DDI_MEX_2009_SAGE_v01_M
Nirmala Naidoo
Yunpeng Huang
2011-11-11
NADA
Version 01 (April 2012) - Adapted version of "DDI-MEX-WHO-SAGE-2011-v01" documented by WHO
Study on Global Ageing and Adult Health 2009-2010
Wave 1
SAGE 2009-10
MEX_2009_SAGE_v01_M
Instituto Nacional de Salud Pública
Dr Richard Suzman
© World Health Organization 2011
NADA
US National Institute on Aging
R01-AG034479, IR21-AG034263-0182
Nirmala Naidoo
World Health Survey [hh/whs]
The Study on Global Ageing and Adult Health is the second round of the World Health Survey which was conducted in 2003. SAGE surveys are designed by the World Health Organization and implemented by national agencies in participating countries.
v01: Edited, anonymous dataset for public distribution.
Purpose:
The multi-country Study on Global Ageing and Adult Health (SAGE) is run by the World Health Organization's Multi-Country Studies unit in the Innovation, Information, Evidence and Research Cluster. SAGE is part of the unit's Longitudinal Study Programme which is compiling longitudinal data on the health and well-being of adult populations, and the ageing process, through primary data collection and secondary data analysis. SAGE baseline data (Wave 0, 2002/3) was collected as part of WHO's World Health Survey http://www.who.int/healthinfo/survey/en/index.html (WHS). SAGE Wave 1 (2007/10) provides a comprehensive data set on the health and well-being of adults in six low and middle-income countries: China, Ghana, India, Mexico, Russian Federation and South Africa.
Objectives:
To obtain reliable, valid and comparable health, health-related and well-being data over a range of key domains for adult and older adult populations in nationally representative samples
To examine patterns and dynamics of age-related changes in health and well-being using longitudinal follow-up of a cohort as they age, and to investigate socio-economic consequences of these health changes
To supplement and cross-validate self-reported measures of health and the anchoring vignette approach to improving comparability of self-reported measures, through measured performance tests for selected health domains
To collect health examination and biomarker data that improves reliability of morbidity and risk factor data and to objectively monitor the effect of interventions
Additional Objectives:
To generate large cohorts of older adult populations and comparison cohorts of younger populations for following-up intermediate outcomes, monitoring trends, examining transitions and life events, and addressing relationships between determinants and health, well-being and health-related outcomes
To develop a mechanism to link survey data to demographic surveillance site data
To build linkages with other national and multi-country ageing studies
To improve the methodologies to enhance the reliability and validity of health outcomes and determinants data
To provide a public-access information base to engage all stakeholders, including national policy makers and health systems planners, in planning and decision-making processes about the health and well-being of older adults
Methods:
SAGE's first full round of data collection included both follow-up and new respondents in most participating countries. The goal of the sampling design was to obtain a nationally representative cohort of persons aged 50 years and older, with a smaller cohort of persons aged 18 to 49 for comparison purposes. In the older households, all persons aged 50+ years (for example, spouses and siblings) were invited to participate. Proxy respondents were identified for respondents who were unable to respond for themselves. Standardized SAGE survey instruments were used in all countries consisting of five main parts: 1) household questionnaire; 2) individual questionnaire; 3) proxy questionnaire; 4) verbal autopsy questionnaire; and, 5) appendices including showcards. A VAQ was completed for deaths in the household over the last 24 months. The procedures for including country-specific adaptations to the standardized questionnaire and translations into local languages from English follow those developed by and used for the World Health Survey.
Content:
Household questionnaire
0000 Coversheet
0100 Sampling Information
0200 Geocoding and GPS Information
0300 Recontact Information
0350 Contact Record
0400 Household Roster
0450 Kish Tables and Household Consent
0500 Housing
0600 Household and Family Support Networks and Transfers
0700 Assets and Household Income
0800 Household Expenditures
0900 Interviewer Observations
Individual questionnaire
1000 Socio-Demographic Characteristics
1500 Work History and Benefits
2000 Health State Descriptions and Vignettes
2500 Anthropometrics, Performance Tests and Biomarkers
3000 Risk Factors and Preventive Health Behaviours
4000 Chronic Conditions and Health Services Coverage
5000 Health Care Utilization
6000 Social Cohesion
7000 Subjective Well-Being and Quality of Life (WHOQoL-8 and Day Reconstruction Method)
8000 Impact of Caregiving
9000 Interviewer Assessment
Mexico
National coverage
- Households;
- Individuals.
The household section of the survey covered all households in all 32 federal states in Mexico. Institutionalised populations are excluded. The individual section covered all persons aged 18 years and older residing within individual households. As the focus of SAGE is older adults, a much larger sample of respondents aged 50 years and older were selected with a smaller comparative sample of respondents aged 18-49 years.
Sample survey data [ssd]
The scope of the Study on Global Ageing and Adult Health includes:
HOUSEHOLD: household characteristics, housing, household and family support, assets and household income, household expenditure.
INDIVIDUAL: socio demographic characteristics, work history, health state, anthropometrics, performance tests and biomarkers, risk factors, chronic conditions and health service coverage, health care utilisation, social cohesion, subjective well-being and quality of life, caregiving.
Instituto Nacional de Salud Pública
In Mexico strata were defined by locality (metropolitan, urban, rural).
A sub-sample of 211 PSUs were selected from the 797 WHS PSUs.
The Basic Geo-Statistical Areas (AGEB) defined by the National Institute of Statistics (INEGI) constitutes a PSU.
PSUs were selected probability proportional to three factors:
a) (WHS/SAGE Wave 0 50plus): number of WHS/SAGE Wave 0 50-plus interviewed at the PSU,
b) (State Population): population of the state to which the PSU belongs,
c) (WHS/SAGE Wave 0 PSU at county): number of PSUs selected from the county to which the PSU belongs for the WHS/SAGE Wave 0;
The first and third factors were included to reduce geographic dispersion. Factor two affords states with larger populations a greater chance of selection.
All WHS/SAGE Wave 0 individuals aged 50 years or older in the selected rural or urban PSUs and a random sample 90% of individuals aged 50 years or older in metropolitan PSUs who had been interviewed for the WHS/SAGE Wave 0 were included in the SAGE Wave 1 ''primary'' sample. The remaining 10% of WHS/SAGE Wave 0 individuals aged 50 years or older in metropolitan areas were then allocated as a ''replacement'' sample for individuals who could not be contacted or did not consent to participate in SAGE Wave 1. A systematic sample of 1000 WHS/SAGE Wave 0 individuals aged 18-49 across all selected PSUs was selected as the ''primary'' sample and 500 as a ''replacement'' sample.
This selection process resulted in a sample which had an over-representation of individuals from metropolitan strata; therefore, it was decided to increase the number of individuals aged 50 years or older from rural and urban strata. This was achieved by including individuals who had not been part of WHS/SAGE Wave 0 (which became a ''supplementary'' sample), although the household in which they lived included an individual from WHS/SAGE Wave 0. All individuals aged 50 or over were included from rural and urban ''18-49 households'' (that is, where an individual aged 18-49 was included in WHS/SAGE Wave 0) as part of the ''primary supplementary'' sample. A systematic random sample of individuals aged 50 years or older was then obtained from urban and rural households where an individual had already been selected as part of the 50 years and older or 18-49 samples. These individuals then formed part of the ''primary supplementary'' sample and the remainder (that is, those not systematically selected) were allocated to the ''replacement supplementary'' sample. Thus, all individuals aged 50 years or older who lived in households in urban and rural PSUs obtained for SAGE Wave 1 were selected as either a primary or replacement participant. A final ''replacement'' sample for the 50 and over age group was obtained from a systematic sample of all individuals aged 50 or over from households which included the individuals already selected for either the 50 and over or 18-49. This sampling strategy also provided participants who had not been included in WHS/SAGE Wave 0, but lived in a household where an individual had been part of WHS/SAGE Wave 0 (that is, the ''supplementary'' sample), in addition to follow-up of individuals who had been included in the WHS/SAGE Wave 0 sample.
Strata: Locality = 3
PSU: AGEBs = 211
SSU: Households = 4 968 surveyed
TSU: Individual = 5 449 surveyed
Face-to-face [f2f], CAPI
The questionnaires were based on the WHS Model Questionnaire with some modification and many new additions. A household questionnaire was administered to all households eligible for the study. A Verbal Autopsy questionnaire was administered to households that had a death in the last 24 months. An Individual questionniare was administered to eligible respondents identified from the household roster. A Proxy questionnaire was administered to individual respondents who had cognitive limitations. The questionnaires were developed in English and were piloted as part of the SAGE pretest in 2005. All documents were translated into Spanish. All SAGE generic questionnaires are available as external resources.
Household weights(variable hhweight) for analysis at household level and individual weights(variable pweight) for analysis at person level were calculated. These were based on the selection probability at each stage of selection. Household weights were post-stratified by locality according to the 2009 population census projections.
Individual weights were post-stratified by sex and age-groups (18-34, 35-49, 50-59, 60-105) according to the 2009 population census projections.
Weights are divided by 1000 and are not normalized.
Data editing took place at a number of stages including:
(1) office editing and coding
(2) during data entry
(3) structural checking of the FoxPro files
(4) range and consistency secondary edits in Stata
Household: Response rate=59%
Individual: Response rate=51%
Nirmala Naidoo
Use of the dataset must be acknowledged using a citation which would include:
- the Identification of the Primary Investigator
- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
- the source and date of download
Example:
Instituto Nacional de Salud Pública. Mexico Study on Global Ageing and Adult Health 2009-2010. Ref. MEX_2009_SAGE_v01_M. Dataset downloaded from www.measuredhs.com on [date]
The user undertakes:
(1) to keep confidential any information concerning individual persons or households.
(2) not to distribute the data to any other user.
(3) to use the data for scientific research only.
(4) to share any planned publications with WHO prior to publication.
The data is being distributed without warranty of any kind. The responsibility for the use of the data lies with the user. In no event shall the World Health Organization be liable for damages arising from its use.
MexicoHHData
0
690
MexicoINDData
0
1680
MexicoINDDataProxy
0
173
MexicoVAData
0
951
Household Case ID 1st wave
Household Case ID 1st wave
Household Case ID 1st wave
Household Case ID 1st wave
Household Case ID 1st wave
Household Case ID 2nd wave
Household Case ID 2nd wave
Household Case ID 2nd wave
Household Case ID 2nd wave
Household Case ID 2nd wave
Q0001: Research Center Number
Q0001: Research Center Number
Q0001: Research Center Number
Q0001: Research Center Number
Q0001: Research Center Number
Research Centre Number
101
China
106
India
140
Mexico
152
Russian Federation
155
South Africa
241
Ghana
Q0002: Household ID number
Q0002: Household ID number
Q0002: Household ID number
Q0002: Household ID number
Q0002: Household ID number
Household ID
Q0003: Type of interview (new, f/u, retest, proxy, validatio
Q0003: Type of interview (new, f/u, retest, proxy, validatio
Q0003: Type of interview (new, f/u, retest, proxy, validatio
Q0003: Type of interview (new, f/u, retest, proxy, validatio
Q0003: Type of interview (new, f/u, retest, proxy, validatio
Is this a new, second (follow-up from WHS), retest or proxy interview?
1
New interview
2
Follow-up interview from WHS
3
Retest
4
Proxy
5
Proxy validation
Q0002a: Household type (18-49, 50+)
Q0002a: Household type (18-49, 50+)
Q0002a: Household type (18-49, 50+)
Q0002a: Household type (18-49, 50+)
Q0002a: Household type (18-49, 50+)
Is this a (18-49 years) or (50+ years) household?
1
HH for 18-49 year old
2
HH for 50+ year old
3
HH for 18-49 year old (Females only) (India only)
Q0003A: Interval
Q0003A: Interval
Q0003A: Interval
Q0003A: Interval
Q0003A: Interval
If retest interview, indicate number of days between first/second and retest.
-9
N/A
-8
DK
Q0004: Interviewer ID
Q0004: Interviewer ID
Q0004: Interviewer ID
Q0004: Interviewer ID
Q0004: Interviewer ID
Interviewer ID
Q0005: Number of calls
Q0005: Number of calls
Q0005: Number of calls
Q0005: Number of calls
Q0005: Number of calls
Total number of calls/visits:
Q0006: Date (DD)
Q0006: Date (DD)
Q0006: Date (DD)
Q0006: Date (DD)
Q0006: Date (DD)
Date of final results:
Q0006: Date (MM)
Q0006: Date (MM)
Q0006: Date (MM)
Q0006: Date (MM)
Q0006: Date (MM)
Q0006: Date (YYYY)
Q0006: Date (YYYY)
Q0006: Date (YYYY)
Q0006: Date (YYYY)
Q0006: Date (YYYY)
Q0007a: Final result code - HHQ
Q0007a: Final result code - HHQ
Q0007a: Final result code - HHQ
Q0007a: Final result code - HHQ
Q0007a: Final result code - HHQ
Final result code Household Q
Q0007b: Final result code - Individual Q
Q0007b: Final result code - Individual Q
Q0007b: Final result code - Individual Q
Q0007b: Final result code - Individual Q
Q0007b: Final result code - Individual Q
Final result code Individual Q for up to 4 respondents - See Q1000c for codes
Q0007b: Final result code - Individual Q
Q0007b: Final result code - Individual Q
Q0007b: Final result code - Individual Q
Q0007b: Final result code - Individual Q
Q0007b: Final result code - Individual Q
Q0007b: Final result code - Individual Q
Q0007b: Final result code - Individual Q
Q0007b: Final result code - Individual Q
Q0007b: Final result code - Individual Q
Q0007b: Final result code - Individual Q
Q0007b: Final result code - Individual Q
Q0007b: Final result code - Individual Q
Q0007b: Final result code - Individual Q
Q0007b: Final result code - Individual Q
Q0007b: Final result code - Individual Q
Q0008: Rotation code
Q0008: Rotation code
Q0008: Rotation code
Q0008: Rotation code
Q0008: Rotation code
Rotation code (Circle One)
Q0009: Edit (DD)
Q0009: Edit (DD)
Q0009: Edit (DD)
Q0009: Edit (DD)
Q0009: Edit (DD)
Date data editing completed
(DD/MM/YYYY)
Q0009: Edit (MM)
Q0009: Edit (MM)
Q0009: Edit (MM)
Q0009: Edit (MM)
Q0009: Edit (MM)
Date data editing completed
(MM)
Q0009: Edit (YYYY)
Q0009: Edit (YYYY)
Q0009: Edit (YYYY)
Q0009: Edit (YYYY)
Q0009: Edit (YYYY)
Date data editing completed
(YYYY)
Q0010: Supervisor Signature
Q0010: Supervisor Signature
Q0010: Supervisor Signature
Q0010: Supervisor Signature
Q0010: Supervisor Signature
Signature of Supervisor:
1
1=Yes
2
2=No
Q0011: Key (DD)
Q0011: Key (DD)
Q0011: Key (DD)
Q0011: Key (DD)
Q0011: Key (DD)
Date data entry completed
(DD/MM/YYYY)
Q0011: Key (MM)
Q0011: Key (MM)
Q0011: Key (MM)
Q0011: Key (MM)
Q0011: Key (MM)
Q0011: Key (YYYY)
Q0011: Key (YYYY)
Q0011: Key (YYYY)
Q0011: Key (YYYY)
Q0011: Key (YYYY)
S0000: Supervisor
S0000: Supervisor
S0000: Supervisor
S0000: Supervisor
S0000: Supervisor
SUPERVISOR
S0000: Field Editor
S0000: Field Editor
S0000: Field Editor
S0000: Field Editor
S0000: Field Editor
FIELD EDITOR
S0000: Office Editor
S0000: Office Editor
S0000: Office Editor
S0000: Office Editor
S0000: Office Editor
OFFICE EDITOR
S0000: Keyed by
S0000: Keyed by
S0000: Keyed by
S0000: Keyed by
S0000: Keyed by
KEYED BY
Actual result code
Actual result code
Actual result code
Actual result code
Actual result code
1
Completed interview
2
Partial interview; no return
3
Contact, initial refusal
4
Contact, uncertain
5
Resistance/refusal
6
Final refusal by respondent
7
Final refusal by HH member
8
Unable to locate HH or informant
9
No interview, informant ineligible
10
Language barrier
11
Vacant, residents elsewhere
12
Unsafe area or no access
13
Deceased informant
14
Informant in institution
Q0101a: PSU Name
Q0101a: PSU Name
Q0101a: PSU Name
Q0101a: PSU Name
Q0101a: PSU Name
Primary Sampling Unit (PSU) Name:
Q0101b: PSU Code
Q0101b: PSU Code
Q0101b: PSU Code
Q0101b: PSU Code
Q0101b: PSU Code
PSU Code
Q0102a: SSU Name
Q0102a: SSU Name
Q0102a: SSU Name
Q0102a: SSU Name
Q0102a: SSU Name
Secondary Sampling Unit (SSU) Name:
Q0102b: SSU Code
Q0102b: SSU Code
Q0102b: SSU Code
Q0102b: SSU Code
Q0102b: SSU Code
SSU Code:
Q0103a: TSU Name
Q0103a: TSU Name
Q0103a: TSU Name
Q0103a: TSU Name
Q0103a: TSU Name
Tertiary Sampling Unit (TSU) Name:
Q0103b: TSU Code
Q0103b: TSU Code
Q0103b: TSU Code
Q0103b: TSU Code
Q0103b: TSU Code
TSU Code:
Q0104: Urban/Rural
Q0104: Urban/Rural
Q0104: Urban/Rural
Q0104: Urban/Rural
Q0104: Urban/Rural
Setting (circle one)
An urban area that has been legally proclaimed as being urban. Such areas include towns, cities and metropolitan areas.
All other areas that are not classified as being urban. This includes commercial farms, small settlements, rural villages and other areas which are further away from towns and cities.
