Suggest a research idea, title, etc. I'll give you the points. Anti-Malarial Month, Kamothe area and other generalized part too, awareness regarding safety measures, mosquito breeding practices, impact of chemicals in mosquito repellents on health, community gaps.

Here's a well-structured research idea based on your points:

Research Proposal

Title

"Anti-Malarial Awareness, Community Practices, and Chemical Safety: A Cross-Sectional Study in Kamothe and Surrounding Suburban Areas of Navi Mumbai"

Alternative Titles

"Bridging the Gap: Malaria Prevention Knowledge, Mosquito Breeding Control, and Repellent Safety Awareness in Kamothe, Raigad District"
"From Breeding Grounds to Chemical Burdens: A Community-Based Assessment of Malaria Prevention Practices in Periurban Navi Mumbai"

Background / Rationale

Malaria remains a significant public health challenge in Maharashtra, particularly in rapidly urbanizing periurban zones like Kamothe (Panvel taluka, Raigad district). Dense housing, construction activity, stagnant water bodies, and inconsistent waste management create ideal breeding conditions for Anopheles mosquitoes. Despite the National Vector Borne Disease Control Programme (NVBDCP) and annual Anti-Malarial Month (AMM) campaigns conducted every June, community uptake of preventive practices remains uneven.

Simultaneously, widespread household use of chemical mosquito repellents (coils, mats, sprays, vaporizers) raises underappreciated concerns about chronic inhalation exposure, skin sensitization, and indoor air pollution - particularly for children, elderly, and people with respiratory conditions.

There is a notable gap in localized, community-level data that links awareness, practice, and chemical safety perceptions in areas like Kamothe.

Objectives

To assess the level of awareness regarding Anti-Malarial Month and malaria prevention among residents of Kamothe and adjoining areas.
To identify common mosquito breeding practices and environmental risk factors in the study area.
To evaluate community knowledge of the health impacts of chemical mosquito repellents (DEET, pyrethroids, organophosphates).
To identify gaps in community participation and health-seeking behavior related to malaria prevention.
To suggest targeted, community-specific interventions to strengthen AMM campaign effectiveness.

Study Design

Parameter	Detail
Type	Cross-sectional, descriptive study
Setting	Kamothe sectors + neighboring areas (Kharghar, Kalamboli, New Panvel)
Population	Household heads / adult residents aged 18+
Sample Size	300-400 participants (calculated at 95% CI, 5% margin of error)
Sampling	Stratified random sampling (urban sectors vs. semi-urban fringes)
Duration	June (Anti-Malarial Month) - aligned for real-time campaign assessment
Tool	Pre-tested structured questionnaire (KAP format - Knowledge, Attitude, Practice)

Key Variables / Domains

1. Awareness of Anti-Malarial Month

Knowledge of AMM (June) and its objectives
Exposure to government campaigns, ASHAs, ANMs, local health workers
Sources of health information (TV, social media, pamphlets, community workers)

2. Mosquito Breeding Practices

Water storage habits (open containers, overhead tanks, flowerpots)
Disposal of solid waste, tyres, coconut shells
Knowledge of Anopheles vs. Aedes breeding sites
Use of larvicides, Gambusia fish, biological control awareness

3. Chemical Repellent Use and Health Impact Awareness

Types of repellents used (coil, mat, spray, vaporizer, cream)
Frequency and duration of use
Awareness of active chemicals: DEET, transfluthrin, allethrin, metofluthrin
Reported symptoms: headache, eye irritation, respiratory symptoms, skin rash
Protective behaviors while using repellents (ventilation, keeping children away)

4. Community Gaps

Participation in government malaria surveys / blood smear camps
Acceptance of indoor residual spraying (IRS)
Barriers to prevention (cost, lack of awareness, cultural beliefs, distrust)
Suggestions from community members themselves

Hypothesis

Residents of Kamothe and surrounding periurban areas have moderate malaria awareness but demonstrate suboptimal mosquito breeding control practices, limited understanding of chemical repellent health risks, and significant gaps in community engagement with Anti-Malarial Month initiatives.

Expected Outcomes

A community-specific KAP profile for malaria prevention
Identification of high-risk microenvironments within Kamothe sectors
Data on repellent chemical awareness gaps - potentially the first localized study on this in periurban Navi Mumbai
Actionable recommendations for municipal health departments, ASHA workers, and NGOs operating in Raigad/Panvel region

Significance

This study would provide ground-level evidence during an actual AMM cycle (June 2026), making findings immediately relevant to the Panvel Municipal Corporation and district health authorities. The chemical safety angle is underexplored in Indian community studies and adds originality to the proposal.

