinking
Water action: Avoid unsafe sources (rivers, open wells, etc.)
Water action: Wash fruits and vegetables more carefully
Water action: Store water in clean, covered containers
Water action: Collect and store rainwater safely
Water action: Do nothing / No change in water & hygiene practices
Water action: Personal hygiene
Water action: Domestic cleaning
Water action: Avoiding dirty places
Water action: Waste management (burying, rubbish)
Water action: Other
Water action: Don't know what to do
If Other household water-related action during emergency, please specify
What hygiene practices does your household follow during cholera outbreak or a d
Hygiene practice: Wash hands more frequently with soap and water/ash
Hygiene practice: Use hand sanitizer when soap/water unavailable
Hygiene practice: Wash food and cooking utensils thoroughly
Hygiene practice: Cover food to avoid flies/contamination
Hygiene practice: Avoid eating food prepared outside the home
Hygiene practice: Children wash hands before meals/after toilet use
Hygiene practice: Do nothing / No specific hygiene changes
Hygiene practice: Reinforced hygiene
Hygiene practice: Avoid open defecation
Hygiene practice: Other
Hygiene practice: Don't know what to do
If Other household hygiene action during emergency, please specify
What sanitation-related measures does your household take during a cholera outbr
Sanitation action: Use more toilets/latrines than before
Sanitation action: Clean/disinfect toilets/latrines more frequently
Sanitation action: Ensure children use toilets properly and clean afterward
Sanitation action: Proper disposal of feces (esp. children, e.g., in latrines)
Sanitation action: Avoid sharing latrines with multiple families
Sanitation action: Construct temporary latrines if existing ones are damaged
Sanitation action: Do nothing/No sanitation changes
Sanitation action: Personal hygiene (handwashing, soap use)
Sanitation action: Environmental measures (e.g. staying in dry place)
Sanitation action: Other
Sanitation action: Don't know what to do
If Other household sanitation action during emergency, please specify
What health seeking actions do you take during a cholera outbreak or a disaster
Health-seeking: Monitor HH for symptoms (diarrhea/vomiting/dehydration)
Health-seeking: Isolate anyone with signs (vomiting/diarrhea)
Health-seeking: Use ORS if someone shows symptoms
Health-seeking: Go to health center/hospital if symptoms appear
Health-seeking: Contact community health worker (APE)
Health-seeking: Follow radio/health authority updates
Health-seeking: Do nothing / No response actions
Health-seeking: Avoiding risk zones
Health-seeking: Personal hygiene (handwashing)
Health-seeking: Household hygiene (keeping house clean/ventilated)
Health-seeking: Other
Health-seeking: Don't know what to do
What protective actions do you take during a cholera outbreak or a disaster (e.g
Protective action: Limit contacts with outsiders/affected areas
Protective action: Limit visitors at home
Protective action: Avoid gatherings/crowded places
Protective action: Avoid contact with neighbors/large groups
Protective action: Follow advice from authorities/health workers
Protective action: Listen to radio/attend community updates
Protective action: Rely on traditional beliefs/remedies
Protective action: Do nothing / No response actions
Protective action: Water treatment (chlorine, boiling, etc.)
Protective action: Safe water consumption (drinking a lot, avoiding rivers)
Protective action: Personal hygiene (handwashing)
Protective action: Mobility restriction (avoid walking a lot)
Protective action: Other
Protective action: Don't know what to do
If Other protective behaviour, please specify
What actions do you or your HH take after a cholera outbreak or disaster to prev
Main reason for ceasing practices (select from list)
Reason cesead:  Costs (money)
Reason ceased: Costs (time)
Reason ceased: Costs (labour)
Reason ceased: No pressure from government/NGOs
Reason ceased: No pressure within the community
Reason ceased: Other
If Other reason for ceasing practices, please specify
What long-term solutions do you think are necessary to prevent future cholera ou
Are local government and NGOs working together effectively in your community to
If you could suggest one policy change to improve cholera prevention in your are
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