1
Urban
2
Rural
8
Don't know
9
Not Applicable
Q0105a: FirstADMLevelName
Q0105a: FirstADMLevelName
Q0105a: FirstADMLevelName
Q0105a: FirstADMLevelName
Q0105a: FirstADMLevelName
administrative division information
Refer to Appendix A0100 for administrative names and codes
First Administrative Level Unit Name:
Q0105b: FirstADMLevelCode
Q0105b: FirstADMLevelCode
Q0105b: FirstADMLevelCode
Q0105b: FirstADMLevelCode
Q0105b: FirstADMLevelCode
First Administrative Level Unit Code:
99 Not applicable if the unit is not in appendix list
Q0106a: SecondADMLevelName
Q0106a: SecondADMLevelName
Q0106a: SecondADMLevelName
Q0106a: SecondADMLevelName
Q0106a: SecondADMLevelName
Second Administrative Level Unit Name:
Q0106b: SecondADMLevelCode
Q0106b: SecondADMLevelCode
Q0106b: SecondADMLevelCode
Q0106b: SecondADMLevelCode
Q0106b: SecondADMLevelCode
Second Administrative Level Unit Code:
99 Not applicable if the unit is not in appendix list
Q0201: Signals
Q0201: Signals
Q0201: Signals
Q0201: Signals
Q0201: Signals
Number of satellite signals received
(must be 3 or more)
None
1
One
2
Two
Q0202: Accuracy
Q0202: Accuracy
Q0202: Accuracy
Q0202: Accuracy
Q0202: Accuracy
Accuracy
feet (must be 65 feet or less)
Q0203A: N/S
Q0203A: N/S
Q0203A: N/S
Q0203A: N/S
Q0203A: N/S
Latitude N/S
Q0203: Reading
Q0203: Reading
Q0203: Reading
Q0203: Reading
Q0203: Reading
Latitude
Q0203B: Degrees
Q0203B: Degrees
Q0203B: Degrees
Q0203B: Degrees
Q0203B: Degrees
Degrees
Q0203C: Minutes
Q0203C: Minutes
Q0203C: Minutes
Q0203C: Minutes
Q0203C: Minutes
Minutes
0 Minutes
Q0204A: E/W
Q0204A: E/W
Q0204A: E/W
Q0204A: E/W
Q0204A: E/W
Longitude E/W
Q0204: Reading
Q0204: Reading
Q0204: Reading
Q0204: Reading
Q0204: Reading
Q0204B: Degrees
Q0204B: Degrees
Q0204B: Degrees
Q0204B: Degrees
Q0204B: Degrees
Degrees
Q0204C: Minutes
Q0204C: Minutes
Q0204C: Minutes
Q0204C: Minutes
Q0204C: Minutes
Minutes
0 Minutes
Q0205: Waypoint
Q0205: Waypoint
Q0205: Waypoint
Q0205: Waypoint
Q0205: Waypoint
Waypoint: Circle one 1 In front of the household
2 Nearby location (for example, a park, communal space or landmark)
Supervisors: Verify Q0203 and Q0204 using Appendix A0200
1
In front of HH
2
Nearby location
Q0301a: Last Name (surname)
Q0301a: Last Name (surname)
Q0301a: Last Name (surname)
Q0301a: Last Name (surname)
Q0301a: Last Name (surname)
What is the informant's full name? (verify spelling and write clearly)
Last Name (surname)
Q0301b: First (given) Name
Q0301b: First (given) Name
Q0301b: First (given) Name
Q0301b: First (given) Name
Q0301b: First (given) Name
First name
Q0302a: StreetAddressNumber
Q0302a: StreetAddressNumber
Q0302a: StreetAddressNumber
Q0302a: StreetAddressNumber
Q0302a: StreetAddressNumber
What is the informant's address?
Street number and name:
Q0302a: StreetAddressName
Q0302a: StreetAddressName
Q0302a: StreetAddressName
Q0302a: StreetAddressName
Q0302a: StreetAddressName
Q0302b: City
Q0302b: City
Q0302b: City
Q0302b: City
Q0302b: City
City
Q0302c: Postal Code
Q0302c: Postal Code
Q0302c: Postal Code
Q0302c: Postal Code
Q0302c: Postal Code
Postal Code:
Q0302d: Other
Q0302d: Other
Q0302d: Other
Q0302d: Other
Q0302d: Other
Other
Q0303: Telephone Y/N?
Q0303: Telephone Y/N?
Q0303: Telephone Y/N?
Q0303: Telephone Y/N?
Q0303: Telephone Y/N?
Does this informant/household have a telephone?
1 Yes 2 No
1
Yes have phone
2
No do not have phone
Q0304: TelephoneNumber
Q0304: TelephoneNumber
Q0304: TelephoneNumber
Q0304: TelephoneNumber
Q0304: TelephoneNumber
What is the telephone number?
Q0305: Phone # in Directory?
Q0305: Phone # in Directory?
Q0305: Phone # in Directory?
Q0305: Phone # in Directory?
Q0305: Phone # in Directory?
Is this telephone number listed in the telephone directory?
1-Yes
2-No
1
In directory
2
Not in directory
8
Don't know
9
Not applicable
Q0306: Contact Y/N?
Q0306: Contact Y/N?
Q0306: Contact Y/N?
Q0306: Contact Y/N?
Q0306: Contact Y/N?
If we cannot contact you for whatever reason, is there someone else we could contact who would know how to reach you or someone in your household?
1-Yes
2-No
1
Contact exists
2
Contact does not exist
8
Don't know
9
Not applicable
Q0306a: Contact last (sur)name
Q0306a: Contact last (sur)name
Q0306a: Contact last (sur)name
Q0306a: Contact last (sur)name
Q0306a: Contact last (sur)name
What is this person's name, relationship to you and his or her address?
Last Name (surname):
Q0306b: Contact first (given) name
Q0306b: Contact first (given) name
Q0306b: Contact first (given) name
Q0306b: Contact first (given) name
Q0306b: Contact first (given) name
First Name:
Q0306c: Contact relationship
Q0306c: Contact relationship
Q0306c: Contact relationship
Q0306c: Contact relationship
Q0306c: Contact relationship
Relationship:
Use codes from Q0405.
-8
DK
1
Spouse
2
Son or daughter
3
Son- or daughter-in-law
4
Grandchild
5
Parent
6
Parent-in-law
7
Sibling (brother or sister)
8
Co-wife
9
Grandparent
10
Other relative
11
Not related
88
Don't know
Q0306d: Contact street number
Q0306d: Contact street number
Q0306d: Contact street number
Q0306d: Contact street number
Q0306d: Contact street number
Street Number
Q0306d: Contact street address name
Q0306d: Contact street address name
Q0306d: Contact street address name
Q0306d: Contact street address name
Q0306d: Contact street address name
Street Name:
Q0306e: Contact city
Q0306e: Contact city
Q0306e: Contact city
Q0306e: Contact city
Q0306e: Contact city
City
Q0306f: Contact postal code
Q0306f: Contact postal code
Q0306f: Contact postal code
Q0306f: Contact postal code
Q0306f: Contact postal code
Postal Code:
Q0306g: Contact other information
Q0306g: Contact other information
Q0306g: Contact other information
Q0306g: Contact other information
Q0306g: Contact other information
Other
A survey supervisor may be calling or visiting you again to verify this interview or to collect additional information in the future
Q0351A: Call #1 DD
Q0351A: Call #1 DD
Q0351A: Call #1 DD
Q0351A: Call #1 DD
Q0351A: Call #1 DD
Contact Record - Household
Date
Q0351A: Call #1 MM
Q0351A: Call #1 MM
Q0351A: Call #1 MM
Q0351A: Call #1 MM
Q0351A: Call #1 MM
Q0351A: Cal #1 YYYY
Q0351A: Cal #1 YYYY
Q0351A: Cal #1 YYYY
Q0351A: Cal #1 YYYY
Q0351A: Cal #1 YYYY
-8
Don't know
Q0351B: Call #1 HH
Q0351B: Call #1 HH
Q0351B: Call #1 HH
Q0351B: Call #1 HH
Q0351B: Call #1 HH
Time of contact
Q0351B: Call #1 mm
Q0351B: Call #1 mm
Q0351B: Call #1 mm
Q0351B: Call #1 mm
Q0351B: Call #1 mm
Q0351C: Call #1 Interviewer ID
Q0351C: Call #1 Interviewer ID
Q0351C: Call #1 Interviewer ID
Q0351C: Call #1 Interviewer ID
Q0351C: Call #1 Interviewer ID
Interviewer I.D.
Q0351D: Call #1 who?
Q0351D: Call #1 who?
Q0351D: Call #1 who?
Q0351D: Call #1 who?
Q0351D: Call #1 who?
Contact with
1=Household Informant
2=Other household member
3=No one
1
Contact w/ informant
2
Contact w/ other HH member
3
No contact
Q0351E: Call #1 listing?
Q0351E: Call #1 listing?
Q0351E: Call #1 listing?
Q0351E: Call #1 listing?
Q0351E: Call #1 listing?
Household roster obtained
1=Yes
2=No
1
Listing obtained
2
Listing not obtained
Q0351F: Call #1 result
Q0351F: Call #1 result
Q0351F: Call #1 result
Q0351F: Call #1 result
Q0351F: Call #1 result
Result code
01=Completed Interview (interview is accepted and conducted)
02=Partial Interview (interview is partially completed and person will not be contacted anymore).
03=Household contacted-initial refusal
04=Household contacted-uncertain about interview
05=Resistance/refusal by household informant
06=Final refusal by household informant
07=Final refusal by other household member
08=Unable to locate household or household informant
09=No interview because informant is not eligible: less than 18, mentally unfit or too ill.
10=Language barrier
11=House is vacant or household occupants are elsewhere (seasonal vacancy, other residence)
12=Unsafe or dangerous area or no access to Informant
13= Deceased informant
14=Informant in institution: jail, hospital and not accessible
INTERVIEWER: INSERT final result code in Section 0000: Coversheet, Q0007a
1
Completed interview
2
Partial interview; no return
3
Contact, initial refusal
4
Contact, uncertain
5
Resistance/refusal
6
Final refusal by respondent
7
Final refusal by HH member
8
Unable to locate HH or informant
9
No interview, informant ineligible
10
Language barrier
11
Vacant, residents elsewhere
12
Unsafe area or no access
13
Deceased informant
14
Informant in institution
Q0352A: Call #2 DD
Q0352A: Call #2 DD
Q0352A: Call #2 DD
Q0352A: Call #2 DD
Q0352A: Call #2 DD
Date
Q0352A: Call #2 MM
Q0352A: Call #2 MM
Q0352A: Call #2 MM
Q0352A: Call #2 MM
Q0352A: Call #2 MM
Q0352A: Call #2 YYYY
Q0352A: Call #2 YYYY
Q0352A: Call #2 YYYY
Q0352A: Call #2 YYYY
Q0352A: Call #2 YYYY
-8
Don't know
Q0352B: Call #2 HH
Q0352B: Call #2 HH
Q0352B: Call #2 HH
Q0352B: Call #2 HH
Q0352B: Call #2 HH
Time of contact
Q0352B: Call #2 mm
Q0352B: Call #2 mm
Q0352B: Call #2 mm
Q0352B: Call #2 mm
Q0352B: Call #2 mm
Q0352C: Call #2 Interviewer ID
Q0352C: Call #2 Interviewer ID
Q0352C: Call #2 Interviewer ID
Q0352C: Call #2 Interviewer ID
Q0352C: Call #2 Interviewer ID
Interviewer I.D.
Q0352D: Call #2 who?
Q0352D: Call #2 who?
Q0352D: Call #2 who?
Q0352D: Call #2 who?
Q0352D: Call #2 who?
Contact with
1=Household Informant
2=Other household member
3=No one
1
Contact w/ informant
2
Contact w/ other HH member
3
No contact
Q0352E: Call #2 listing?
Q0352E: Call #2 listing?
Q0352E: Call #2 listing?
Q0352E: Call #2 listing?
Q0352E: Call #2 listing?
Household roster obtained
1=Yes
2=No
1
Listing obtained
2
Listing not obtained
Q0352F: Call #2 result
Q0352F: Call #2 result
Q0352F: Call #2 result
Q0352F: Call #2 result
Q0352F: Call #2 result
Result code
01=Completed Interview (interview is accepted and conducted)
02=Partial Interview (interview is partially completed and person will not be contacted anymore).
03=Household contacted-initial refusal
04=Household contacted-uncertain about interview
05=Resistance/refusal by household informant
06=Final refusal by household informant
07=Final refusal by other household member
08=Unable to locate household or household informant
09=No interview because informant is not eligible: less than 18, mentally unfit or too ill.
10=Language barrier
11=House is vacant or household occupants are elsewhere (seasonal vacancy, other residence)
12=Unsafe or dangerous area or no access to Informant
13= Deceased informant
14=Informant in institution: jail, hospital and not accessible
INTERVIEWER: INSERT final result code in Section 0000: Coversheet, Q0007a.
1
Completed interview
2
Partial interview; no return
3
Contact, initial refusal
4
Contact, uncertain
5
Resistance/refusal
6
Final refusal by respondent
7
Final refusal by HH member
8
Unable to locate HH or informant
9
No interview, informant ineligible
10
Language barrier
11
Vacant, residents elsewhere
12
Unsafe area or no access
13
Deceased informant
14
Informant in institution
Q0353A: Call #3 DD
Q0353A: Call #3 DD
Q0353A: Call #3 DD
Q0353A: Call #3 DD
Q0353A: Call #3 DD
Date
Q0353A: Call #3 MM
Q0353A: Call #3 MM
Q0353A: Call #3 MM
Q0353A: Call #3 MM
Q0353A: Call #3 MM
Q0353A: Call #3 YYYY
Q0353A: Call #3 YYYY
Q0353A: Call #3 YYYY
Q0353A: Call #3 YYYY
Q0353A: Call #3 YYYY
-8
Don't know
Q0353B: Call #3 HH
Q0353B: Call #3 HH
Q0353B: Call #3 HH
Q0353B: Call #3 HH
Q0353B: Call #3 HH
Time of contact
Q0353B: Call #3 mm
Q0353B: Call #3 mm
Q0353B: Call #3 mm
Q0353B: Call #3 mm
Q0353B: Call #3 mm
Q0353C: Call #3 Interviewer ID
Q0353C: Call #3 Interviewer ID
Q0353C: Call #3 Interviewer ID
Q0353C: Call #3 Interviewer ID
Q0353C: Call #3 Interviewer ID
Interviewer I.D.
Q0353D: Call #3 who?
Q0353D: Call #3 who?
Q0353D: Call #3 who?
Q0353D: Call #3 who?
Q0353D: Call #3 who?
Contact with
1=Household Informant
2=Other household member
3=No one
1
Contact w/ informant
2
Contact w/ other HH member
3
No contact
Q0353E: Call #3 listing?
Q0353E: Call #3 listing?
Q0353E: Call #3 listing?
Q0353E: Call #3 listing?
Q0353E: Call #3 listing?
Household roster obtained
1=Yes
2=No
1
Listing obtained
2
Listing not obtained
Q0353F: Call #3 result
Q0353F: Call #3 result
Q0353F: Call #3 result
Q0353F: Call #3 result
Q0353F: Call #3 result
Result code
01=Completed Interview (interview is accepted and conducted)
02=Partial Interview (interview is partially completed and person will not be contacted anymore).
03=Household contacted-initial refusal
04=Household contacted-uncertain about interview
05=Resistance/refusal by household informant
06=Final refusal by household informant
07=Final refusal by other household member
08=Unable to locate household or household informant
09=No interview because informant is not eligible: less than 18, mentally unfit or too ill.
10=Language barrier
11=House is vacant or household occupants are elsewhere (seasonal vacancy, other residence)
12=Unsafe or dangerous area or no access to Informant
13= Deceased informant
14=Informant in institution: jail, hospital and not accessible
INTERVIEWER: INSERT final result code in Section 0000: Coversheet, Q0007a.
1
Completed interview
2
Partial interview; no return
3
Contact, initial refusal
4
Contact, uncertain
5
Resistance/refusal
6
Final refusal by respondent
7
Final refusal by HH member
8
Unable to locate HH or informant
9
No interview, informant ineligible
10
Language barrier
11
Vacant, residents elsewhere
12
Unsafe area or no access
13
Deceased informant
14
Informant in institution
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Col. Number
Col. Number
Col. Number
Col. Number
Col. Number
In order to determine who to interview, I need to know who lives at this address. Let me assure you that any information you provide is strictly confidential. By asking “who lives at this household?”, I mean those who share meals ('eat out of the same cooking pot') and usually stay here for at least four months a year.
I would like to know the age, sex, marital status, educational level and relationship to the household head of each of the members of this household who live here.
Please include people who may presently be in an institution due to their health (for example, in hospital or old people's home) for a short time.
What is the total number of people who live in this household?
We want to start with the person who is the head of the household. By head of the household we mean the main decision maker in the household. The head can be either male or female. If two people are equal decision-makers, take the older person.
INTERVIEWER: Identify and collect information on REINTERVIEW household members first, then address new household members (those who were not part of the household in the previous interview in 2003).
INTERVIEWER: By "new" household member, we mean someone who was not a household member when we interviewed this household in 2002/2003 as part of WHO's World Health Survey.
INTERVIEWER AND SUPERVISOR: For reinterview household members from the WHS, interviewer should determine if person still a HH member in Q0404a (Yes or No) and supervisor/interviewer should insert WHS ID from WHS HH roster in Q0404b. For new household member, circle "9=N/A" for Q0404a and use "9 8" in Q0404b.
INTERVIEWER: remember to include people who may presently be in an institution for a short time due to their health.