Suggested Keywords

Malaria prevention · Anti-Malarial Month · Kamothe · Navi Mumbai · KAP study · mosquito breeding · mosquito repellent toxicity · community health gaps · NVBDCP · periurban malaria India

Let me know which section you'd like to expand - methodology, literature review references, statistical analysis plan, or a full questionnaire draft.

Wait for the protocol, I'll let you know. Generate a section wise questionnaire. Not just Kamothe, but in general too.

Here is a complete, section-wise KAP questionnaire - general enough for any community, but contextually relevant to periurban/urban India.

QUESTIONNAIRE

"Anti-Malarial Awareness, Mosquito Breeding Practices, Repellent Safety, and Community Gaps"

A Community-Based KAP Study

Instructions to Interviewer: Read each question clearly. Circle or tick the appropriate response. This is voluntary and confidential. Estimated time: 15-20 minutes.

SECTION A: SOCIODEMOGRAPHIC PROFILE

A1. Age: _______ years

A2. Gender:

( ) Male
( ) Female
( ) Prefer not to say

A3. Educational Qualification:

( ) Illiterate
( ) Primary (up to 5th std)
( ) Secondary (6th - 10th std)
( ) Higher Secondary (11th - 12th std)
( ) Graduate and above

A4. Occupation:

( ) Homemaker
( ) Daily wage / Labour
( ) Government/Private service
( ) Self-employed / Business
( ) Student
( ) Unemployed
( ) Other: ___________

A5. Monthly household income (approx.):

( ) Below ₹5,000
( ) ₹5,000 - ₹15,000
( ) ₹15,001 - ₹30,000
( ) Above ₹30,000
( ) Prefer not to say

A6. Type of residence:

( ) Pucca (permanent structure)
( ) Semi-pucca
( ) Kutcha / temporary / slum

A7. Area of residence:

( ) Urban (city / metro)
( ) Periurban (town / suburb)
( ) Rural (village)

A8. Number of people living in the household: _______

A9. Are there children below 5 years in your household?

( ) Yes
( ) No

A10. Are there elderly (60+) or pregnant women in your household?

( ) Yes
( ) No

SECTION B: KNOWLEDGE ABOUT MALARIA

(Circle the correct answer / tick applicable options)

B1. Have you heard of malaria?

( ) Yes
( ) No (If No, skip to Section D)

B2. What causes malaria? (Single best answer)

( ) Virus
( ) Bacteria
( ) Parasite (Plasmodium)
( ) Fungus
( ) Don't know

B3. How is malaria transmitted to humans?

( ) Through contaminated food or water
( ) By bite of infected female Anopheles mosquito
( ) By touching an infected person
( ) Through the air
( ) Don't know

B4. Which type of mosquito spreads malaria?

( ) Aedes aegypti
( ) Culex mosquito
( ) Female Anopheles mosquito
( ) All mosquitoes
( ) Don't know

B5. At what time of day is the malaria mosquito most active?

( ) Morning
( ) Afternoon
( ) Evening / Night
( ) All the time
( ) Don't know

B6. What are the common symptoms of malaria? (Tick all that apply)

( ) Fever with chills and sweating
( ) Headache and body ache
( ) Nausea/vomiting
( ) Jaundice
( ) Diarrhea
( ) Don't know

B7. Where does the malaria-causing mosquito breed?

( ) Clear stagnant water
( ) Dirty/sewage water
( ) Salt water
( ) Flowing rivers
( ) Don't know

B8. Can malaria be fatal if untreated?

( ) Yes
( ) No
( ) Don't know

B9. Is malaria curable?

( ) Yes, with proper treatment
( ) No, there is no cure
( ) Don't know

B10. Which of the following groups is at highest risk for severe malaria? (Tick all that apply)

( ) Pregnant women
( ) Children under 5
( ) Elderly
( ) Healthy young adults
( ) Don't know

SECTION C: AWARENESS OF ANTI-MALARIAL MONTH (AMM)

C1. Have you heard of "Anti-Malarial Month"?

( ) Yes
( ) No

C2. Which month is observed as Anti-Malarial Month in India?

( ) April
( ) May
( ) June
( ) July
( ) Don't know

C3. What is the main purpose of Anti-Malarial Month? (Tick all that apply)

( ) To distribute medicines
( ) To spread awareness about malaria prevention
( ) To conduct blood smear/RDT camps
( ) To spray anti-larval chemicals
( ) Don't know

C4. From where did you first hear about Anti-Malarial Month? (Tick main source)

( ) ASHA / ANM / health worker
( ) Government hospital / clinic
( ) Television / radio
( ) Social media (WhatsApp, Facebook, etc.)
( ) Newspaper / pamphlet
( ) Neighbour / family
( ) Never heard of it

C5. Did any government health worker visit your home for malaria-related activities in the last 12 months?

