Form 0920-18ANU KAP Adult

K AP: Adults and Adolescents

1. If you could change or improve three things in your community, what would they be?

Do not read the options; it is okay if they only provide 1-2 answers.  Standing water  Environmental/Pollution  Stray animals  Crime/Gangs/Safety  Potable water distribution  Drugs  Electricity  Teen pregnancy  Sexually transmitted diseases/HIV  Diseases transmitted by mosquitoes (dengue, Zika, chikungunya)  Debris  Lack of sewage system  Children’s health  Maintenance of green spaces  Flies, no-see-ums, other insects  Mosquitoes  Homelessness  Trash removal  Messy or dirty neighborhood  None  Other: _______________________

2. In the last 12 months, since this month of the past year, which of the following sources have you used to obtain health information?

Probe if necessary. Select all that apply.

 School  Brochures  Internet  Children  Newspapers/magazines  Official spokespeople  Health professionals  Radio

 Social networks (Facebook, Twitter, Instagram)  Community meetings  TV  Neighbors  WhatsApp

3. Do you think that mosquitoes transmit diseases?

 Yes |  No

4 . In the next 12 months, how much risk do you think there is in this house of becoming sick with:

a. Dengue	 High |  Low |  None  None because I have had it
b. Zika	 High |  Low |  None  None because I have had it
c. Chikungunya	 High |  Low |  None  None because I have had it

5. Would you go to the doctor if you thought you had chikungunya, dengue, o Zika?

 Yes |  No |  Only if the symptoms were severe

11. Do you think controlling mosquito-breeding sites is a good strategy to prevent mosquito-borne diseases?

 Yes |  No

12. In the last 12 months, have you spoken with any of the following people about how to control mosquitoes?

a. Your family  Yes |  No

b. Your neighbors  Yes |  No

c. Your community  Yes |  No

13. Do you think that your community should do more to control mosquitoes?

 Yes |  No

14. Who do you think is responsible for controlling mosquitoes?

a. The government and/or the Department of Health?	 Yes |  No
b. You?	 Yes |  No

15. Do you think it is worth it to invest time and money each month to control mosquitoes inside and outside the house?

 Yes |  No

KAP: Adults and Adolescents

6. Do you think that diseases transmitted by mosquitos such as dengue, Zika and chikungunya are a problem in your community?

 Yes |  No

7. Have you used mosquito repellent in the last 30 days?

 Yes |  No

7a. What type of repellant have you used to prevent mosquito bites?

 Citronella  Store-bought spray (Off)  Cream  Towelettes

 Natural/Artisanal/ Homemade repellants  Other: _____________

8. In the last 12 months, how often have you used a mosquito net?

 Daily

 One time per week

 One time per month

 Rarely

 Never

9. Where do mosquitoes bite you most frequently?

Read the options. Select all that apply.

 Around the house outside

 Inside the house

 Work

 School

 Community sports field

 Somewhere else in the community

 Somewhere else outside of the community

 Mosquitoes do not bite me

A mosquito-breeding site is anything that retains water that enables mosquitoes to reproduce. Mosquitoes can even reproduce in an area as small as a bottle cap.

10. Currently, what are the most common mosquito breeding sites in this community?

Select all that apply, do not read the options.

 Hollow trees

 Abandoned houses

 Neighbors’ houses

 Garbage containers

 Drains

 Debris from hurricane

 Tires

 Other containers

 Pools in abandoned houses

 Untreated pools

 Septic tanks

 Soil

 Rooves

 There are no breeding sites

 Other: _______________________

16. Did you know that we would be here in your community?

 Yes |  No

16a. How did you find out that we would be in your community?

 Through the community leader

 Informational flyer

 Through someone else

Who? _____________________________

 Facebook

 Which page? .

 Loud speaker

 Where? _ .

 Radio

 Which station? _ .

 Street banner

 Newspaper

 Which one? .

 Other: .

Participant Laboratory Data

**Project flag:** Fever in last 7 days

No: COPA

Yes: COPA_SYM