INTERVIEWER: if Q0404a=2 then skip to Q0415
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
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Q0403a: Last (sur)name
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Q0403a: Last (sur)name
Q0403a: Last (sur)name
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Q0403a: Last (sur)name
Q0403a: Last (sur)name
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Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
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Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
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Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
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Q0403a: Last (sur)name
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Q0403a: Last (sur)name
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Q0403b: First (given) name
Q0403b: First (given) name
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Q0403b: First (given) name
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Q0403b: First (given) name
Q0403b: First (given) name
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Q0403b: First (given) name
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Q0403b: First (given) name
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Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes è Continue
2 = No è Go to Q0415 or Next Person
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died è go to Next HH member
87 = Other, Specify:
88 = Don't know
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
Go to next HH member or if last HH member è go to Q0417
* Examples of Mandatory include: Employees State Ins Scheme (ESIS), Central Government Health Scheme (CGHS), Railways Health Services (RHS), Defence Medical Services (DMS), Ex-servicemen Contributory Health Scheme (ECHS), Medical Reimbursement From Employers - Government and Public Sector (MREG), Medical Reimbursement From Employers- Private Companies (MREP), or Other Health Ins Through Employer (OHIE)
** Examples of Voluntary include: Community Health Ins. Scheme (CHIS)-Group Mediclaim Policy, BPL and SEWA Schemes, Commercial Health Ins. Schemes from Public Sector Comp (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Commercial Health Ins from Private Sector Comp. (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram)
S0400: HH begin
S0400: HH begin
S0400: HH begin
S0400: HH begin
S0400: HH begin
S0400: MM begin
S0400: MM begin
S0400: MM begin
S0400: MM begin
S0400: MM begin
S0400: HH end
S0400: HH end
S0400: HH end
S0400: HH end
S0400: HH end
S0400: MM end
S0400: MM end
S0400: MM end
S0400: MM end
S0400: MM end
Q0401: Total number of persons in HH
Q0401: Total number of persons in HH
Q0401: Total number of persons in HH
Q0401: Total number of persons in HH
Q0401: Total number of persons in HH
-9
Followup refused to give roster information
-8
Don't know
Q0402a: HH Head Last (sur)name
Q0402a: HH Head Last (sur)name
Q0402a: HH Head Last (sur)name
Q0402a: HH Head Last (sur)name
Q0402a: HH Head Last (sur)name
Q0402b: HH Head First (given) name
Q0402b: HH Head First (given) name
Q0402b: HH Head First (given) name
Q0402b: HH Head First (given) name
Q0402b: HH Head First (given) name
Q0417: Other infants or kids?
Q0417: Other infants or kids?
Q0417: Other infants or kids?
Q0417: Other infants or kids?
Q0417: Other infants or kids?
Are there any other persons such as small children or infants that we have not listed?
1=Yes
2=No
(go back to HH roster and complete column)
INTERVIEWER: Check Q0401 - make sure total number of persons listed in the roster table above is equal to the number of persons living in the household.
1
Yes
2
No
8
Don't know
9
Not applicable
Q0418: Other persons?
Q0418: Other persons?
Q0418: Other persons?
Q0418: Other persons?
Q0418: Other persons?
Are there any other persons not here at the moment who are usually part of your household?
1=Yes
2=No
(go back to HH roster and complete column)
1
Yes
2
No
8
Don't know
9
Not applicable
Q0419: Main earner?
Q0419: Main earner?
Q0419: Main earner?
Q0419: Main earner?
Q0419: Main earner?
Who is the main income earner for the household (person who brings in most money)?
NTERVIEWER: insert the Person (HH member) number from the roster table above. If person outside HH, circle "87".
-8
DK
87
Other person not in HH
88
Don't know
98
Not applicable
Q0420: Who completed HH roster?
Q0420: Who completed HH roster?
Q0420: Who completed HH roster?
Q0420: Who completed HH roster?
Q0420: Who completed HH roster?
Who is the household member who completed the household roster?
INTERVIEWER: insert the Person (HH member) number from the roster table above.
-8
Don't know
88
Don't know
98
Not applicable
Q0421: Deaths in 24 months?
Q0421: Deaths in 24 months?
Q0421: Deaths in 24 months?
Q0421: Deaths in 24 months?
Q0421: Deaths in 24 months?
We want to know if there have been any deaths in this household/dwelling in the last 24 months.
Has any member of this household died in the last 24 months?
1=Yes
2=No
Section 0450
INTERVIEWER: (identify the correct time period - for example, "since April 2005?").
1
Yes
2
No
8
Don't know
9
Not applicable
Q0422: How many deaths?
Q0422: How many deaths?
Q0422: How many deaths?
Q0422: How many deaths?
Q0422: How many deaths?
How many deaths were there in the household in the last 24 months?
-8
Don't know
88
Don't know
98
Not applicable
Q0423a: Sex (person 1)
Q0423a: Sex (person 1)
Q0423a: Sex (person 1)
Q0423a: Sex (person 1)
Q0423a: Sex (person 1)
Sex of deceased?
1=Male, 2=Female
IF person aged 50 years or older - complete VERBAL AUTOPSY (Section 0910).
1
Male
2
Female
Q0424a: Age at death in years
Q0424a: Age at death in years
Q0424a: Age at death in years
Q0424a: Age at death in years
Q0424a: Age at death in years
What was his/her age at death (in years)?
Age at last birthday.
For children less than 1 year, enter “000”.
IF person aged 50 years or older - complete VERBAL AUTOPSY (Section 0910).
-8
Don't know
Q0423b: Sex (person 2)
Q0423b: Sex (person 2)
Q0423b: Sex (person 2)
Q0423b: Sex (person 2)
Q0423b: Sex (person 2)
Sex of deceased?
1=Male, 2=Female
IF person aged 50 years or older - complete VERBAL AUTOPSY (Section 0910).
1
Male
2
Female
Q0424b: Age at death in years
Q0424b: Age at death in years
Q0424b: Age at death in years
Q0424b: Age at death in years
Q0424b: Age at death in years
What was his/her age at death (in years)?
Age at last birthday.
For children less than 1 year, enter “000”.
IF person aged 50 years or older - complete VERBAL AUTOPSY (Section 0910).
-8
Don't know
Q0423c: Sex (person 3)
Q0423c: Sex (person 3)
Q0423c: Sex (person 3)
Q0423c: Sex (person 3)
Q0423c: Sex (person 3)
Sex of deceased?
1=Male, 2=Female
IF person aged 50 years or older - complete VERBAL AUTOPSY (Section 0910).
1
Male
2
Female
Q0424c: Age at death in years
Q0424c: Age at death in years
Q0424c: Age at death in years
Q0424c: Age at death in years
Q0424c: Age at death in years
What was his/her age at death (in years)?
Age at last birthday.
For children less than 1 year, enter “000”.
IF person aged 50 years or older - complete VERBAL AUTOPSY (Section 0910).
-8
Don't know
Q0423d: Sex (person 4)
Q0423d: Sex (person 4)
Q0423d: Sex (person 4)
Q0423d: Sex (person 4)
Q0423d: Sex (person 4)
Sex of deceased?
1=Male, 2=Female
IF person aged 50 years or older - complete VERBAL AUTOPSY (Section 0910).
1
Male
2
Female
Q0424d: Age at death in years
Q0424d: Age at death in years
Q0424d: Age at death in years
Q0424d: Age at death in years
Q0424d: Age at death in years
What was his/her age at death (in years)?
Age at last birthday.
For children less than 1 year, enter “000”.
IF person aged 50 years or older - complete VERBAL AUTOPSY (Section 0910).
-8
Don't know
Q0451: HH Informant - Person (HH member) number from HH rost
Q0451: HH Informant - Person (HH member) number from HH rost
Q0451: HH Informant - Person (HH member) number from HH rost
Q0451: HH Informant - Person (HH member) number from HH rost
Q0451: HH Informant - Person (HH member) number from HH rost
INTERVIEWER: Indicate who is the 'Household Informant'?
Record the Person (HH member) number from the Household Roster
Section 0450: Household Consent
Interviewer: you will select an informant to complete the remaining sections of the household questionnaire and a respondent for the individual questionnaire at his point. The household informant and individual respondent may or may not be the same person. We want to interview all persons aged 50 years and older present in the household on the day of the interview, but someone younger than 50 may complete the household questionnaire.
A. INSTRUCTIONS FOR SELECTING RESPONDENT FOR HOUSEHOLD QUESTIONNAIRE
INTERVIEWER: For the Household Informant, choose the person in the household most knowledgeable about the household and household members' health status, employment, financial condition, expenditures and health insurance. Several persons in the household may have to be spoken to in order to determine this, but the most knowledgeable should be identified and coded in Q0451. The person identified here may be different from the person chosen to complete the individual questionnaire.
-8
Don't know
88
Don't know
98
Not applicable
Q0451a: HHConsentProvided
Q0451a: HHConsentProvided
Q0451a: HHConsentProvided
Q0451a: HHConsentProvided
Q0451a: HHConsentProvided
Was the Household Consent Form Agreed to and Signed / Agreed but Witness Signed or Refused?
Section 0450: Household Consent
Interviewer: you will select an informant to complete the remaining sections of the household questionnaire and a respondent for the individual questionnaire at his point. The household informant and individual respondent may or may not be the same person. We want to interview all persons aged 50 years and older present in the household on the day of the interview, but someone younger than 50 may complete the household questionnaire.
A. INSTRUCTIONS FOR SELECTING RESPONDENT FOR HOUSEHOLD QUESTIONNAIRE
INTERVIEWER: For the Household Informant, choose the person in the household most knowledgeable about the household and household members' health status, employment, financial condition, expenditures and health insurance. Several persons in the household may have to be spoken to in order to determine this, but the most knowledgeable should be identified and coded in Q0451. The person identified here may be different from the person chosen to complete the individual questionnaire.
1
Agreed, Informant Signed
2
Agreed, witness signed
3
Refused
9
N/A
Q0451b: Kish Code (for new 18-49 HH only)
Q0451b: Kish Code (for new 18-49 HH only)
Q0451b: Kish Code (for new 18-49 HH only)
Q0451b: Kish Code (for new 18-49 HH only)
Q0451b: Kish Code (for new 18-49 HH only)
INTERVIEWER:
Enter Kish Table Code: 18-49 HH only (A,B1,B2,C,D,E1,E2 or F)
Section 0450: Household Consent
Interviewer: you will select an informant to complete the remaining sections of the household questionnaire and a respondent for the individual questionnaire at his point. The household informant and individual respondent may or may not be the same person. We want to interview all persons aged 50 years and older present in the household on the day of the interview, but someone younger than 50 may complete the household questionnaire.
A. INSTRUCTIONS FOR SELECTING RESPONDENT FOR HOUSEHOLD QUESTIONNAIRE
INTERVIEWER: For the Household Informant, choose the person in the household most knowledgeable about the household and household members' health status, employment, financial condition, expenditures and health insurance. Several persons in the household may have to be spoken to in order to determine this, but the most knowledgeable should be identified and coded in Q0451. The person identified here may be different from the person chosen to complete the individual questionnaire.
Q0452: Person (HH member) number - first person
Q0452: Person (HH member) number - first person
Q0452: Person (HH member) number - first person
Q0452: Person (HH member) number - first person
Q0452: Person (HH member) number - first person
B. INSTRUCTIONS FOR SELECTING RESPONDENT FOR INDIVIDUAL QUESTIONNAIRE
For Households scheduled for an interview with a respondent aged 18 to 49, include that Person (Household member) number from the Household roster column. The Person number will be recorded below in Q0452 and then in Q1007 on the Individual Respondent Questionnaire - and Q0453 to Q0456 will be left blank. The younger respondent will be a follow-up respondent from the World Health Survey.
For Households scheduled for an interview with a respondent aged 50+ years - you will interview all persons aged 50+ years. Someone younger than 50 years may complete the Household Questionnaire.
You may have multiple individual interviews for one household, but you need to complete the household questionnaire only once. The multiple respondents for the individual questionnaire should be listed below starting with Q0452 for the first person, Q0453 for the second, Q0454 for the third…and so on. Then also insert in Q1007 on the Individual Respondent Questionnaire.
Person (Household member) number
INTERVIEWER:
To complete the remaining sections in the Household Questionnaire, make sure to obtain consent using Household Informant Consent Form - before proceeding to Section 0500.
-8
Don't know
88
Don't know
98
Not applicable
Q0453: Person (HH member) number - second person (if any, 50
Q0453: Person (HH member) number - second person (if any, 50
Q0453: Person (HH member) number - second person (if any, 50
Q0453: Person (HH member) number - second person (if any, 50
Q0453: Person (HH member) number - second person (if any, 50
B. INSTRUCTIONS FOR SELECTING RESPONDENT FOR INDIVIDUAL QUESTIONNAIRE
For Households scheduled for an interview with a respondent aged 18 to 49, include that Person (Household member) number from the Household roster column. The Person number will be recorded below in Q0452 and then in Q1007 on the Individual Respondent Questionnaire - and Q0453 to Q0456 will be left blank. The younger respondent will be a follow-up respondent from the World Health Survey.
For Households scheduled for an interview with a respondent aged 50+ years - you will interview all persons aged 50+ years. Someone younger than 50 years may complete the Household Questionnaire.
You may have multiple individual interviews for one household, but you need to complete the household questionnaire only once. The multiple respondents for the individual questionnaire should be listed below starting with Q0452 for the first person, Q0453 for the second, Q0454 for the third…and so on. Then also insert in Q1007 on the Individual Respondent Questionnaire.
If a second person; Person (Household member) number
INTERVIEWER:
To complete the remaining sections in the Household Questionnaire, make sure to obtain consent using Household Informant Consent Form - before proceeding to Section 0500.
-8
Don't know
88
Don't know
98
Not applicable
Q0454: Person (HH member) number - third person (if any, 50+
Q0454: Person (HH member) number - third person (if any, 50+
Q0454: Person (HH member) number - third person (if any, 50+
Q0454: Person (HH member) number - third person (if any, 50+
Q0454: Person (HH member) number - third person (if any, 50+
B. INSTRUCTIONS FOR SELECTING RESPONDENT FOR INDIVIDUAL QUESTIONNAIRE
For Households scheduled for an interview with a respondent aged 18 to 49, include that Person (Household member) number from the Household roster column. The Person number will be recorded below in Q0452 and then in Q1007 on the Individual Respondent Questionnaire - and Q0453 to Q0456 will be left blank. The younger respondent will be a follow-up respondent from the World Health Survey.
For Households scheduled for an interview with a respondent aged 50+ years - you will interview all persons aged 50+ years. Someone younger than 50 years may complete the Household Questionnaire.
You may have multiple individual interviews for one household, but you need to complete the household questionnaire only once. The multiple respondents for the individual questionnaire should be listed below starting with Q0452 for the first person, Q0453 for the second, Q0454 for the third…and so on. Then also insert in Q1007 on the Individual Respondent Questionnaire.
If a third person; Person (Household member) number
INTERVIEWER:
To complete the remaining sections in the Household Questionnaire, make sure to obtain consent using Household Informant Consent Form - before proceeding to Section 0500.
-8
Don't know
88
Don't know
98
Not applicable
Q0455: Person (HH member) number - fourth person (if any, 50
Q0455: Person (HH member) number - fourth person (if any, 50
Q0455: Person (HH member) number - fourth person (if any, 50
Q0455: Person (HH member) number - fourth person (if any, 50
Q0455: Person (HH member) number - fourth person (if any, 50
B. INSTRUCTIONS FOR SELECTING RESPONDENT FOR INDIVIDUAL QUESTIONNAIRE
For Households scheduled for an interview with a respondent aged 18 to 49, include that Person (Household member) number from the Household roster column. The Person number will be recorded below in Q0452 and then in Q1007 on the Individual Respondent Questionnaire - and Q0453 to Q0456 will be left blank. The younger respondent will be a follow-up respondent from the World Health Survey.
For Households scheduled for an interview with a respondent aged 50+ years - you will interview all persons aged 50+ years. Someone younger than 50 years may complete the Household Questionnaire.
You may have multiple individual interviews for one household, but you need to complete the household questionnaire only once. The multiple respondents for the individual questionnaire should be listed below starting with Q0452 for the first person, Q0453 for the second, Q0454 for the third…and so on. Then also insert in Q1007 on the Individual Respondent Questionnaire.
If a fourth person; Person (Household member) number
INTERVIEWER:
To complete the remaining sections in the Household Questionnaire, make sure to obtain consent using Household Informant Consent Form - before proceeding to Section 0500.
-8
Don't know
98
Not applicable
Q0456: Person (HH member) number - fifth person (if any, 50+
Q0456: Person (HH member) number - fifth person (if any, 50+
Q0456: Person (HH member) number - fifth person (if any, 50+
Q0456: Person (HH member) number - fifth person (if any, 50+
Q0456: Person (HH member) number - fifth person (if any, 50+
B. INSTRUCTIONS FOR SELECTING RESPONDENT FOR INDIVIDUAL QUESTIONNAIRE
For Households scheduled for an interview with a respondent aged 18 to 49, include that Person (Household member) number from the Household roster column. The Person number will be recorded below in Q0452 and then in Q1007 on the Individual Respondent Questionnaire - and Q0453 to Q0456 will be left blank. The younger respondent will be a follow-up respondent from the World Health Survey.
For Households scheduled for an interview with a respondent aged 50+ years - you will interview all persons aged 50+ years. Someone younger than 50 years may complete the Household Questionnaire.
You may have multiple individual interviews for one household, but you need to complete the household questionnaire only once. The multiple respondents for the individual questionnaire should be listed below starting with Q0452 for the first person, Q0453 for the second, Q0454 for the third…and so on. Then also insert in Q1007 on the Individual Respondent Questionnaire.
If a fifth person; Person (Household member) number
INTERVIEWER:
To complete the remaining sections in the Household Questionnaire, make sure to obtain consent using Household Informant Consent Form - before proceeding to Section 0500.