( ) Yes
( ) No
( ) Don't remember

C6. Were you asked to provide a blood sample for malaria testing in the last 12 months?

( ) Yes, and I gave the sample
( ) Yes, but I refused
( ) No, nobody asked
( ) Don't remember

C7. Did your area have indoor residual spraying (IRS) in the last 12 months?

( ) Yes
( ) No
( ) Don't know

C8. If IRS was done, did you allow it inside your home?

( ) Yes, allowed fully
( ) Partially allowed
( ) Refused / not comfortable
( ) IRS was not done in my area

SECTION D: MOSQUITO BREEDING PRACTICES AT HOME

D1. Do you store water at home (in drums, buckets, tanks, pots)?

( ) Yes
( ) No

D2. If yes, how often do you clean/change stored water?

( ) Daily
( ) Every 2-3 days
( ) Once a week
( ) Rarely / never
( ) N/A

D3. Do you cover water storage containers?

( ) Always
( ) Sometimes
( ) Never

D4. Which of the following are present in or around your house? (Tick all that apply)

( ) Overhead/underground water tank
( ) Flowerpots / trays with standing water
( ) Old tyres / buckets / cans lying outside
( ) Drainage / nala nearby
( ) Construction work in vicinity
( ) Cooler with stagnant water
( ) None of the above

D5. Do you empty or clean the cooler tray regularly during monsoon?

( ) Yes, regularly
( ) Sometimes
( ) No
( ) Do not use cooler

D6. Is there open garbage dumping near your residence?

( ) Yes, regularly
( ) Occasionally
( ) No

D7. Do you use any biological or natural methods to prevent mosquito breeding? (Tick all that apply)

( ) Gambusia / larvivorous fish in tanks
( ) Neem oil in water storage
( ) Covering all water containers
( ) None
( ) Don't know about such methods

D8. Have you ever used temephos (abate) / larvicide powder in water tanks?

( ) Yes
( ) No
( ) Don't know what it is

D9. Have you ever reported stagnant water / mosquito breeding sites to local authorities?

( ) Yes
( ) No
( ) Did not know this was possible

SECTION E: USE OF MOSQUITO REPELLENTS

E1. Do you use any mosquito repellent at home?

( ) Yes
( ) No (If No, skip to E10)

E2. Which type(s) of repellent do you use? (Tick all that apply)

( ) Mosquito coil
( ) Electric mat/vaporizer (liquid or mat)
( ) Aerosol/spray (e.g., HIT, Baygon)
( ) Skin-applied cream/lotion (e.g., Odomos)
( ) Mosquito net (untreated)
( ) Insecticide-treated net (ITN)
( ) Natural/herbal (neem, camphor, citronella)
( ) Other: ___________

E3. How often do you use repellents?

( ) Every night
( ) Only in monsoon/summer
( ) Only when mosquitoes are visible
( ) Rarely

E4. Where do you use them? (Tick all that apply)

( ) Bedroom while sleeping
( ) Living room
( ) Kitchen
( ) Entire house

E5. Do you keep windows/doors open when using coils or vaporizers?

( ) Always
( ) Sometimes
( ) Never (room is closed)

E6. Do you use repellents near children or infants?

( ) Yes, without any precaution
( ) Yes, but with precautions (e.g., keeping distance, ventilating)
( ) No, avoid using near children
( ) No children in household

E7. Have you or anyone in your family experienced any of the following after using repellents? (Tick all that apply)

( ) Headache
( ) Eye irritation or watering
( ) Cough or breathing difficulty
( ) Skin rash or itching
( ) Nausea or dizziness
( ) No symptoms noticed
( ) Don't know / never observed

E8. Did you consult a doctor for any of the above symptoms?

( ) Yes
( ) No, managed at home
( ) No, ignored it
( ) Did not experience any symptoms

E9. How do you decide which repellent to buy?

( ) Doctor/health worker recommendation
( ) Advertisement (TV/social media)
( ) Brand familiarity / habit
( ) Price / availability
( ) Neighbour/family suggestion

E10. Have you ever read the label/instructions on a mosquito repellent product?

( ) Yes, always
( ) Sometimes
( ) Never

SECTION F: KNOWLEDGE OF CHEMICAL SAFETY IN REPELLENTS

F1. Do you know that mosquito coils/vaporizers contain chemicals that may be harmful?