-8
Don't know
98
Not applicable
S0500: HH begin
S0500: HH begin
S0500: HH begin
S0500: HH begin
S0500: HH begin
S0500: MM begin
S0500: MM begin
S0500: MM begin
S0500: MM begin
S0500: MM begin
S0500: HH end
S0500: HH end
S0500: HH end
S0500: HH end
S0500: HH end
S0500: MM end
S0500: MM end
S0500: MM end
S0500: MM end
S0500: MM end
Q0501: HH/dwelling ownership status
Q0501: HH/dwelling ownership status
Q0501: HH/dwelling ownership status
Q0501: HH/dwelling ownership status
Q0501: HH/dwelling ownership status
I would like to ask you some questions about your dwelling or home
Is this dwelling where you live…?
1 Owned by the household head and fully paid off 2 Owned by the household head but not yet fully paid off 3 Owned by someone else in household and fully paid off 4 Owned by someone else in household but not yet fully paid off 5 Rented…………………………………..…..è 6 Provided free of charge…………..……….è 7 Other, specify:
INTERVIEWER: read options to the respondent.
1
Owned in full by HH Head
2
Owned and HH Head paying
3
Owned in full by other in HH
4
Owned by other in HH and other paying
5
Rented
6
Free of charge
7
Other
8
Don't know
9
Not applicable
Q0502: Value
Q0502: Value
Q0502: Value
Q0502: Value
Q0502: Value
If the owner [you] were to sell this dwelling today, what is the approximate value (about how much is it worth)?
Use local currency.
-8
DK
Q0503: Rooms for living
Q0503: Rooms for living
Q0503: Rooms for living
Q0503: Rooms for living
Q0503: Rooms for living
How many rooms does this dwelling have in total, without counting the bathrooms/ toilets or hallways/passage ways?
-8
Don't know
98
Not applicable
Q0504: Floor
Q0504: Floor
Q0504: Floor
Q0504: Floor
Q0504: Floor
environmental risk factors / water and sanitation
What type of floor does your dwelling have?
1Hard Floor (Tile, Cement, Brick, Wood)
2 Earth Floor
1
Hard floor
2
Earth floor
8
Don't know
9
Not applicable
Q0505: Walls
Q0505: Walls
Q0505: Walls
Q0505: Walls
Q0505: Walls
What type of wall does your dwelling have?
(Circle main type)
1Cement, Brick, Stone or wood
2Mud/ Mud brick
3Thatch and other
4Plastic Sheet
5Metal Sheet
7 Other, specify:
1
Durable material
2
Mud/adobe
3
Thatch etc.
4
Plastic sheet
5
Metal sheet
7
Other
8
Don't know
9
Not applicable
Q0506: Drinking water
Q0506: Drinking water
Q0506: Drinking water
Q0506: Drinking water
Q0506: Drinking water
What is the main source of drinking water for members of this household?
(Use pictorials in Appendix A0500A)
1Piped water into dwelling …………………è Q508
2Piped water to yard/plot ………..………..èQ508
3Public tap/standpipe ……………...………..èQ507
4Tubewell/borehole ………….……………..èQ507
5Protected dug well ………………………..èQ507
6Unprotected dug well……………………..èQ507
7Protected spring…………………………..èQ507
8Unprotected spring………………………..èQ507
9Rainwater collection ……………………..èQ507
10Bottled water ……………………………..èQ506a
11Small scale vendor ………………………..èQ507
12Tanker-truck …………………………….....èQ507
13Surface water (river, dam, lake, pond, stream, canal, irrigation channels) …......èQ507
87 Other, specify: Q507
1
Piped private
2
Piped to yard/plot
3
Public tap/standpipe
4
Tubewell/borehole
5
Protected dug well
6
Unprotected dug well
7
Protected spring
8
Unprotected spring
9
Rainwater collection
10
Bottled water
11
Small scale vendor
12
Tanker-truck/lorry
13
Surface water (river, lake, etc)
87
Other, specify
88
Don't know
98
Not applicable
Q0506a: Water for handwashing
Q0506a: Water for handwashing
Q0506a: Water for handwashing
Q0506a: Water for handwashing
Q0506a: Water for handwashing
What is the main source of water used by your household for other purposes such as handwashing?
(Use pictorials in Appendix A0500A)
1Piped water into dwelling ………………è Q508
2Piped water to yard/plot ………………è Q508
3Public tap/standpipe
4Tubewell/borehole
5Protected dug well
6Unprotected dug well
7Protected spring
8Unprotected spring
9Rainwater collection
10Bottled water
11Cart with small tank/drum
12Tanker-truck
13Surface water (river, dam, lake, pond, stream, canal, irrigation channels)
87 Other, specify:
1
Piped private
2
Piped to yard/plot
3
Public standpipe
4
Tubewell/borehole
5
Protected dug well
6
Unprotected dug well
7
Protected spring
8
Unprotected spring
9
Rainwater collection
10
Bottled water
11
Small scale vendor
12
Tanker-truck/lorry
13
Surface water (river, lake, etc)
87
Other, specify
88
Don't know
98
Not applicable
Q0507: Time to fetch water
Q0507: Time to fetch water
Q0507: Time to fetch water
Q0507: Time to fetch water
Q0507: Time to fetch water
How long does it take to go there, get water and come back?
0Water on premises ……………..……...è Q508
-8 Don't know
-9
Not applicable
-8
Don't know
Water on premises
Q0507a: Who fetches water
Q0507a: Who fetches water
Q0507a: Who fetches water
Q0507a: Who fetches water
Q0507a: Who fetches water
Who usually goes to this source to fetch the water for your household?
1Adult man
2Adult woman
3Male child (under 15 years old)
4Female child (under 15 years old)
7 Other, specify:
1
Adult man
2
Adult woman
3
Male child (under 15)
4
Female child (under 15)
7
Other
8
Don't know
9
Not applicable
Q0508: Toilet facilities
Q0508: Toilet facilities
Q0508: Toilet facilities
Q0508: Toilet facilities
Q0508: Toilet facilities
What type of toilet facility do members of your household usually use?
(Use pictorials in Appendix A0500B )
If respondent indicates “flush” or “pour flush”, probe:
Where does it flush to?
1Flush/pour flush to piped sewer system
2Flush/pour flush to septic tank
3Flush/pour flush to pit latrine
4Flush/pour flush to other location
5Flush/pour flush to unknown place/not sure
6Ventilated improved pit latrine (VIP)
7Pit latrine with slab
8Pit latrine without slab/open pit
9Composting toilet
10Bucket latrine
11Hanging toilet/hanging latrine
12No facilities or bush or field …………….è Q510
87 Other, specify:
1
Flush/pour to piped sewage system
2
Flush/pour to septic tank
3
Flush/pour to pit latrine
4
Flush/pour to other location
5
Flush/pour to unknown
6
Ventilation improved pit latrine
7
Pit with slab
8
Pit witout slap/open
9
Composting toilet
10
Bucket
11
Hanging toilet/latrine
12
No facilities (bush, field)
87
Other, specify
88
Don't know
98
Not applicable
Q0509: Toilet shared?
Q0509: Toilet shared?
Q0509: Toilet shared?
Q0509: Toilet shared?
Q0509: Toilet shared?
Do you share this facility with other households?
1 =Yes
2= No
1
Yes
2
No
8
Don't know
9
Not applicable (NA)
Q0510: Cooking fuel
Q0510: Cooking fuel
Q0510: Cooking fuel
Q0510: Cooking fuel
Q0510: Cooking fuel
What type of fuel does your household mainly use for cooking?
1Gas ……………………………..….……...è Q601
2Electricity ……………………..……....….èQ601
3Kerosene/paraffin …………………...….èQ601
4Coal/Charcoal
5Wood
6Agriculture/crop
7Animal dung
8Shrubs/grass
87 Other, specify:
-8
DK
1
Gas
2
Electricity
3
Kerosene/paraffin
4
Coal, charcoal
5
Wood
6
Agricultural residue
7
Animal dung
8
Shrubs, grass
87
Other
88
Don't know
98
Not applicable
Q0511: Food cooked on?
Q0511: Food cooked on?
Q0511: Food cooked on?
Q0511: Food cooked on?
Q0511: Food cooked on?
In this household, is food cooked on an open fire, an open or closed stove?
INTERVIEWER: indicate main type.
Use pictorials in Appendix A0500C.
1Open fire
2Open stove
3Closed stove
7 Other, specify:
1
Open fire
2
Open stove
3
Closed stove
7
Other
8
Don't know
9
Not applicable
Q0512: Fire/stove have chimney or hood?
Q0512: Fire/stove have chimney or hood?
Q0512: Fire/stove have chimney or hood?
Q0512: Fire/stove have chimney or hood?
Q0512: Fire/stove have chimney or hood?
Does the fire/stove have a chimney, hood or neither?
1Chimney
2Hood
3 Neither
1
Chimney
2
Hood
3
Neither
8
Don't know
9
Not applicable
Q0513: Where cooking usually done?
Q0513: Where cooking usually done?
Q0513: Where cooking usually done?
Q0513: Where cooking usually done?
Q0513: Where cooking usually done?
Where is cooking usually done?
1In a room used for living or sleeping
2In a separate room used as kitchen
3In a separate building used as kitchen
4Outdoor
7 Other, specify:
1
In room used for living or sleeping
2
In separate room used as kitchen
3
In separate building used as kitchen
4
Outdoor
7
Other, specify
8
Don't know
9
Not applicable
S0600: HH begin
S0600: HH begin
S0600: HH begin
S0600: HH begin
S0600: HH begin
The next questions are about your family and friends, specifically those not living with you in this household. Families and friends sometimes help one another in a variety of different ways, and each type of help or support can be important. Part of our survey involves finding out how they do that. We would now like to ask some questions about your family and friends who do not live with you, and the different ways in which you help or support each other. The next questions are about help received by your household in the last 12 months.
INTERVIEWER: The first part of this section is intended to collect information about sources of transfers into the household from those outside the household.
S0600: MM begin
S0600: MM begin
S0600: MM begin
S0600: MM begin
S0600: MM begin
The next questions are about your family and friends, specifically those not living with you in this household. Families and friends sometimes help one another in a variety of different ways, and each type of help or support can be important. Part of our survey involves finding out how they do that. We would now like to ask some questions about your family and friends who do not live with you, and the different ways in which you help or support each other. The next questions are about help received by your household in the last 12 months.
INTERVIEWER: The first part of this section is intended to collect information about sources of transfers into the household from those outside the household.
S0600: HH end
S0600: HH end
S0600: HH end
S0600: HH end
S0600: HH end
The next questions are about your family and friends, specifically those not living with you in this household. Families and friends sometimes help one another in a variety of different ways, and each type of help or support can be important. Part of our survey involves finding out how they do that. We would now like to ask some questions about your family and friends who do not live with you, and the different ways in which you help or support each other. The next questions are about help received by your household in the last 12 months.
INTERVIEWER: The first part of this section is intended to collect information about sources of transfers into the household from those outside the household.
S0600: MM end
S0600: MM end
S0600: MM end
S0600: MM end
S0600: MM end
The next questions are about your family and friends, specifically those not living with you in this household. Families and friends sometimes help one another in a variety of different ways, and each type of help or support can be important. Part of our survey involves finding out how they do that. We would now like to ask some questions about your family and friends who do not live with you, and the different ways in which you help or support each other. The next questions are about help received by your household in the last 12 months.
INTERVIEWER: The first part of this section is intended to collect information about sources of transfers into the household from those outside the household.
Q0601: Family
Q0601: Family
Q0601: Family
Q0601: Family
Q0601: Family
In the last 12 months, has anyone in the household received any financial or in-kind support from your family (children, siblings or parents) and relatives (other kin) who do not live with you?
1Yes
2No…………………………….……. èQ0604
8 Don't know………………………... è Q0604
1
Help from family received
2
Help not received from family
8
Don't know
9
Not applicable
Q0602aA: Money, loans, tuition, etc
Q0602aA: Money, loans, tuition, etc
Q0602aA: Money, loans, tuition, etc
Q0602aA: Money, loans, tuition, etc
Q0602aA: Money, loans, tuition, etc
What type of financial or in-kind support did your household receive?
Money, loans, tuition, paying for bills, fees or taxes (that is, cash)?
1Yes
2No - b
8 DK
If Yes, è Column B.
If no è skip to next Q
1
Yes
2
No
8
Don't know
Q0602aB: Amount
Q0602aB: Amount
Q0602aB: Amount
Q0602aB: Amount
Q0602aB: Amount
What type of financial or in-kind support did your household receive?
Money, loans, tuition, paying for bills, fees or taxes (that is, cash)?
8 DK
About how much was this amount in total over the last 12 months? (cash or cash equivalent)
-8
DK
Q0602bA: Food, land, livestock
Q0602bA: Food, land, livestock
Q0602bA: Food, land, livestock
Q0602bA: Food, land, livestock
Q0602bA: Food, land, livestock
What type of financial or in-kind support did your household receive?
Value of food or other goods (that is, non-monetary)?
1Yes
2No ---c
8 DK
If Yes, è Column B.
If no è skip to next Q
1
Yes
2
No
8
Don't know
Q0602bB: Amount
Q0602bB: Amount
Q0602bB: Amount
Q0602bB: Amount
Q0602bB: Amount
What type of financial or in-kind support did your household receive?
Value of food or other goods (that is, non-monetary)?
8 DK
About how much was this amount in total over the last 12 months? (cash or cash equivalent)
-8
DK
Q0602cA: HH chores, personal care
Q0602cA: HH chores, personal care
Q0602cA: HH chores, personal care
Q0602cA: HH chores, personal care
Q0602cA: HH chores, personal care
What type of financial or in-kind support did your household receive?
Doing household chores or activities (meal preparation, shopping, cleaning, laundry), providing care or transportation (help getting around outside the home)?
1Yes
2No to Q0603
8 DK
If Yes, è Column B.
If no è skip to next Q
INTERVIEWER: This DOES NOT include paid or hired help.
1
Yes
2
No
8
Don't know
Q0602cB: Hours per week
Q0602cB: Hours per week
Q0602cB: Hours per week
Q0602cB: Hours per week
Q0602cB: Hours per week
What type of financial or in-kind support did your household receive?
Doing household chores or activities (meal preparation, shopping, cleaning, laundry), providing care or transportation (help getting around outside the home)?
Average hours per week
-8 Don't know
About how much was this amount in total over the last 12 months? (cash or cash equivalent)
INTERVIEWER: This DOES NOT include paid or hired help.
-8
DK
Q0603: Rely on support?
Q0603: Rely on support?
Q0603: Rely on support?
Q0603: Rely on support?
Q0603: Rely on support?
Keeping the support you just identified in mind, do you consider this as income or support that the household can count on in the future?
1Yes
2No
8 Don't know
1
Yes
2
No
8
Don't know
Q0604: Support from community?
Q0604: Support from community?
Q0604: Support from community?
Q0604: Support from community?
Q0604: Support from community?
In the last 12 months, has your household received any financial or in-kind support from any clubs, or groups in your community?
1Yes
2No…………………………….…….…Q0607
8 Don't know….................Q0607
1
Help from community received
2
No community help received
8
Don't know
Q0605aA: Money, loans, tuition, etc
Q0605aA: Money, loans, tuition, etc
Q0605aA: Money, loans, tuition, etc
Q0605aA: Money, loans, tuition, etc
Q0605aA: Money, loans, tuition, etc
What type of financial or in-kind support did your household receive?
Money, loans, tuition, paying for bills, fees or taxes (that is, cash)?
1Yes
2No to b
8 DK
1
Yes
2
No
8
Don't know
Q0605aB: Amount
Q0605aB: Amount
Q0605aB: Amount
Q0605aB: Amount
Q0605aB: Amount
What type of financial or in-kind support did your household receive?
Money, loans, tuition, paying for bills, fees or taxes (that is, cash)?
About how much was this amount in total over the last 12 months? (cash or cash equivalent)
8 Don't know
-8
DK
Q0605bA: Food, land, livestock
Q0605bA: Food, land, livestock
Q0605bA: Food, land, livestock
Q0605bA: Food, land, livestock
Q0605bA: Food, land, livestock
What type of financial or in-kind support did your household receive?
Value of food or other goods (that is, non-monetary)?
1Yes
2No to c
8 DK
1
Yes
2
No
8
Don't know
Q0605bB: Amount
Q0605bB: Amount
Q0605bB: Amount
Q0605bB: Amount
Q0605bB: Amount
What type of financial or in-kind support did your household receive?
About how much was this amount in total over the last 12 months? (cash or cash equivalent)
8 Don't know
-8
DK
Q0605cA: HH chores, personal care
Q0605cA: HH chores, personal care
Q0605cA: HH chores, personal care
Q0605cA: HH chores, personal care
Q0605cA: HH chores, personal care
What type of financial or in-kind support did your household receive?
Doing household chores or activities (meal preparation, shopping, cleaning, laundry), providing care or transportation (help getting around outside the home)?
1Yes
2No to Q0606
8 DK
INTERVIEWER: This DOES NOT include paid or hired help.
1
Yes
2
No
8
Don't know
Q0605cB: Hours per week
Q0605cB: Hours per week
Q0605cB: Hours per week
Q0605cB: Hours per week
Q0605cB: Hours per week
What type of financial or in-kind support did your household receive?
About how much was this amount in total over the last 12 months? (cash or cash equivalent)
Average hours per week
-8 Don't know
-8
DK
Q0606: Rely on support?
Q0606: Rely on support?
Q0606: Rely on support?
Q0606: Rely on support?
Q0606: Rely on support?
Keeping in mind what you just described from your community, do you consider this support as income that the household can count on in the future?
1Yes
2No
8 Don't know
1
Yes
2
No
8
Don't know
Q0607: Support from government?
Q0607: Support from government?
Q0607: Support from government?
Q0607: Support from government?
Q0607: Support from government?
In the last 12 months, has your household received any financial or in-kind support from the government?
1Yes
2No……………………….………Q0610
8 don't know………………..…………… .Q0610
1
Yes
2
No
8
Don't know
Q0608aA: Money, loans, tuition, etc
Q0608aA: Money, loans, tuition, etc
Q0608aA: Money, loans, tuition, etc
Q0608aA: Money, loans, tuition, etc
Q0608aA: Money, loans, tuition, etc
What type of support did your household receive?
Money, loans, tuition, paying for bills, fees or taxes (that is, cash)?
f Yes, to Column B
If no to skip to next Q
1Yes
2No to b
8 DK
1
Yes
2
No
8
Don't know
Q0608aB: Amount
Q0608aB: Amount
Q0608aB: Amount
Q0608aB: Amount
Q0608aB: Amount
What type of support did your household receive?
About how much was this amount in total over the last 12 months? (cash or cash equivalent)
8 Don't know
-8
DK
Q0608bA: Food, land, livestock
Q0608bA: Food, land, livestock
Q0608bA: Food, land, livestock
Q0608bA: Food, land, livestock
Q0608bA: Food, land, livestock
What type of support did your household receive?
Value of food or other goods (that is, non-monetary)?
1Yes
2 No to Q0609
1
Yes
2
No
8
Don't know
Q0608bB: Amount
Q0608bB: Amount
Q0608bB: Amount
Q0608bB: Amount
Q0608bB: Amount
What type of support did your household receive?
About how much was this amount in total over the last 12 months? (cash or cash equivalent)
8 Don't know
-8
DK
Q0609: Rely on support
Q0609: Rely on support
Q0609: Rely on support
Q0609: Rely on support
Q0609: Rely on support
Keeping in mind what you just described from the government, do you consider this as income or support that the household can count on in the future?
1Yes
2No
8 don't know
1
Yes
2
No
8
Don't know
Q0610: Support provided?
Q0610: Support provided?
Q0610: Support provided?
Q0610: Support provided?
Q0610: Support provided?
Now, moving away from assistance your household received, we would like to find out what financial and in-kind assistance you or other members of your household provided in the last 12 months to others who do not live with you.
In the last 12 months, has your household provided any financial or in-kind support to any of your children, grandchildren and/or other relatives (and those of your spouse) who do not live in this household?
1yes
2no….……………………….………Q0612
8 Don't know…................Q0612
1
Help to family provided
2
No help to family provided
8
Don't know
Q0611aA: Money, loans, tuition, etc
Q0611aA: Money, loans, tuition, etc
Q0611aA: Money, loans, tuition, etc
Q0611aA: Money, loans, tuition, etc
Q0611aA: Money, loans, tuition, etc
What type of financial or in-kind support did your household give?
Money, loans, tuition, paying for bills, fees or taxes (cash)?
A.
If Yes, ....... Column B
If no .......skip to next Q
1
Yes
2
No
8
Don't know
Q0611aB: Amount
Q0611aB: Amount
Q0611aB: Amount
Q0611aB: Amount
Q0611aB: Amount
What type of financial or in-kind support did your household give?
Money, loans, tuition, paying for bills, fees or taxes (cash)?
About how much was this amount in total over the last 12 months? (cash or cash equivalent)
8 Don't know
-8
DK
Q0611bA: Food, land, livestock
Q0611bA: Food, land, livestock
Q0611bA: Food, land, livestock
Q0611bA: Food, land, livestock
Q0611bA: Food, land, livestock
What type of financial or in-kind support did your household give?
Value of food or other goods (that is, non-monetary)?
If Yes, to Column B
If no to skip to next Q
1 YES
2 NO to c
8 DK
1
Yes
2
No
8
Don't know
Q0611bB: Amount
Q0611bB: Amount
Q0611bB: Amount
Q0611bB: Amount
Q0611bB: Amount
What type of financial or in-kind support did your household give?
Q0611b. Value of food or other goods (that is, non-monetary)?
About how much was this amount in total over the last 12 months? (cash or cash equivalent)
8 Don't know
-8
DK
Q0611cA: HH chores, personal care
Q0611cA: HH chores, personal care
Q0611cA: HH chores, personal care
Q0611cA: HH chores, personal care
Q0611cA: HH chores, personal care
What type of financial or in-kind support did your household give?
Doing household chores or activities (meal preparation, shopping, cleaning, laundry), providing care or transportation (help getting around outside the home)?
If Yes, to Column B
If no to skip to next Q
1 YES
2 NO to Q0612
8 DK
INTERVIEWER: This DOES NOT include paid or hired help.
1
Yes
2
No
8
Don't know
Q0611cB: Hours per week
Q0611cB: Hours per week
Q0611cB: Hours per week
Q0611cB: Hours per week
Q0611cB: Hours per week
What type of financial or in-kind support did your household give?
Doing household chores or activities (meal preparation, shopping, cleaning, laundry), providing care or transportation (help getting around outside the home)?
About how much was this amount in total over the last 12 months? (cash or cash equivalent)
Average hours per week
-8 Don't know
INTERVIEWER: This DOES NOT include paid or hired help.
-8
DK
Q0612: Support provided?
Q0612: Support provided?
Q0612: Support provided?
Q0612: Support provided?
Q0612: Support provided?
In the last 12 months, has your household provided financial or in-kind support to any other kin, neighbours, or community members/groups?
1Yes
2 No ------------------------------Q0614
8 Don't know…--------- Q0614
1
Help to community/neighbors provided
2
No help to community/neighbors provided
8
Don't know
Q0613aA: Money, loans, tuition, etc
Q0613aA: Money, loans, tuition, etc
Q0613aA: Money, loans, tuition, etc
Q0613aA: Money, loans, tuition, etc
Q0613aA: Money, loans, tuition, etc
What type of support did your household give?
Money, loans, tuition, paying for bills, fees or taxes?
If Yes, to Column B
If no to skip to next Q
1Yes
2No to b
8 DK
1
Yes
2
No
8
Don't know
Q0613aB: Amount
Q0613aB: Amount
Q0613aB: Amount
Q0613aB: Amount
Q0613aB: Amount
What type of support did your household give?
Money, loans, tuition, paying for bills, fees or taxes?
About how much was this amount in total over the last 12 months? (cash or cash equivalent)
8 Don't know
-8
DK
Q0613bA: Food, land, livestock
Q0613bA: Food, land, livestock
Q0613bA: Food, land, livestock
Q0613bA: Food, land, livestock
Q0613bA: Food, land, livestock
What type of support did your household give?
Value of food or other goods (that is, non-monetary)?
If Yes, to Column B
If no to skip to next Q
1Yes
2No to c
8 DK
1
Yes
2
No
8
Don't know
Q0613bB: Amount
Q0613bB: Amount
Q0613bB: Amount
Q0613bB: Amount
Q0613bB: Amount
What type of support did your household give?
Value of food or other goods (that is, non-monetary)?
About how much was this amount in total over the last 12 months? (cash or cash equivalent)
8 Don't know
-8
DK
Q0613cA: HH chores, personal care
Q0613cA: HH chores, personal care
Q0613cA: HH chores, personal care
Q0613cA: HH chores, personal care
Q0613cA: HH chores, personal care
What type of support did your household give?
Doing household chores or activities (meal preparation, shopping, cleaning, laundry), providing care or transportation (help getting around outside the home)?
If Yes, to Column B
If no to skip to next Q
1Yes
2Noto Q0614
8 DK
INTERVIEWER: This DOES NOT include paid or hired help.
1
Yes
2
No
8
Don't know
Q0613cB: Hours per week
Q0613cB: Hours per week
Q0613cB: Hours per week
Q0613cB: Hours per week
Q0613cB: Hours per week
What type of support did your household give?
Doing household chores or activities (meal preparation, shopping, cleaning, laundry), providing care or transportation (help getting around outside the home)?
About how much was this amount in total over the last 12 months? (cash or cash equivalent)
average hours per week
-8 Don't know
INTERVIEWER: This DOES NOT include paid or hired help.
-8
DK
Q0614: Help with health care
Q0614: Help with health care
Q0614: Help with health care
Q0614: Help with health care
Q0614: Help with health care
During the last 12 months, did you or someone in your household provide help to a relative or friend (adult or child), because this person has a long-term physical or mental illness or disability, or is getting old and weak?
1 yes
2 no--------------Q0701
1
Yes
2
No
8
Don't know
Q0615a: Personal care Y/N
Q0615a: Personal care Y/N
Q0615a: Personal care Y/N
Q0615a: Personal care Y/N
Q0615a: Personal care Y/N
Please tell me the kind of care that was provided:
Helped with personal care, such as going to the toilet, washing, getting dressed, and eating?
If Yes, to Column B
If no to skip to next Q
1yes
2no to b
8 DK
1
Yes
2
No
8
Don't know
9
Not applicable
Q0615a: Personal ave hrs/wk
Q0615a: Personal ave hrs/wk
Q0615a: Personal ave hrs/wk
Q0615a: Personal ave hrs/wk
Q0615a: Personal ave hrs/wk
Please tell me the kind of care that was provided:
Helped with personal care, such as going to the toilet, washing, getting dressed, and eating?
About how many hours per week, on average, was this over the last 12 months?
average hours/ week
-8 Don't know
-8
DK
Q0615b: Medical care Y/N
Q0615b: Medical care Y/N
Q0615b: Medical care Y/N
Q0615b: Medical care Y/N
Q0615b: Medical care Y/N
Please tell me the kind of care that was provided:
Helped with medical care, like changing bandages and giving medicines?
If Yes, to Column B
If no to skip to next Q
1yes
2no to c
8 DK
1
Yes
2
No
8
Don't know
Q0615b: Medical ave hrs/wk
Q0615b: Medical ave hrs/wk
Q0615b: Medical ave hrs/wk
Q0615b: Medical ave hrs/wk
Q0615b: Medical ave hrs/wk
Please tell me the kind of care that was provided:
Helped with medical care, like changing bandages and giving medicines?
About how many hours per week, on average, was this over the last 12 months?
average hours/ week
-8 Don't know
-8
DK
Q0615c: Watching over Y/N
Q0615c: Watching over Y/N
Q0615c: Watching over Y/N
Q0615c: Watching over Y/N
Q0615c: Watching over Y/N
Please tell me the kind of care that was provided:
Watched over them since their behaviour can be upsetting or dangerous to themselves or others?
If Yes, to Column B
If no to skip to next Q
1yes
2no
8 DK
1
Yes
2
No
8
Don't know
Q0615c: Watching ave hrs/wk
Q0615c: Watching ave hrs/wk
Q0615c: Watching ave hrs/wk
Q0615c: Watching ave hrs/wk
Q0615c: Watching ave hrs/wk
Please tell me the kind of care that was provided:
Watched over them since their behaviour can be upsetting or dangerous to themselves or others?
About how many hours per week, on average, was this over the last 12 months?
average hours/ week
-8 Don't know
-8
DK
S0700: HH begin
S0700: HH begin
S0700: HH begin
S0700: HH begin
S0700: HH begin
S0700: MM begin
S0700: MM begin
S0700: MM begin
S0700: MM begin
S0700: MM begin
S0700: HH end
S0700: HH end
S0700: HH end
S0700: HH end
S0700: HH end
S0700: MM end
S0700: MM end
S0700: MM end
S0700: MM end
S0700: MM end
Q0701: #1 Number of 'asset #1' owned
Q0701: #1 Number of 'asset #1' owned
Q0701: #1 Number of 'asset #1' owned
Q0701: #1 Number of 'asset #1' owned
Q0701: #1 Number of 'asset #1' owned
permanent income indicators (assets)
I would like to ask you a few more questions about your home and items you might have in your home. remember that any information you provide will be kept confidential.
How many chairs are there in your household?
(If none enter “00”)
-8
Don't know
Q0702: #2 - # of 'tables' owned/or security system(1=Y/2=N)
Q0702: #2 - # of 'tables' owned/or security system(1=Y/2=N)
Q0702: #2 - # of 'tables' owned/or security system(1=Y/2=N)
Q0702: #2 - # of 'tables' owned/or security system(1=Y/2=N)
Q0702: #2 - # of 'tables' owned/or security system(1=Y/2=N)
permanent income indicators (assets)
I would like to ask you a few more questions about your home and items you might have in your home. remember that any information you provide will be kept confidential.
How many tables are there in your household?
(If none enter “00”)
-8
Don't know
Q0703: #3 Number of cars/vehicles owned
Q0703: #3 Number of cars/vehicles owned
Q0703: #3 Number of cars/vehicles owned
Q0703: #3 Number of cars/vehicles owned
Q0703: #3 Number of cars/vehicles owned
permanent income indicators (assets)
I would like to ask you a few more questions about your home and items you might have in your home. remember that any information you provide will be kept confidential.
How many cars are there in your household?
(If none enter “00”)
-8
Don't know
Q0704: #4 Electricity
Q0704: #4 Electricity
Q0704: #4 Electricity
Q0704: #4 Electricity
Q0704: #4 Electricity
permanent income indicators (assets)
I would like to ask you a few more questions about your home and items you might have in your home. remember that any information you provide will be kept confidential.
Does your home have electricity
1
Yes
2
No
8
Don't know
Q0705: Asset #5
Q0705: Asset #5
Q0705: Asset #5
Q0705: Asset #5
Q0705: Asset #5
A bicycle
1
Yes
2
No
8
DK
Q0706: Asset #6
Q0706: Asset #6
Q0706: Asset #6
Q0706: Asset #6
Q0706: Asset #6
A clock?
1
Yes
2
No
8
DK
Q0707: Asset #7
Q0707: Asset #7
Q0707: Asset #7
Q0707: Asset #7
Q0707: Asset #7
A bucket?
1
Yes
2
No
8
DK
Q0708: Asset #8
Q0708: Asset #8
Q0708: Asset #8
Q0708: Asset #8
Q0708: Asset #8
A cot / bed / mattress?
1
Yes
2
No
8
DK
Q0709: #9 Dishwasher
Q0709: #9 Dishwasher
Q0709: #9 Dishwasher
Q0709: #9 Dishwasher
Q0709: #9 Dishwasher
A dishwasher?
1
Yes
2
No
8
DK
Q0710: #10 Refrigerator/freezer
Q0710: #10 Refrigerator/freezer
Q0710: #10 Refrigerator/freezer
Q0710: #10 Refrigerator/freezer
Q0710: #10 Refrigerator/freezer
A refrigerator?
1
Yes
2
No
8
DK
Q0711: Asset #11
Q0711: Asset #11
Q0711: Asset #11
Q0711: Asset #11
Q0711: Asset #11
A fixed-line telephone?
1
Yes
2
No
8
DK
Q0712: Asset#12
Q0712: Asset#12
Q0712: Asset#12
Q0712: Asset#12
Q0712: Asset#12
A mobile / cellular telephone?
1
Yes
2
No
8
DK
Q0713: Asset#13
Q0713: Asset#13
Q0713: Asset#13
Q0713: Asset#13
Q0713: Asset#13
A television?
1
Yes
2
No
8
DK
Q0714: Asset#14
Q0714: Asset#14
Q0714: Asset#14
Q0714: Asset#14
Q0714: Asset#14
A computer?
1
Yes
2
No
8
DK
Q0715: Asset#15
Q0715: Asset#15
Q0715: Asset#15
Q0715: Asset#15
Q0715: Asset#15
A radio / tape or CD player?
1
Yes
2
No
8
DK
Q0716: Asset#16
Q0716: Asset#16
Q0716: Asset#16
Q0716: Asset#16
Q0716: Asset#16
Livestock (cattle only)?
1
Yes
2
No
8
DK
Q0717: Asset#17
Q0717: Asset#17
Q0717: Asset#17
Q0717: Asset#17
Q0717: Asset#17
A sewing machine?
1
Yes
2
No
8
DK
Q0718: Asset#18
Q0718: Asset#18
Q0718: Asset#18
Q0718: Asset#18
Q0718: Asset#18
A moped / scooter / motorcycle?
1
Yes
2
No
8
DK
Q0719: Asset#19
Q0719: Asset#19
Q0719: Asset#19
Q0719: Asset#19
Q0719: Asset#19
A bullock cart or animal drawn cart?
1
Yes
2
No
8
DK
Q0720: Land?
Q0720: Land?
Q0720: Land?
Q0720: Land?
Q0720: Land?
I would now like to know if you own any land or jewellery - and the approximate value (amount). I know this is sensitive information and will not share this with any persons outside of the survey team.
Please tell us if you own any land or jewellery and other items of value.
Land or property?
If Yes, to Column B
If no to skip to next Q
1Yes
2No to Q0721
8 DK
1
Yes
2
No
8
Don't know
9
Refused
Q0720a: Land amount
Q0720a: Land amount
Q0720a: Land amount
Q0720a: Land amount
Q0720a: Land amount
I would now like to know if you own any land or jewellery - and the approximate value (amount). I know this is sensitive information and will not share this with any persons outside of the survey team.
Please tell us if you own any land or jewellery and other items of value.
Land or property?
About how much is this worth in total? (cash equivalent)
8 Don't know
-9 Refused
-9
Refused
-8
DK
Q0721: Jewelry
Q0721: Jewelry
Q0721: Jewelry
Q0721: Jewelry
Q0721: Jewelry
I would now like to know if you own any land or jewellery - and the approximate value (amount). I know this is sensitive information and will not share this with any persons outside of the survey team.
Please tell us if you own any land or jewellery and other items of value.
Other valuable items, such as jewellery, books, art or other valuable items?
If Yes, to Column B
If no to skip to next Q
1Yes
2No to Q0722
8 DK
1
Yes
2
No
8
Don't know
9
Refused
Q0721a: Jewelry amount
Q0721a: Jewelry amount
Q0721a: Jewelry amount
Q0721a: Jewelry amount
Q0721a: Jewelry amount
I would now like to know if you own any land or jewellery - and the approximate value (amount). I know this is sensitive information and will not share this with any persons outside of the survey team.