( ) Yes, I am aware
( ) Heard about it but not sure
( ) No, I thought they were safe
( ) Don't know

F2. Have you heard of any of the following chemicals used in repellents? (Tick all that apply)

( ) DEET
( ) Allethrin
( ) Transfluthrin
( ) Permethrin
( ) None of the above
( ) Don't know

F3. Do you think prolonged/daily use of chemical repellents can harm health?

( ) Yes, definitely
( ) Possibly
( ) No, they are safe
( ) Don't know

F4. Are you aware that burning mosquito coils in a closed room is equivalent to smoking several cigarettes (in terms of particulate matter)?

( ) Yes
( ) No
( ) Surprising / didn't know

F5. Do you think children and pregnant women are more vulnerable to repellent chemicals?

( ) Yes
( ) No
( ) Don't know

F6. Would you switch to safer alternatives if you knew your current repellent was harmful?

( ) Yes, definitely
( ) Maybe, if affordable
( ) No, I trust my current product
( ) Don't know

F7. Have you ever received any information or counselling about safe use of mosquito repellents from a health worker, doctor, or government program?

( ) Yes
( ) No

SECTION G: ATTITUDE TOWARDS MALARIA PREVENTION

G1. Do you think malaria is a serious disease that needs active prevention?

( ) Yes, very serious
( ) Somewhat serious
( ) Not that serious
( ) It doesn't affect me

G2. Do you think individual/household actions can prevent malaria?

( ) Yes, significantly
( ) Partially - government must also act
( ) No, it's entirely the government's responsibility
( ) Don't know

G3. Would you participate in community malaria drives (cleaning drives, awareness camps, blood testing camps) if organized in your area?

( ) Yes, willingly
( ) Maybe
( ) No, too busy
( ) No, not interested

G4. Do you feel the government does enough for malaria prevention in your area?

( ) Yes, satisfactory
( ) Somewhat - can do better
( ) No, very inadequate
( ) Not aware of any government effort

G5. Would you share malaria prevention information with your neighbors?

( ) Yes
( ) Maybe
( ) No

SECTION H: COMMUNITY GAPS AND BARRIERS

H1. What are the biggest challenges in preventing malaria in your area? (Tick top 2)

( ) Lack of awareness
( ) Poor drainage / sanitation infrastructure
( ) Unaffordable preventive measures
( ) Lack of government action
( ) Language barrier in health messages
( ) Distrust of health workers or government schemes
( ) Busy lifestyle / no time
( ) Other: ___________

H2. Have you ever faced difficulty accessing malaria treatment or testing in your area?

( ) Yes
( ) No
( ) Never needed to

H3. In your opinion, which group in your community is most neglected in malaria awareness programs? (Single answer)

( ) Daily wage labourers / migrants
( ) Women (especially homemakers)
( ) Children
( ) Elderly
( ) Slum / informal settlement residents
( ) No group is neglected

H4. How would you prefer to receive health information about malaria? (Tick top 2)

( ) Door-to-door visits by ASHA/health worker
( ) WhatsApp / social media messages
( ) Television / radio
( ) Community meetings / village sabha
( ) Posters / pamphlets
( ) School or college programs

H5. In your opinion, what ONE change would most improve malaria prevention in your area? (Open-ended - write response)

SECTION I: PERSONAL MALARIA HISTORY

I1. Have you or anyone in your household ever been diagnosed with malaria?

( ) Yes
( ) No
( ) Suspected but not confirmed

I2. If yes, how many times in the last 3 years? _______

I3. Where was treatment taken?

( ) Government hospital / PHC / health post
( ) Private doctor / clinic
( ) Pharmacy (self-medication)
( ) Home remedies
( ) N/A

I4. Were you satisfied with the treatment received?

( ) Yes
( ) Partially
( ) No
( ) N/A

I5. Did you complete the full course of anti-malarial medication?

( ) Yes, full course
( ) Partial course
( ) No / stopped after feeling better
( ) N/A

SCORING GUIDE (for researcher use)

Section	Max Score	Scoring Method
B (Knowledge)	10	1 mark per correct answer
C (AMM Awareness)	8	1 mark per correct/positive response
D (Breeding Practices)	8	1 mark per safe practice
E (Repellent Use)	6	1 mark per safe behavior
F (Chemical Knowledge)	7	1 mark per correct/aware response
G (Attitude)	5	Likert-type, scored 1-3 per item

Interpretation:

>75% score = Good KAP
50-75% = Moderate KAP
<50% = Poor KAP - priority target group

"Thank you for your time. Your responses will contribute to improving malaria prevention in your community."