Please tell us if you own any land or jewellery and other items of value.
Other valuable items, such as jewellery, books, art or other valuable items?
About how much is this worth in total? (cash equivalent)
8 Don't know
-9 Refused
-9
Refused
-8
DK
Q0722: Regular income?
Q0722: Regular income?
Q0722: Regular income?
Q0722: Regular income?
Q0722: Regular income?
In the last part of this section, I will ask about the total income for the household in the last 12 months (previous to today) from paid work or other sources. I would like to know about all sources of income. I know it may be difficult to calculate that figure, but please do try to give as accurate an amount as possible. Remember that all information will be kept strictly confidential. This information is important to assess overall health and well-being of people in your household compared to other similar households.
Does your household have a regular source of income?
1Yes, regular source
2Yes, regular but seasonal
3 No
Interviewer: Regular income over the last 12 months, meaning that the household can depend on a source to provide an income at intervals that can be used to base household budget decisions.
1
Yes, regular source
2
Yes, regular but seasonal
3
No
8
Don't know
9
Not applicable
Q0723aA: wages/salary
Q0723aA: wages/salary
Q0723aA: wages/salary
Q0723aA: wages/salary
Q0723aA: wages/salary
I am now going to read you a list of possible sources of income. Thinking over the last 12 months, can you tell me what the average earnings of the household have been per week or per month or per year? Please tell me whichever time period that is easier for you.
Please tell me from which of these sources members of your household receive income:
Wages, salary from job?
f Yes, to Column B
If no to go to next Q
1Yes, weekly
2Yes, monthly
3Yes, yearly
4No to b
8 DK
1
Yes, weekly
2
Yes, monthly
3
Yes, yearly
4
No
8
Don't know
Q0723aB: wages/salary (n)
Q0723aB: wages/salary (n)
Q0723aB: wages/salary (n)
Q0723aB: wages/salary (n)
Q0723aB: wages/salary (n)
I am now going to read you a list of possible sources of income. Thinking over the last 12 months, can you tell me what the average earnings of the household have been per week or per month or per year? Please tell me whichever time period that is easier for you.
Please tell me from which of these sources members of your household receive income:
Wages, salary from job?
Can you estimate an approximate total amount of income for the household over the last…
[week/month/year - time period circled in Column A]?
8 Don't know
-8
DK
Q0723bA: earnings
Q0723bA: earnings
Q0723bA: earnings
Q0723bA: earnings
Q0723bA: earnings
I am now going to read you a list of possible sources of income. Thinking over the last 12 months, can you tell me what the average earnings of the household have been per week or per month or per year? Please tell me whichever time period that is easier for you.
Please tell me from which of these sources members of your household receive income:
Earnings from selling, trading or hawking products?
f Yes, to Column B
If no to go to next Q
1Yes, weekly
2Yes, monthly
3Yes, Yearly
4No to c
8 DK
1
Yes, weekly
2
Yes, monthly
3
Yes, yearly
4
No
8
Don't know
Q0723bB: earnings (n)
Q0723bB: earnings (n)
Q0723bB: earnings (n)
Q0723bB: earnings (n)
Q0723bB: earnings (n)
I am now going to read you a list of possible sources of income. Thinking over the last 12 months, can you tell me what the average earnings of the household have been per week or per month or per year? Please tell me whichever time period that is easier for you.
Please tell me from which of these sources members of your household receive income:
Earnings from selling, trading or hawking products?
Can you estimate an approximate total amount of income for the household over the last…
[week/month/year - time period circled in Column A]?
8 Don't know
-9
NA
-8
DK
Q0723cA: rental income
Q0723cA: rental income
Q0723cA: rental income
Q0723cA: rental income
Q0723cA: rental income
I am now going to read you a list of possible sources of income. Thinking over the last 12 months, can you tell me what the average earnings of the household have been per week or per month or per year? Please tell me whichever time period that is easier for you.
Please tell me from which of these sources members of your household receive income:
Income from rental of property?
f Yes, to Column B
If no to go to next Q
1Yes, weekly
2Yes, monthly
3Yes, yearly
4No to d
8 DK
1
Yes, weekly
2
Yes, monthly
3
Yes, yearly
4
No
8
Don't know
Q0723cB: rental income (n)
Q0723cB: rental income (n)
Q0723cB: rental income (n)
Q0723cB: rental income (n)
Q0723cB: rental income (n)
I am now going to read you a list of possible sources of income. Thinking over the last 12 months, can you tell me what the average earnings of the household have been per week or per month or per year? Please tell me whichever time period that is easier for you.
Please tell me from which of these sources members of your household receive income:
Income from rental of property?
Can you estimate an approximate total amount of income for the household over the last…
[week/month/year - time period circled in Column A]?
8 Don't know
-8
DK
Q0723dA: pension
Q0723dA: pension
Q0723dA: pension
Q0723dA: pension
Q0723dA: pension
I am now going to read you a list of possible sources of income. Thinking over the last 12 months, can you tell me what the average earnings of the household have been per week or per month or per year? Please tell me whichever time period that is easier for you.
Please tell me from which of these sources members of your household receive income:
State old-age (veteran's/civil service) pension, contributory pension fund, provident fund or social security benefit?
f Yes, to Column B
If no to go to next Q
1Yes, weekly
2Yes, monthly
3Yes, yearly
4No to e
8 DK
1
Yes, weekly
2
Yes, monthly
3
Yes, yearly
4
No
8
Don't know
Q0723dB: pension (n)
Q0723dB: pension (n)
Q0723dB: pension (n)
Q0723dB: pension (n)
Q0723dB: pension (n)
I am now going to read you a list of possible sources of income. Thinking over the last 12 months, can you tell me what the average earnings of the household have been per week or per month or per year? Please tell me whichever time period that is easier for you.
Please tell me from which of these sources members of your household receive income:
State old-age (veteran's/civil service) pension, contributory pension fund, provident fund or social security benefit?
Can you estimate an approximate total amount of income for the household over the last…
[week/month/year - time period circled in Column A]?
8 Don't know
-8
DK
Q0723eA: interest/dividends
Q0723eA: interest/dividends
Q0723eA: interest/dividends
Q0723eA: interest/dividends
Q0723eA: interest/dividends
I am now going to read you a list of possible sources of income. Thinking over the last 12 months, can you tell me what the average earnings of the household have been per week or per month or per year? Please tell me whichever time period that is easier for you.
Please tell me from which of these sources members of your household receive income:
Interest, dividends (for example, from savings account or fixed deposits)?
f Yes, to Column B
If no to go to next Q
1Yes, weekly
2Yes, monthly
3Yes, yearly
4No to f
8 DK
1
Yes, weekly
2
Yes, monthly
3
Yes, yearly
4
No
8
Don't know
Q0723eB: interest (n)
Q0723eB: interest (n)
Q0723eB: interest (n)
Q0723eB: interest (n)
Q0723eB: interest (n)
I am now going to read you a list of possible sources of income. Thinking over the last 12 months, can you tell me what the average earnings of the household have been per week or per month or per year? Please tell me whichever time period that is easier for you.
Please tell me from which of these sources members of your household receive income:
Interest, dividends (for example, from savings account or fixed deposits)?
Can you estimate an approximate total amount of income for the household over the last…
[week/month/year - time period circled in Column A]?
8 Don't know
-8
DK
Q0723fA: other
Q0723fA: other
Q0723fA: other
Q0723fA: other
Q0723fA: other
I am now going to read you a list of possible sources of income. Thinking over the last 12 months, can you tell me what the average earnings of the household have been per week or per month or per year? Please tell me whichever time period that is easier for you.
Please tell me from which of these sources members of your household receive income:
Other (specify):
f Yes, to Column B
If no to go to next Q
1Yes, weekly
2Yes, monthly
3Yes, yearly
4 No to Q0724
1
Yes, weekly
2
Yes, monthly
3
Yes, yearly
4
No
8
DK
Q0723fB: other (n)
Q0723fB: other (n)
Q0723fB: other (n)
Q0723fB: other (n)
Q0723fB: other (n)
I am now going to read you a list of possible sources of income. Thinking over the last 12 months, can you tell me what the average earnings of the household have been per week or per month or per year? Please tell me whichever time period that is easier for you.
Please tell me from which of these sources members of your household receive income:
Other (specify):
Can you estimate an approximate total amount of income for the household over the last…
[week/month/year - time period circled in Column A]?
8 Don't know
-8
DK
Q0724: Total (n)
Q0724: Total (n)
Q0724: Total (n)
Q0724: Total (n)
Q0724: Total (n)
So to verify this information, your approximate total household income from ALL sources over the last 12 months is about how much?
8 don't know
-8
DK
Q0725: Dependents (n)
Q0725: Dependents (n)
Q0725: Dependents (n)
Q0725: Dependents (n)
Q0725: Dependents (n)
How many people depend on this income?
Number of peopl-e
-8 don't know
(INTERVIEWER: This number should include the respondent - so enter "01" if only the respondent depends on/is supported by this income.)
-8
DK
Q0726: Debt or loans
Q0726: Debt or loans
Q0726: Debt or loans
Q0726: Debt or loans
Q0726: Debt or loans
Does your household or any members of the household have current debt or outstanding loans?
1Yes
2No ………………to Q0720
8 don't know
1
Yes
2
No
8
Don't know
Q0726a: Total amount of debt or loans
Q0726a: Total amount of debt or loans
Q0726a: Total amount of debt or loans
Q0726a: Total amount of debt or loans
Q0726a: Total amount of debt or loans
What is the approximate total amount of this debt or loan(s)?
8 don't know
-8
DK
Q0727: Enough?
Q0727: Enough?
Q0727: Enough?
Q0727: Enough?
Q0727: Enough?
Thinking about the income for this household, do you believe that it is enough money to cover your daily living needs and obligations?
1Yes
2No
8 don't know
1
Yes
2
No
8
Don't know
Q0728: Situation
Q0728: Situation
Q0728: Situation
Q0728: Situation
Q0728: Situation
Would you say your household's financial situation is…?
1Very Good
2Good
3Moderate
4Bad
5Very Bad
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
S0800: HH begin
S0800: HH begin
S0800: HH begin
S0800: HH begin
S0800: HH begin
S0800: MM begin
S0800: MM begin
S0800: MM begin
S0800: MM begin
S0800: MM begin
S0800: HH end
S0800: HH end
S0800: HH end
S0800: HH end
S0800: HH end
S0800: MM end
S0800: MM end
S0800: MM end
S0800: MM end
S0800: MM end
Q0801a: 7d staple foods amount
Q0801a: 7d staple foods amount
Q0801a: 7d staple foods amount
Q0801a: 7d staple foods amount
Q0801a: 7d staple foods amount
I would like to ask you some questions about how much your household and all its members spends on food, household items, health services and other things. Expenditures can be monetary or in-kind. The value of in-kind payments and items produced or raised, and consumed, by the household need to be estimated and included. We ask about different time periods, so please listen carefully to the time frame.
For all questions in this section report all values in local currency, whether paid in cash or in kind.
I would like to start by asking about household expenses over the last 7 days. The next questions are about food items purchased by the household. I would like to start with asking details about the types of food your household has purchased in cash or kind and/or self-produced goods consumed in the last 7 days.
In the last 7 days, how much did your household spend on:
Q0801a. Staple foods (rice, pulses, cassava, pasta, potatoes, bread, crackers)?
8 don't know
(INTERVIEWER: Use "0" for no expenditure below.)
-8
DK
Q0801b: 7d meat amount
Q0801b: 7d meat amount
Q0801b: 7d meat amount
Q0801b: 7d meat amount
Q0801b: 7d meat amount
I would like to ask you some questions about how much your household and all its members spends on food, household items, health services and other things. Expenditures can be monetary or in-kind. The value of in-kind payments and items produced or raised, and consumed, by the household need to be estimated and included. We ask about different time periods, so please listen carefully to the time frame.
For all questions in this section report all values in local currency, whether paid in cash or in kind.
I would like to start by asking about household expenses over the last 7 days. The next questions are about food items purchased by the household. I would like to start with asking details about the types of food your household has purchased in cash or kind and/or self-produced goods consumed in the last 7 days.
In the last 7 days, how much did your household spend on:
Meat (beef, pork, lamb, mutton, chicken, turkey, duck, bushmeat, or other meat - fish or other seafood)?
8 don't know
(INTERVIEWER: Use "0" for no expenditure below.)
-8
DK
Q0801c: 7d F&V amount
Q0801c: 7d F&V amount
Q0801c: 7d F&V amount
Q0801c: 7d F&V amount
Q0801c: 7d F&V amount
I would like to ask you some questions about how much your household and all its members spends on food, household items, health services and other things. Expenditures can be monetary or in-kind. The value of in-kind payments and items produced or raised, and consumed, by the household need to be estimated and included. We ask about different time periods, so please listen carefully to the time frame.
For all questions in this section report all values in local currency, whether paid in cash or in kind.
I would like to start by asking about household expenses over the last 7 days. The next questions are about food items purchased by the household. I would like to start with asking details about the types of food your household has purchased in cash or kind and/or self-produced goods consumed in the last 7 days.
In the last 7 days, how much did your household spend on:
Fruits and vegetables?
8 don't know
(INTERVIEWER: Use "0" for no expenditure below.)
-8
DK
Q0801d: 7d Milk & eggs amount
Q0801d: 7d Milk & eggs amount
Q0801d: 7d Milk & eggs amount
Q0801d: 7d Milk & eggs amount
Q0801d: 7d Milk & eggs amount
I would like to ask you some questions about how much your household and all its members spends on food, household items, health services and other things. Expenditures can be monetary or in-kind. The value of in-kind payments and items produced or raised, and consumed, by the household need to be estimated and included. We ask about different time periods, so please listen carefully to the time frame.
For all questions in this section report all values in local currency, whether paid in cash or in kind.
I would like to start by asking about household expenses over the last 7 days. The next questions are about food items purchased by the household. I would like to start with asking details about the types of food your household has purchased in cash or kind and/or self-produced goods consumed in the last 7 days.
In the last 7 days, how much did your household spend on:
Milk and eggs?
8 don't know
(INTERVIEWER: Use "0" for no expenditure below.)
-8
DK
Q0801e: 7d spices & oils amount
Q0801e: 7d spices & oils amount
Q0801e: 7d spices & oils amount
Q0801e: 7d spices & oils amount
Q0801e: 7d spices & oils amount
I would like to ask you some questions about how much your household and all its members spends on food, household items, health services and other things. Expenditures can be monetary or in-kind. The value of in-kind payments and items produced or raised, and consumed, by the household need to be estimated and included. We ask about different time periods, so please listen carefully to the time frame.
For all questions in this section report all values in local currency, whether paid in cash or in kind.
I would like to start by asking about household expenses over the last 7 days. The next questions are about food items purchased by the household. I would like to start with asking details about the types of food your household has purchased in cash or kind and/or self-produced goods consumed in the last 7 days.
In the last 7 days, how much did your household spend on:
Spices and oils (salt, sugar, curry, garlic, ginger, pepper, chilli, or other - butter, lard, cooking oils (coconut oil, palm oil, vegetable oil, corn oil))?
8 don't know
(INTERVIEWER: Use "0" for no expenditure below.)
-8
DK
Q0801f: 7d beverages amount (non-alcoholic)
Q0801f: 7d beverages amount (non-alcoholic)
Q0801f: 7d beverages amount (non-alcoholic)
Q0801f: 7d beverages amount (non-alcoholic)
Q0801f: 7d beverages amount (non-alcoholic)
I would like to ask you some questions about how much your household and all its members spends on food, household items, health services and other things. Expenditures can be monetary or in-kind. The value of in-kind payments and items produced or raised, and consumed, by the household need to be estimated and included. We ask about different time periods, so please listen carefully to the time frame.
For all questions in this section report all values in local currency, whether paid in cash or in kind.
I would like to start by asking about household expenses over the last 7 days. The next questions are about food items purchased by the household. I would like to start with asking details about the types of food your household has purchased in cash or kind and/or self-produced goods consumed in the last 7 days.
In the last 7 days, how much did your household spend on:
Beverages and other non-alcoholic drinks such as coffee, tea, juice, water and soft drinks.
8 don't know
(INTERVIEWER: Use "0" for no expenditure below.)
-8
DK
Q0801g: 7d tobacco and alcohol amount
Q0801g: 7d tobacco and alcohol amount
Q0801g: 7d tobacco and alcohol amount
Q0801g: 7d tobacco and alcohol amount
Q0801g: 7d tobacco and alcohol amount
I would like to ask you some questions about how much your household and all its members spends on food, household items, health services and other things. Expenditures can be monetary or in-kind. The value of in-kind payments and items produced or raised, and consumed, by the household need to be estimated and included. We ask about different time periods, so please listen carefully to the time frame.
For all questions in this section report all values in local currency, whether paid in cash or in kind.
I would like to start by asking about household expenses over the last 7 days. The next questions are about food items purchased by the household. I would like to start with asking details about the types of food your household has purchased in cash or kind and/or self-produced goods consumed in the last 7 days.
In the last 7 days, how much did your household spend on:
Tobacco and alcoholic beverages (including, beer, wine, spirits)?
8 don't know
(INTERVIEWER: Use "0" for no expenditure below.)
-8
DK
Q0801h: 7d food outside HH amount
Q0801h: 7d food outside HH amount
Q0801h: 7d food outside HH amount
Q0801h: 7d food outside HH amount
Q0801h: 7d food outside HH amount
I would like to ask you some questions about how much your household and all its members spends on food, household items, health services and other things. Expenditures can be monetary or in-kind. The value of in-kind payments and items produced or raised, and consumed, by the household need to be estimated and included. We ask about different time periods, so please listen carefully to the time frame.
For all questions in this section report all values in local currency, whether paid in cash or in kind.
I would like to start by asking about household expenses over the last 7 days. The next questions are about food items purchased by the household. I would like to start with asking details about the types of food your household has purchased in cash or kind and/or self-produced goods consumed in the last 7 days.
In the last 7 days, how much did your household spend on:
Food eaten outside the dwelling (for example, at vendors, kiosks or restaurants)?
8 don't know
(INTERVIEWER: Use "0" for no expenditure below.)
-8
DK
Q0801i: 7d all other foods/drink amount
Q0801i: 7d all other foods/drink amount
Q0801i: 7d all other foods/drink amount
Q0801i: 7d all other foods/drink amount
Q0801i: 7d all other foods/drink amount
I would like to ask you some questions about how much your household and all its members spends on food, household items, health services and other things. Expenditures can be monetary or in-kind. The value of in-kind payments and items produced or raised, and consumed, by the household need to be estimated and included. We ask about different time periods, so please listen carefully to the time frame.
For all questions in this section report all values in local currency, whether paid in cash or in kind.
I would like to start by asking about household expenses over the last 7 days. The next questions are about food items purchased by the household. I would like to start with asking details about the types of food your household has purchased in cash or kind and/or self-produced goods consumed in the last 7 days.
In the last 7 days, how much did your household spend on:
All other food items.
8 don't know
(INTERVIEWER: Use "0" for no expenditure below.)
-8
DK
Q0802: 7d food overall amount
Q0802: 7d food overall amount
Q0802: 7d food overall amount
Q0802: 7d food overall amount
Q0802: 7d food overall amount
Please if you could now give us a total of how much your household spent overall on food items.
In the last 7 days, how much did your household spend on food items overall?
8 don't know
-8
DK
Q0803a: 4-wk housing and utilities
Q0803a: 4-wk housing and utilities
Q0803a: 4-wk housing and utilities
Q0803a: 4-wk housing and utilities
Q0803a: 4-wk housing and utilities
Now I will shift into expenses for your household over the last 30 days. We are interested in frequent or regularly occurring non-food expenditures for the household.
In the last 30 days, how much did your household spend on:
Housing and utilities (rent, mortgage, electricity, heating/cooking fuel, water, telephone…)?
8 don't know
-8
DK
Q0803b: 4-wk clothing & other personal items
Q0803b: 4-wk clothing & other personal items
Q0803b: 4-wk clothing & other personal items
Q0803b: 4-wk clothing & other personal items
Q0803b: 4-wk clothing & other personal items
Now I will shift into expenses for your household over the last 30 days. We are interested in frequent or regularly occurring non-food expenditures for the household.
In the last 30 days, how much did your household spend on:
Clothing (footwear, hats, shirts, pants, dresses, skirt, jackets, coats…) and other personal items (soap, shampoo, cosmetics, shaving cream…)?
8 don't know
-8
DK
Q0803c: 4-wk transportation
Q0803c: 4-wk transportation
Q0803c: 4-wk transportation
Q0803c: 4-wk transportation
Q0803c: 4-wk transportation
Now I will shift into expenses for your household over the last 30 days. We are interested in frequent or regularly occurring non-food expenditures for the household.
In the last 30 days, how much did your household spend on:
Transportation (bus fares, cab/taxi fares, vehicle repair costs, petrol…)?
8 don't know
-8
DK
Q0803d: 4-wk recreation & entertainment
Q0803d: 4-wk recreation & entertainment
Q0803d: 4-wk recreation & entertainment
Q0803d: 4-wk recreation & entertainment
Q0803d: 4-wk recreation & entertainment
Now I will shift into expenses for your household over the last 30 days. We are interested in frequent or regularly occurring non-food expenditures for the household.
In the last 30 days, how much did your household spend on:
Recreation and entertainment?
8 don't know
-8
DK
Q0803e: 4-wk all other, amount
Q0803e: 4-wk all other, amount
Q0803e: 4-wk all other, amount
Q0803e: 4-wk all other, amount
Q0803e: 4-wk all other, amount
Now I will shift into expenses for your household over the last 30 days. We are interested in frequent or regularly occurring non-food expenditures for the household.
In the last 30 days, how much did your household spend on:
All other goods and services?
Specify:
8 don't know
NTERVIEWER: See QxQ for acceptable items - do not include "big expenditure" items that would be listed as expenditures in the last 12 months (Q0811-0821)
-8
DK
Q0804: 4-wk professional fees
Q0804: 4-wk professional fees
Q0804: 4-wk professional fees
Q0804: 4-wk professional fees
Q0804: 4-wk professional fees
I would like to ask you more specific questions about how much your household and all its members spent in cash or in-kind on all health care and services that did not require an overnight stay. Again, we want expenses in the last 30 days. If payment was in-kind, please estimate a monetary value. Please exclude costs to be reimbursed by insurance.
In the last 30 days, how much did your household spend on:
Registration and consultation fees by doctors, nurses, or trained midwives that did not require an overnight stay?
8 don't know
-8
DK
Q0805: 4-wk health care traditional/alt healers
Q0805: 4-wk health care traditional/alt healers
Q0805: 4-wk health care traditional/alt healers
Q0805: 4-wk health care traditional/alt healers
Q0805: 4-wk health care traditional/alt healers
I would like to ask you more specific questions about how much your household and all its members spent in cash or in-kind on all health care and services that did not require an overnight stay. Again, we want expenses in the last 30 days. If payment was in-kind, please estimate a monetary value. Please exclude costs to be reimbursed by insurance.
In the last 30 days, how much did your household spend on:
Health care by traditional or alternative healers (use other local names)?
8 don't know
-8
DK
Q0806: 4-wk health care diagnostic and lab tests
Q0806: 4-wk health care diagnostic and lab tests
Q0806: 4-wk health care diagnostic and lab tests
Q0806: 4-wk health care diagnostic and lab tests
Q0806: 4-wk health care diagnostic and lab tests
I would like to ask you more specific questions about how much your household and all its members spent in cash or in-kind on all health care and services that did not require an overnight stay. Again, we want expenses in the last 30 days. If payment was in-kind, please estimate a monetary value. Please exclude costs to be reimbursed by insurance.
In the last 30 days, how much did your household spend on:
Diagnostic and laboratory tests such as X-rays or blood tests?
8 don't know
-8
DK
Q0807: 4-wk health care medications
Q0807: 4-wk health care medications
Q0807: 4-wk health care medications
Q0807: 4-wk health care medications
Q0807: 4-wk health care medications
I would like to ask you more specific questions about how much your household and all its members spent in cash or in-kind on all health care and services that did not require an overnight stay. Again, we want expenses in the last 30 days. If payment was in-kind, please estimate a monetary value. Please exclude costs to be reimbursed by insurance.
In the last 30 days, how much did your household spend on:
Medications or drugs (prescription, non-prescription, traditional, homeopathic…)?
8 don't know
-8
DK
Q0808: 4-wk dentists or dental care
Q0808: 4-wk dentists or dental care
Q0808: 4-wk dentists or dental care
Q0808: 4-wk dentists or dental care
Q0808: 4-wk dentists or dental care
I would like to ask you more specific questions about how much your household and all its members spent in cash or in-kind on all health care and services that did not require an overnight stay. Again, we want expenses in the last 30 days. If payment was in-kind, please estimate a monetary value. Please exclude costs to be reimbursed by insurance.
In the last 30 days, how much did your household spend on:
Dentists or dental care?
8 don't know
-8
DK
Q0809: 4-wk ambulance transport
Q0809: 4-wk ambulance transport
Q0809: 4-wk ambulance transport
Q0809: 4-wk ambulance transport
Q0809: 4-wk ambulance transport
I would like to ask you more specific questions about how much your household and all its members spent in cash or in-kind on all health care and services that did not require an overnight stay. Again, we want expenses in the last 30 days. If payment was in-kind, please estimate a monetary value. Please exclude costs to be reimbursed by insurance.
In the last 30 days, how much did your household spend on:
Ambulance?
8 don't know
-8
DK
Q0810: 4-wk other, amount
Q0810: 4-wk other, amount
Q0810: 4-wk other, amount
Q0810: 4-wk other, amount
Q0810: 4-wk other, amount
I would like to ask you more specific questions about how much your household and all its members spent in cash or in-kind on all health care and services that did not require an overnight stay. Again, we want expenses in the last 30 days. If payment was in-kind, please estimate a monetary value. Please exclude costs to be reimbursed by insurance.
In the last 30 days, how much did your household spend on:
Any other health care products or services that were not included above?
Specify:
8 don't know
-9
Missing
-8
DK
Q0811: 12mo education fees and supplies
Q0811: 12mo education fees and supplies
Q0811: 12mo education fees and supplies
Q0811: 12mo education fees and supplies
Q0811: 12mo education fees and supplies
I know these questions may be difficult to answer - try to give us the best estimate of expenses. Now I want you to focus on household expenses over the last 12 months. These are expenses that may be more periodic or "big purchases". I would like to ask how much money was spent by all household members for the following items in the last 12 months
In the last 12 months, how much did your household spend on:
Education fees and supplies (tuition, course fees, books)?
8 don't know
-8
DK
* Examples of Mandatory include: ESIS, CGHS, RHS, DMS, ECHS, MREG, MREP, OHIE
** Examples of Voluntary include: CHIS-Group Mediclaim Policy, BPL and SEWA Schemes, Public Sector (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Private Sector (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram).
Q0812: 12mo durable goods & appliances & furniture
Q0812: 12mo durable goods & appliances & furniture
Q0812: 12mo durable goods & appliances & furniture
Q0812: 12mo durable goods & appliances & furniture
Q0812: 12mo durable goods & appliances & furniture
I know these questions may be difficult to answer - try to give us the best estimate of expenses. Now I want you to focus on household expenses over the last 12 months. These are expenses that may be more periodic or "big purchases". I would like to ask how much money was spent by all household members for the following items in the last 12 months
In the last 12 months, how much did your household spend on:
Durable goods (televisions, phones, bed sheets, towels, tools), furniture (tables, chairs, beds) and appliances (refrigerators, washing machines)?
8 don't know
-8
DK
* Examples of Mandatory include: ESIS, CGHS, RHS, DMS, ECHS, MREG, MREP, OHIE
** Examples of Voluntary include: CHIS-Group Mediclaim Policy, BPL and SEWA Schemes, Public Sector (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Private Sector (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram).
Q0813: 12mo vehicles + upkeep & repair
Q0813: 12mo vehicles + upkeep & repair
Q0813: 12mo vehicles + upkeep & repair
Q0813: 12mo vehicles + upkeep & repair
Q0813: 12mo vehicles + upkeep & repair
I know these questions may be difficult to answer - try to give us the best estimate of expenses. Now I want you to focus on household expenses over the last 12 months. These are expenses that may be more periodic or "big purchases". I would like to ask how much money was spent by all household members for the following items in the last 12 months
In the last 12 months, how much did your household spend on:
Vehicles (trucks, cars, motorcycles, scooters, bicycles) and upkeep/repairs?
8 don't know
-8
DK
* Examples of Mandatory include: ESIS, CGHS, RHS, DMS, ECHS, MREG, MREP, OHIE
** Examples of Voluntary include: CHIS-Group Mediclaim Policy, BPL and SEWA Schemes, Public Sector (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Private Sector (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram).
Q0814: 12 mo rituals, gifts
Q0814: 12 mo rituals, gifts
Q0814: 12 mo rituals, gifts
Q0814: 12 mo rituals, gifts
Q0814: 12 mo rituals, gifts
I know these questions may be difficult to answer - try to give us the best estimate of expenses. Now I want you to focus on household expenses over the last 12 months. These are expenses that may be more periodic or "big purchases". I would like to ask how much money was spent by all household members for the following items in the last 12 months
In the last 12 months, how much did your household spend on:
Rituals, gifts or ceremonies (funerals, birthdays, weddings…)?
8 don't know
-8
DK
* Examples of Mandatory include: ESIS, CGHS, RHS, DMS, ECHS, MREG, MREP, OHIE
** Examples of Voluntary include: CHIS-Group Mediclaim Policy, BPL and SEWA Schemes, Public Sector (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Private Sector (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram).
Q0815: 12mo taxes
Q0815: 12mo taxes
Q0815: 12mo taxes
Q0815: 12mo taxes
Q0815: 12mo taxes
I know these questions may be difficult to answer - try to give us the best estimate of expenses. Now I want you to focus on household expenses over the last 12 months. These are expenses that may be more periodic or "big purchases". I would like to ask how much money was spent by all household members for the following items in the last 12 months
In the last 12 months, how much did your household spend on:
Taxes (property tax, vehicle tax, income tax…) and non-health related insurance (personal, vehicle, household, life…)?
8 don't know
-8
DK
* Examples of Mandatory include: ESIS, CGHS, RHS, DMS, ECHS, MREG, MREP, OHIE
** Examples of Voluntary include: CHIS-Group Mediclaim Policy, BPL and SEWA Schemes, Public Sector (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Private Sector (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram).
Q0816: 12mo mandatory health insurance
Q0816: 12mo mandatory health insurance
Q0816: 12mo mandatory health insurance
Q0816: 12mo mandatory health insurance
Q0816: 12mo mandatory health insurance
I know these questions may be difficult to answer - try to give us the best estimate of expenses. Now I want you to focus on household expenses over the last 12 months. These are expenses that may be more periodic or "big purchases". I would like to ask how much money was spent by all household members for the following items in the last 12 months
In the last 12 months, how much did your household spend on:
Mandatory health insurance premiums or pre-paid health plans?*
8 don't know
-8
DK
* Examples of Mandatory include: ESIS, CGHS, RHS, DMS, ECHS, MREG, MREP, OHIE
** Examples of Voluntary include: CHIS-Group Mediclaim Policy, BPL and SEWA Schemes, Public Sector (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Private Sector (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram).
Q0817: 12mo voluntary health insurance
Q0817: 12mo voluntary health insurance
Q0817: 12mo voluntary health insurance
Q0817: 12mo voluntary health insurance
Q0817: 12mo voluntary health insurance
I know these questions may be difficult to answer - try to give us the best estimate of expenses. Now I want you to focus on household expenses over the last 12 months. These are expenses that may be more periodic or "big purchases". I would like to ask how much money was spent by all household members for the following items in the last 12 months
In the last 12 months, how much did your household spend on:
Voluntary health insurance premiums (including, community health insurance schemes)?**
8 don't know
-8
DK
* Examples of Mandatory include: ESIS, CGHS, RHS, DMS, ECHS, MREG, MREP, OHIE
** Examples of Voluntary include: CHIS-Group Mediclaim Policy, BPL and SEWA Schemes, Public Sector (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Private Sector (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram).
Q0818: 12mo health-related items & devices
Q0818: 12mo health-related items & devices
Q0818: 12mo health-related items & devices
Q0818: 12mo health-related items & devices
Q0818: 12mo health-related items & devices
I know these questions may be difficult to answer - try to give us the best estimate of expenses. Now I want you to focus on household expenses over the last 12 months. These are expenses that may be more periodic or "big purchases". I would like to ask how much money was spent by all household members for the following items in the last 12 months
In the last 12 months, how much did your household spend on:
Health-related items (prescription glasses, hearing aids, canes, prosthetic devices…)?
8 don't know
-8
DK
* Examples of Mandatory include: ESIS, CGHS, RHS, DMS, ECHS, MREG, MREP, OHIE
** Examples of Voluntary include: CHIS-Group Mediclaim Policy, BPL and SEWA Schemes, Public Sector (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Private Sector (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram).
Q0819: 12-mo overnight health care stay
Q0819: 12-mo overnight health care stay
Q0819: 12-mo overnight health care stay
Q0819: 12-mo overnight health care stay
Q0819: 12-mo overnight health care stay
I know these questions may be difficult to answer - try to give us the best estimate of expenses. Now I want you to focus on household expenses over the last 12 months. These are expenses that may be more periodic or "big purchases". I would like to ask how much money was spent by all household members for the following items in the last 12 months
In the last 12 months, how much did your household spend on:
Costs associated with overnight stays in a hospital or health facility?
Please exclude any reimbursements from insurance and transportation costs.
8 don't know
-8
DK
* Examples of Mandatory include: ESIS, CGHS, RHS, DMS, ECHS, MREG, MREP, OHIE
** Examples of Voluntary include: CHIS-Group Mediclaim Policy, BPL and SEWA Schemes, Public Sector (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Private Sector (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram).
Q0820: 12-mo costs long-term care facility
Q0820: 12-mo costs long-term care facility
Q0820: 12-mo costs long-term care facility
Q0820: 12-mo costs long-term care facility
Q0820: 12-mo costs long-term care facility
I know these questions may be difficult to answer - try to give us the best estimate of expenses. Now I want you to focus on household expenses over the last 12 months. These are expenses that may be more periodic or "big purchases". I would like to ask how much money was spent by all household members for the following items in the last 12 months
In the last 12 months, how much did your household spend on:
Costs associated with long-term care facility?
Please exclude any reimbursements from insurance and transportation costs.
8 don't know
-8
DK
* Examples of Mandatory include: ESIS, CGHS, RHS, DMS, ECHS, MREG, MREP, OHIE
** Examples of Voluntary include: CHIS-Group Mediclaim Policy, BPL and SEWA Schemes, Public Sector (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Private Sector (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram).
Q0821: 12-mo all other goods & services
Q0821: 12-mo all other goods & services
Q0821: 12-mo all other goods & services
Q0821: 12-mo all other goods & services
Q0821: 12-mo all other goods & services
I know these questions may be difficult to answer - try to give us the best estimate of expenses. Now I want you to focus on household expenses over the last 12 months. These are expenses that may be more periodic or "big purchases". I would like to ask how much money was spent by all household members for the following items in the last 12 months
In the last 12 months, how much did your household spend on:
All other goods and services (property, land, livestock, cleaning services, repair services…)?