Let me know when the protocol is ready, or if you want this formatted as a Word/PDF document, or if any section needs to be added, modified, or reordered.

Create a Word document version of this questionnaire ready for printing

Reading File

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Writing File

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The document is ready. Here's your download link:

Malaria KAP Questionnaire

Word Document · DOCX

What's included in the document:

A4 format, print-ready with 1-inch margins
Running header on every page (study name + "Confidential")
Page X of Y footer with a Respondent ID field
9 sections (A through I) with clear section-heading banners in navy blue
Checkbox squares (hollow boxes) before every option - ready to tick on paper
Skip instruction callouts in red italic (e.g., "If No, skip to Section D")
Open-ended response lines for H5
Colour-coded scoring table at the end (green/yellow/red for Good/Moderate/Poor KAP)
Study metadata block on the first page (Date, Site, Interviewer, Respondent ID, time slots)

Let me know when the protocol is ready and I can add your institution name, logo, ethics clearance number, or any other header details before printing.

I want to make a Google Form to reach max. people.

Asking for Preferences

Got it - here's the complete Google Form layout, section by section, ready for you to copy-paste directly. Every question includes the type to select, options, and any skip logic notes.

GOOGLE FORM - READY FORMAT

Form Title

Anti-Malarial Awareness, Mosquito Breeding Practices & Repellent Safety: A Community KAP Survey

Form Description

This survey is part of a community health study on malaria prevention awareness, mosquito breeding practices, and safe use of mosquito repellents. It takes approximately 10-15 minutes. All responses are anonymous and confidential. Participation is completely voluntary.

HOW TO SET UP SECTIONS IN GOOGLE FORMS

Click Add Section (the = icon in the right sidebar) before each section below. Name each section as shown.

SECTION 1: Sociodemographic Profile

Section description:

Please fill in your basic details. This helps us understand the community better.

Q1 | Type: Short answer

What is your age? (in years)

(Mark as Required)

Q2 | Type: Multiple choice

Gender

Options:

Male
Female
Prefer not to say

(Required)

Q3 | Type: Multiple choice

What is your highest educational qualification?

Options:

Illiterate / No formal education
Primary (up to 5th standard)
Secondary (6th - 10th standard)
Higher Secondary (11th - 12th standard)
Graduate and above

(Required)

Q4 | Type: Multiple choice

What is your occupation?

Options:

Homemaker
Daily wage worker / Labour
Government / Private service
Self-employed / Business
Student
Unemployed
Other

Q5 | Type: Multiple choice

What is your approximate monthly household income?

Options:

Below Rs. 5,000
Rs. 5,000 - Rs. 15,000
Rs. 15,001 - Rs. 30,000
Above Rs. 30,000
Prefer not to say

Q6 | Type: Multiple choice

What type of house do you live in?

Options:

Pucca (permanent brick / concrete structure)
Semi-pucca
Kutcha / Temporary / Slum

(Required)

Q7 | Type: Multiple choice

What type of area do you live in?

Options:

Urban (city / metro)
Periurban (town / suburb / nagar)
Rural (village)

(Required)

Q8 | Type: Short answer

How many people live in your household? (total count)

Q9 | Type: Multiple choice

Are there children below 5 years of age in your household?

Options:

Yes
No

Q10 | Type: Multiple choice

Are there elderly persons (60+) or pregnant women in your household?

Options:

Yes
No

SECTION 2: Knowledge About Malaria

Section description:

The following questions test your knowledge about malaria. Please answer to the best of your understanding. There are no wrong answers.

Q11 | Type: Multiple choice

Have you heard of malaria?

Options:

Yes
No

Skip logic: If "No" → go to Section 4 (Mosquito Breeding Practices) (Required)

Q12 | Type: Multiple choice

What causes malaria?

Options:

Virus
Bacteria
Parasite (Plasmodium)
Fungus
I don't know

Q13 | Type: Multiple choice

How is malaria transmitted to humans?

Options:

Through contaminated food or water
By the bite of an infected female Anopheles mosquito
By touching an infected person
Through the air / breathing
I don't know

Q14 | Type: Multiple choice

Which type of mosquito spreads malaria?

Options:

Aedes aegypti (dengue mosquito)
Culex mosquito
Female Anopheles mosquito
All types of mosquitoes
I don't know

Q15 | Type: Multiple choice

At what time of day is the malaria mosquito most active?

Options:

Morning
Afternoon
Evening / Night
All the time
I don't know

Q16 | Type: Checkboxes (Tick all that apply)

What are the common symptoms of malaria? (Select all that apply)

Options:

Fever with chills and sweating
Headache and body ache
Nausea / Vomiting
Jaundice (yellow eyes/skin)
Diarrhea
I don't know

Q17 | Type: Multiple choice

Where does the malaria-causing mosquito breed?

Options:

Clean stagnant water
Dirty / sewage water
Salt water
Flowing rivers / streams
I don't know

Q18 | Type: Multiple choice

Can malaria be fatal (cause death) if left untreated?

Options:

Yes
No
I don't know

Q19 | Type: Multiple choice

Is malaria curable?

Options:

Yes, with proper treatment
No, there is no cure
I don't know

Q20 | Type: Checkboxes (Tick all that apply)

Who is at highest risk for severe malaria? (Select all that apply)

Options:

Pregnant women
Children under 5 years
Elderly persons
Healthy young adults
I don't know

SECTION 3: Awareness of Anti-Malarial Month

Section description:

These questions relate to the government's Anti-Malarial Month campaign and local health activities.

Q21 | Type: Multiple choice

Have you heard of "Anti-Malarial Month"?

Options:

Yes
No

Q22 | Type: Multiple choice

Which month is observed as Anti-Malarial Month in India?

Options:

April
May
June
July
I don't know

Q23 | Type: Checkboxes

What do you think is the purpose of Anti-Malarial Month? (Select all that apply)

Options:

To distribute medicines
To spread awareness about malaria prevention
To conduct blood smear / rapid diagnostic test (RDT) camps
To spray anti-larval chemicals in breeding sites
I don't know

Q24 | Type: Multiple choice

How did you first hear about Anti-Malarial Month?

Options:

ASHA / ANM / health worker visit
Government hospital or clinic
Television / Radio
Social media (WhatsApp, Facebook, YouTube, etc.)
Newspaper / pamphlet / poster
Neighbour or family member
I have never heard of it

Q25 | Type: Multiple choice

Did any government health worker visit your home for malaria-related activities in the last 12 months?

Options:

Yes
No
I don't remember

Q26 | Type: Multiple choice

Were you asked to provide a blood sample for malaria testing in the last 12 months?

Options:

Yes, and I gave the sample
Yes, but I refused
No, nobody asked me
I don't remember

Q27 | Type: Multiple choice

Was indoor residual spraying (IRS - chemical spraying inside homes) done in your area in the last 12 months?

Options:

Yes
No
I don't know

Q28 | Type: Multiple choice

If indoor spraying (IRS) was done, did you allow it in your home?

Options:

Yes, I allowed it fully
I allowed it partially
I refused / was not comfortable
IRS was not done in my area

SECTION 4: Mosquito Breeding Practices at Home

Section description:

The following questions are about water storage habits and mosquito breeding conditions around your home.

Q29 | Type: Multiple choice

Do you store water at home (in drums, buckets, overhead tanks, earthen pots, etc.)?

Options:

Yes
No

Q30 | Type: Multiple choice

If yes, how often do you clean or change the stored water?

Options:

Daily
Every 2-3 days
Once a week
Rarely or never
Not applicable

Q31 | Type: Multiple choice

Do you cover your water storage containers with a lid?

Options:

Always
Sometimes
Never

Q32 | Type: Checkboxes

Which of the following exist in or around your home? (Select all that apply)

Options:

Overhead or underground water tank
Flowerpots or saucers with standing water
Old tyres, buckets, or cans lying outside
Open drainage / nala nearby
Construction work nearby
Desert cooler with stagnant water
None of the above

Q33 | Type: Multiple choice

Do you clean or empty the cooler tray regularly during summer and monsoon season?

Options:

Yes, regularly
Sometimes
No
I don't use a cooler

Q34 | Type: Multiple choice

Is there open garbage dumping near your home?

Options:

Yes, regularly
Occasionally
No

Q35 | Type: Checkboxes

Do you use any natural or biological methods to prevent mosquito breeding? (Select all that apply)

Options:

Larvivorous fish (like Gambusia) in water tanks
Neem oil in stored water
Covering all water containers with tight lids
None
I don't know about such methods

Q36 | Type: Multiple choice

Have you ever used larvicide powder (like Temephos / Abate) in water storage containers?

Options:

Yes
No
I don't know what it is

Q37 | Type: Multiple choice

Have you ever reported stagnant water or mosquito breeding sites to local municipal authorities or health workers?

Options:

Yes
No
I did not know this was possible

SECTION 5: Use of Mosquito Repellents

Section description:

The following questions are about how you protect yourself from mosquitoes at home.

Q38 | Type: Multiple choice

Do you use any form of mosquito repellent at home?

Options:

Yes
No

Skip logic: If "No" → go to Section 6

Q39 | Type: Checkboxes

Which type(s) of mosquito repellent do you use? (Select all that apply)

Options:

Mosquito coil
Electric mat or vaporizer (liquid or pad type)
Aerosol spray (e.g., HIT, Baygon)
Skin-applied cream or lotion (e.g., Odomos)
Untreated mosquito net
Insecticide-treated mosquito net (ITN)
Natural / herbal repellent (neem, camphor, citronella)
Other

Q40 | Type: Multiple choice

How often do you use mosquito repellents?

Options:

Every night
Only during monsoon or summer
Only when mosquitoes are visibly present
Rarely

Q41 | Type: Checkboxes

In which rooms do you use repellents? (Select all that apply)

Options:

Bedroom while sleeping
Living room
Kitchen
All rooms

Q42 | Type: Multiple choice

Do you keep windows or doors open when using mosquito coils or vaporizers?

Options:

Always (room is well ventilated)
Sometimes
Never (I use them in a closed room)

Q43 | Type: Multiple choice

Do you use repellents (coils/sprays/vaporizers) near children or infants?

Options:

Yes, without any special precaution
Yes, but I take precautions (ventilate, keep distance, etc.)
No, I avoid using them near children
No children in my household

Q44 | Type: Checkboxes

Have you or anyone in your family experienced any of the following AFTER using mosquito repellents? (Select all that apply)

Options:

Headache
Eye irritation or watering
Cough or breathing difficulty
Skin rash or itching
Nausea or dizziness
No symptoms noticed
Never observed / not sure

Q45 | Type: Multiple choice

Did you consult a doctor for any of these symptoms?

Options:

Yes
No, I managed at home
No, I ignored the symptoms
I did not experience any symptoms

Q46 | Type: Multiple choice

How do you usually decide which mosquito repellent to buy?

Options:

Doctor or health worker recommendation
TV or social media advertisement
Brand familiarity / habit
Price or availability
Neighbour or family suggestion

Q47 | Type: Multiple choice

Have you ever read the label or instructions printed on a mosquito repellent product?

Options:

Yes, always
Sometimes
Never

SECTION 6: Knowledge of Chemical Safety in Repellents

Section description:

This section explores your awareness about the chemicals present in mosquito repellents and their potential health effects.

Q48 | Type: Multiple choice

Do you know that mosquito coils and vaporizers contain synthetic chemicals that may be harmful with long-term use?

Options:

Yes, I am aware
I have heard about it but I am not sure
No, I thought all repellents are completely safe
I don't know

Q49 | Type: Checkboxes

Have you heard of any of the following chemicals found in mosquito repellents? (Select all that apply)

Options:

DEET
Allethrin
Transfluthrin
Permethrin
None of the above
I don't know

Q50 | Type: Multiple choice

Do you think prolonged or daily use of chemical mosquito repellents can harm health?

Options:

Yes, definitely
Possibly
No, they are completely safe
I don't know

Q51 | Type: Multiple choice

Were you aware that burning a mosquito coil in a closed room produces high levels of fine particulate matter (smoke particles that affect lungs)?

Options:

Yes, I was already aware
No, I did not know this
This is surprising to me

Q52 | Type: Multiple choice

Do you think children and pregnant women are more vulnerable to the health effects of repellent chemicals than healthy adults?

Options:

Yes
No
I don't know

Q53 | Type: Multiple choice

If you were told your current mosquito repellent was harmful to health, would you switch to a safer alternative?

Options:

Yes, definitely
Maybe, if a safer option is affordable
No, I trust my current product
I don't know

Q54 | Type: Multiple choice

Have you ever received counselling or information about the safe use of mosquito repellents from a health worker, doctor, or government program?

Options:

Yes
No

SECTION 7: Attitude Towards Malaria Prevention

Q55 | Type: Multiple choice

How serious do you consider malaria as a disease?

Options:

Very serious - it can be life-threatening
Somewhat serious
Not very serious
It doesn't affect me personally

Q56 | Type: Multiple choice

Do you believe that individual or household actions can significantly reduce the risk of malaria?

Options:

Yes, individual actions make a big difference
Partially - both individuals and government must act
No, it is entirely the government's responsibility
I don't know

Q57 | Type: Multiple choice

Would you participate in community malaria prevention activities (cleaning drives, blood testing camps, awareness sessions) if organized in your area?

Options:

Yes, willingly
Maybe
No, I am too busy
No, I am not interested

Q58 | Type: Multiple choice

How satisfied are you with the government's efforts for malaria prevention in your area?

Options:

Very satisfied
Somewhat satisfied - there is room for improvement
Not satisfied - efforts are inadequate
I am not aware of any government effort

Q59 | Type: Multiple choice

Would you be willing to share malaria prevention information with your neighbours and community?

Options:

Yes
Maybe
No

SECTION 8: Community Gaps and Barriers

Q60 | Type: Checkboxes (Ask respondent to tick top 2)

What do you think are the biggest challenges in malaria prevention in your area? (Select up to 2)

Options:

Lack of awareness in the community
Poor drainage and sanitation infrastructure
High cost of preventive measures
Lack of government action
Health messages in a language I don't understand
Distrust of health workers or government programs
Too busy / no time to take precautions
Other

Q61 | Type: Multiple choice

Have you ever faced difficulty accessing malaria diagnosis or treatment in your area?

Options:

Yes
No
I have never needed malaria treatment

Q62 | Type: Multiple choice

In your opinion, which group in your community is most neglected by malaria awareness programs?

Options:

Daily wage labourers and migrant workers
Women (especially homemakers)
Children
Elderly persons
Residents of slums or informal settlements
No group is neglected - awareness reaches everyone

Q63 | Type: Checkboxes (Ask to pick top 2)

How would you prefer to receive health information about malaria? (Select up to 2)

Options:

Door-to-door visits by ASHA or health worker
WhatsApp or social media messages
Television or radio
Community meetings or village assemblies
Posters, pamphlets, or wall paintings
School or college programs

Q64 | Type: Paragraph (long text)

In your opinion, what ONE change would most improve malaria prevention in your community? (Write your answer below)

(Optional)

SECTION 9: Personal Malaria History

Q65 | Type: Multiple choice

Have you or anyone in your household ever been diagnosed with malaria?

Options:

Yes
No
Suspected but not confirmed by test

Q66 | Type: Multiple choice

If yes, how many times in the last 3 years?

Options:

Once
Twice
3 or more times
Not applicable

Q67 | Type: Multiple choice

Where was treatment taken?

Options:

Government hospital / Primary Health Centre (PHC)
Private doctor or clinic
Pharmacy (self-medication without prescription)
Home remedies
Not applicable

Q68 | Type: Multiple choice

Were you satisfied with the malaria treatment received?

Options:

Yes, fully satisfied
Partially satisfied
No, not satisfied
Not applicable

Q69 | Type: Multiple choice

Did you complete the full course of anti-malarial medicines prescribed?

Options:

Yes, I completed the full course
I completed only a partial course
No, I stopped as soon as I felt better
Not applicable

FORM END MESSAGE

Set this under Settings > Confirmation message:

Thank you for taking the time to complete this survey. Your responses are completely confidential and will be used only for research purposes to improve malaria prevention in your community. We appreciate your contribution to public health.

QUICK SETUP TIPS FOR GOOGLE FORMS

Task	How to do it
Add a section	Click the = icon in the floating right toolbar
Set question type	Use the dropdown (Multiple choice / Checkboxes / Short answer / Paragraph)
Make a question required	Toggle the Required switch at the bottom of each question
Add skip logic	Click the 3-dot menu on a Multiple choice question → Go to section based on answer
Change form theme	Click the palette icon at the top → choose a colour (suggest green/teal for health theme)
Collect email (optional)	Settings → Responses → Collect email addresses
Limit to 1 response	Settings → Responses → Limit to 1 response
View responses as spreadsheet	Responses tab → click the green Sheets icon

Skip logic to set up (2 places):

Q11 (Have you heard of malaria?) - "No" → skip to Section 4
Q38 (Do you use repellents?) - "No" → skip to Section 6

That's everything you need - just open Google Forms and build it section by section using this as your reference. Let me know when the protocol is ready and we can refine this further.

Make a questionnaire of the PDF.

I don't see any PDF attached to your message. Could you please share the PDF file?

Sorry, PDF of questionnaire.

Asking for Preferences

Reading File

Running Command

Done! Here's your PDF:

Malaria KAP Questionnaire

PDF Document · PDF

It's 272 KB, converted directly from the Word document so the formatting, section headings, checkboxes, tables, header, and footer are all preserved exactly. Both files are ready for use:

Malaria KAP Questionnaire
Word Document · DOCX
- editable Word version
Malaria KAP Questionnaire
PDF Document · PDF
- print-ready PDF version

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