8 don't know
-8
DK
* Examples of Mandatory include: ESIS, CGHS, RHS, DMS, ECHS, MREG, MREP, OHIE
** Examples of Voluntary include: CHIS-Group Mediclaim Policy, BPL and SEWA Schemes, Public Sector (GICI, NICL, NIACL, OICL, UICL)-Mediclaim, Jan Arogya, Jeevan Surakhya. Private Sector (Tata-AIG, ICICI-Lombard, Bajaj-Allianz, Reliance General, IFFCO Tokia, Royal Sundaram).
Q0822: 12-mo current HH income
Q0822: 12-mo current HH income
Q0822: 12-mo current HH income
Q0822: 12-mo current HH income
Q0822: 12-mo current HH income
Finally, I want you to think of how you paid for your health care expenditures over the last 12 months. This includes costs for all fees, services and goods, including overnight stays.
In the last 12 months, which of the following financial sources did your household use to pay for any and all health expenditures?
Current income of any household members (salaries, pensions, paid benefits…)?
1yes
2no
8 don't know
INTERVIEWER: If no health expenditures, (Q0804 to Q0810 = "0" and Q0818 to Q0820 = "0") è SKIP TO Q0829
1
Yes
2
No
8
Don't know
Q0823: 12-mo savings
Q0823: 12-mo savings
Q0823: 12-mo savings
Q0823: 12-mo savings
Q0823: 12-mo savings
Finally, I want you to think of how you paid for your health care expenditures over the last 12 months. This includes costs for all fees, services and goods, including overnight stays.
In the last 12 months, which of the following financial sources did your household use to pay for any and all health expenditures?
Savings?
1yes
2no
8 don't know
INTERVIEWER: If no health expenditures, (Q0804 to Q0810 = "0" and Q0818 to Q0820 = "0") è SKIP TO Q0829
1
Yes
2
No
8
Don't know
Q0824: 12-mo insurance
Q0824: 12-mo insurance
Q0824: 12-mo insurance
Q0824: 12-mo insurance
Q0824: 12-mo insurance
Finally, I want you to think of how you paid for your health care expenditures over the last 12 months. This includes costs for all fees, services and goods, including overnight stays.
In the last 12 months, which of the following financial sources did your household use to pay for any and all health expenditures?
Payment or reimbursement from a health insurance plan (including community health schemes)?
1yes
2no
8 don't know
INTERVIEWER: If no health expenditures, (Q0804 to Q0810 = "0" and Q0818 to Q0820 = "0") è SKIP TO Q0829
1
Yes
2
No
8
Don't know
Q0825: 12-mo selling items
Q0825: 12-mo selling items
Q0825: 12-mo selling items
Q0825: 12-mo selling items
Q0825: 12-mo selling items
Finally, I want you to think of how you paid for your health care expenditures over the last 12 months. This includes costs for all fees, services and goods, including overnight stays.
In the last 12 months, which of the following financial sources did your household use to pay for any and all health expenditures?
Sold items (land, property, furniture, livestock, jewellery…)?
1yes
2no
8 don't know
INTERVIEWER: If no health expenditures, (Q0804 to Q0810 = "0" and Q0818 to Q0820 = "0") è SKIP TO Q0829
1
Yes
2
No
8
Don't know
Q0826: 12-mo family/friends
Q0826: 12-mo family/friends
Q0826: 12-mo family/friends
Q0826: 12-mo family/friends
Q0826: 12-mo family/friends
Finally, I want you to think of how you paid for your health care expenditures over the last 12 months. This includes costs for all fees, services and goods, including overnight stays.
In the last 12 months, which of the following financial sources did your household use to pay for any and all health expenditures?
Relatives or friends from outside the household?
1yes
2no
8 don't know
INTERVIEWER: If no health expenditures, (Q0804 to Q0810 = "0" and Q0818 to Q0820 = "0") è SKIP TO Q0829
1
Yes
2
No
8
Don't know
Q0827: 12-mo borrowing
Q0827: 12-mo borrowing
Q0827: 12-mo borrowing
Q0827: 12-mo borrowing
Q0827: 12-mo borrowing
Finally, I want you to think of how you paid for your health care expenditures over the last 12 months. This includes costs for all fees, services and goods, including overnight stays.
In the last 12 months, which of the following financial sources did your household use to pay for any and all health expenditures?
Borrowed from financial institutions or agencies (microfinance schemes, banks…)?
1yes
2no
8 don't know
INTERVIEWER: If no health expenditures, (Q0804 to Q0810 = "0" and Q0818 to Q0820 = "0") è SKIP TO Q0829
1
Yes
2
No
8
Don't know
Q0828: 12-mo other
Q0828: 12-mo other
Q0828: 12-mo other
Q0828: 12-mo other
Q0828: 12-mo other
Finally, I want you to think of how you paid for your health care expenditures over the last 12 months. This includes costs for all fees, services and goods, including overnight stays.
In the last 12 months, which of the following financial sources did your household use to pay for any and all health expenditures?
Other, specify
1yes
2no
8 don't know
INTERVIEWER: If no health expenditures, (Q0804 to Q0810 = "0" and Q0818 to Q0820 = "0") è SKIP TO Q0829
1
Yes
2
No
8
Don't know
Q0829: Average overall monthly HH spending
Q0829: Average overall monthly HH spending
Q0829: Average overall monthly HH spending
Q0829: Average overall monthly HH spending
Q0829: Average overall monthly HH spending
Last, we want you to think of a typical month and the expenditures for your household. We want to know an average total amount your household spends on all items in a typical month. This includes the total amount your household and all its members spent on everything, for example, clothing, transport, rent and rates, school fees, food, drink, entertainment, health care and all other expenses.
In general, what is your household's average overall monthly spending?
8 don't know
INTERVIEWER: If no health expenditures, (Q0804 to Q0810 = "0" and Q0818 to Q0820 = "0") è SKIP TO Q0829
-8
DK
Q0901: Someone else present?
Q0901: Someone else present?
Q0901: Someone else present?
Q0901: Someone else present?
Q0901: Someone else present?
Was someone else present during the interview?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q0902: Accuracy
Q0902: Accuracy
Q0902: Accuracy
Q0902: Accuracy
Q0902: Accuracy
What is your evaluation of the accuracy of the informant's answers?
1Very good
2Good
3Moderate
4Bad
5Very bad
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
strata code
strata code
strata code
strata code
strata code
post stratified houshold weight
post stratified houshold weight
post stratified houshold weight
post stratified houshold weight
post stratified houshold weight
permanent income continuous
permanent income continuous
permanent income continuous
permanent income continuous
permanent income continuous
permanent income quintile
permanent income quintile
permanent income quintile
permanent income quintile
permanent income quintile
Individual Case ID 1st wave
Individual Case ID 1st wave
Individual Case ID 1st wave
Individual Case ID 1st wave
Individual Case ID 1st wave
Individual Case ID 2nd wave
Individual Case ID 2nd wave
Individual Case ID 2nd wave
Individual Case ID 2nd wave
Individual Case ID 2nd wave
Q0001: Research Center Number
Q0001: Research Center Number
Q0001: Research Center Number
Q0001: Research Center Number
Q0001: Research Center Number
Research Centre Number
101
China
106
India
140
Mexico
152
Russian Federation
155
South Africa
241
Ghana
Q0002: Household ID number
Q0002: Household ID number
Q0002: Household ID number
Q0002: Household ID number
Q0002: Household ID number
Household ID
Q0003: Type of interview (new, f/u, retest, proxy, validatio
Q0003: Type of interview (new, f/u, retest, proxy, validatio
Q0003: Type of interview (new, f/u, retest, proxy, validatio
Q0003: Type of interview (new, f/u, retest, proxy, validatio
Q0003: Type of interview (new, f/u, retest, proxy, validatio
Is this a new, second (follow-up from WHS), retest or proxy interview?
1= First (new) ………..…to Q0004
2= Second (follow-up)….to Q0004
3= Retest …………….....to Q0003a
4= Proxy………………....to Q0004
5= Supervisor validation.to Q0003a
1
New interview
2
Follow-up interview from WHS
3
Retest
4
Proxy
5
Proxy validation
Q1007: Respondent Number
Q1007: Respondent Number
Q1007: Respondent Number
Q1007: Respondent Number
Q1007: Respondent Number
Person (HH member) number from HH roster (number from column)
-9
Not applicable
-8
Don't know
Q0002a: Household type (18-49, 50+)
Q0002a: Household type (18-49, 50+)
Q0002a: Household type (18-49, 50+)
Q0002a: Household type (18-49, 50+)
Q0002a: Household type (18-49, 50+)
Is this a (18-49 years) or (50+ years) household?
1=18 to 49
2=50+
1
HH for 18-49 year old
2
HH for 50+ year old
3
HH for 18-49 year old (Females only) (India only)
Q0008: Rotation code
Q0008: Rotation code
Q0008: Rotation code
Q0008: Rotation code
Q0008: Rotation code
Rotation code (Circle One)
A B C D
Q0101b: PSU Code
Q0101b: PSU Code
Q0101b: PSU Code
Q0101b: PSU Code
Q0101b: PSU Code
PSU Code:
Q0104: Urban/Rural
Q0104: Urban/Rural
Q0104: Urban/Rural
Q0104: Urban/Rural
Q0104: Urban/Rural
An urban area that has been legally proclaimed as being urban. Such areas include towns, cities and metropolitan areas.
1 = Urban
All other areas that are not classified as being urban. This includes commercial farms, small settlements, rural villages and other areas which are further away from towns and cities.
2 = Rural
1
Urban
2
Rural
8
Don't know
9
Not Applicable
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
Q0403a: Last (sur)name
First name and surname
A. Last/surname:
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
Q0403b: First (given) name
First name and surname
B. First (given)
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Q0404a: Is person still in HH?
Is person still a member of the HH (follow-up interviews only)?
1= Yes; 2 =No; 9=N/A
1
Yes, in HH
2
No longer in HH
9
Not applicable
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Q0404b: WHS Person Number
Person number (from WHS 2003)
If new household member, insert "9 8"
98
New HH member
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
Q0405: Relationship to respondent
What is [NAME]'s relationship to the household head?
01=spouse
02=son or daughter
03=son or daughter-in-law
04=grandchild
05=parent
06=parent-in-law
07=brother or sister
08=co-wife
09=grandparent
10=other relative
11=not related (friends, servants, boarders, lodgers, other)
88=don't know
-8
DK
1
Spouse
2
Son or daughter
3
Son- or daughter-in-law
4
Grandchild
5
Parent
6
Parent-in-law
7
Sibling (brother or sister)
8
Co-wife
9
Grandparent
10
Other relative
11
Not related
88
Don't know
98
Not applicable
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Q0406: Sex
Is [NAME] a male or a female?
1 = Male
2 = Female
1
Male
2
Female
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
Q0407: Age
How old is he/she?
(if less than 1 year old enter "00")
-8
Don't know
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
Q0408: Marital status
What is [NAME]'s marital status?
1= Never married (and not cohabiting)
2= Currently married
3= Cohabiting
4= Separated/divorced
5= Widowed
8=don't know
1
Never married
2
Currently married
3
Cohabitating
4
Separated/Divorced
5
Widowed
8
DK
9
Not applicable
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
Q0409: Highest education level
What is the highest level of education [NAME] completed?
0=No formal education
1=Less than primary school
2=Primary school completed
3=Secondary school completed
4=High school (or equivalent) completed
5=College/Preuniversity/University completed
6=Post graduate degree completed
No formal education
1
Less than primary school
2
Primary school completed
3
Secondary school completed
4
High school (or equivalent) completed
5
College/university completed
6
Post-graduate degree completed
8
Don't know
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Q0411: Health insurance
Does [NAME] have health insurance coverage?
1 = Yes, mandatory insurance*
2 = Yes, voluntary insurance**
3 = Yes, both mandatory and voluntary insurance
4 = No, none.
1
Yes, mandatory
2
Yes, voluntary
3
Yes, both mandatory and voluntary insurance coverage
4
No, none
8
Don't know
9
Not applicable
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Q0412: Needs care?
Does [NAME] need care due to his/her health condition, such as a long-term physical or mental illness or disability, or because he/she is getting old and weak?
1 = Yes to Continue
2 = No to Go to Q0415 or Next Person
1
Yes
2
No
8
Don't know
9
Not applicable
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
Q0413: How much care?
How much care does he/she need?
1 = Needs help/watching all the time (day and night)
2 = Cannot be without help/watching or be left alone at home for more than an hour
3 = Can be left on his/her own at home for several hours but requires accompaniment when leaving home
4 = Needs some help at home and sometimes needs to be accompanied when leaving home
1
Needs help at all times
2
Cannot be left for more than 1H
3
Can be left more than 1H
4
Needs some help
8
Don't know
9
Not applicable
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Q0414: In institution?
Is [NAME] presently in an institution (hospital, after care home, home for the aged, hospice) due to his/her health condition?
1 = yes; 2 = no
1
Yes
2
No
8
Don't know
9
Not applicable
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
Q0415: Reason for absence
If person was a household member in WHS 2003, but is now NOT a household member, continue with Q0415. If person is a NEW household member or was household member in 2003 and is still a household member today, do NOT answer Q0415 or Q0416 è go to Next HH member, or if last HH member è go to Q0417.
What is the reason for [NAME]'s absence?
01 = Employment
02 = Looking for work
03 = School
04 = Visit family
05 = Visit friends
06 = Marriage/cohabitation
07 = Personal reasons
08 = Escape violence or political problems
09 = Prison
10 = Hospital /clinic
11 = Nursing home/old persons home
12 = Died to go to Next HH member
87 = Other, Specify:
88 = Don't know
-8
DK
1
Employment
2
Looking for work
3
Schooling
4
Visiting family
5
Visiting friends
6
W/ other spouse
7
Personal reasons
8
Escape violence/political
9
Prison
10
Hospital/clinic
11
Nursing home
12
Died
87
Other
88
Don't know
98
Not applicable
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Q0416: Went where?
Where did [NAME] go to?
1 = Different household in same community/locality/ neighbourhood
2 = Rural area in different part of the country
3 = City in different part of the country
4 = Rural area in another country
5 = City in another country
8 = don't know
1
Other HH, same locality
2
Rural, same country
3
Urban, same country
4
Rural, other country
5
Urban, other country
8
Don't know
9
Not applicable
Q1000A: Interviewer ID number
Q1000A: Interviewer ID number
Q1000A: Interviewer ID number
Q1000A: Interviewer ID number
Q1000A: Interviewer ID number
Interviewer I.D
Q1000B: Contact with:
Q1000B: Contact with:
Q1000B: Contact with:
Q1000B: Contact with:
Q1000B: Contact with:
Contact with:
1=Individual respondent
2=Proxy respondent
3=No one
1
Respondent
2
Proxy respondent
3
No one
8
Don't know
9
Not applicable
Q1000C: Result code
Q1000C: Result code
Q1000C: Result code
Q1000C: Result code
Q1000C: Result code
Result code
01=Completed Interview (interview is accepted and conducted - this includes interview and body measurement, performance tests and blood sample)
02=Partial Interview (interview is partially completed and person will not be contacted anymore).
03=Respondent contacted-initial refusal
04=Respondent contacted-uncertain about interview
05=Resistance/refusal by respondent
06=Final refusal by respondent
07=Final refusal by other household member
08=Unable to locate respondent
09=No interview because respondent is not eligible: less than 18, mentally unfit or too ill.
10=Language barrier
11=House is vacant or household occupants are elsewhere (seasonal vacancy, other residence)
12=Unsafe or dangerous area or no access to respondent
13=Deceased respondent
14=Respondent in institution: jail, hospital and not accessible
NTERVIEWER: INSERT final result code in Section 0000: Coversheet, Q0007b.
-8
Don't know
1
Completed interview
2
Partial interview; no return
3
Contact, initial refusal
4
Contact, uncertain
5
Resistance/refusal
6
Final refusal by respondent
7
Final refusal by HH member
8
Unable to locate respondent
9
No interview; respondent ineligible
10
Language barrier
11
Vacant, residents elsewhere
12
Unsafe area or no access
13
Deceased respondent
14
Respondent in institution
Q1001: Cognitive limitations
Q1001: Cognitive limitations
Q1001: Cognitive limitations
Q1001: Cognitive limitations
Q1001: Cognitive limitations
Does the respondent have obvious cognitive limitations that prevent him/her from being interviewed?
1= Yes
2= No
1
Yes limitations
2
No limitations
8
Don't know
9
Not applicable
Q1002: Memory at present
Q1002: Memory at present
Q1002: Memory at present
Q1002: Memory at present
Q1002: Memory at present
I would like to start by asking you some background questions before asking you questions about your health. This information is confidential and you will not be identified individually or without your consent.
One of the issues we are exploring in this study are the memory problems that some older persons can have. I know these questions may be sensitive or difficult to answer, but please try to provide an answer. I would like to start by asking you two questions about your memory
How would you best describe your memory at present? Is it very good, good, moderate, bad or very bad?
1Very good
2Good
3Moderate
4Bad
5 Very bad
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
Q1003: Memory comparison
Q1003: Memory comparison
Q1003: Memory comparison
Q1003: Memory comparison
Q1003: Memory comparison
Compared to 12 months ago, would you say your memory is now better, the same or worse than it was then?
1Better
2Same
3 Worse
1
Better
2
Same
3
Worse
8
Don't know
9
Not applicable
Q1004: Interviewer judgment
Q1004: Interviewer judgment
Q1004: Interviewer judgment
Q1004: Interviewer judgment
Q1004: Interviewer judgment
Interviewer
1 No reason to think Respondent has any cognitive limitations .
******Individual Consent form and Individual Q
2 Cognitive limitations or health problems, proxy
****Q1005
1
No limitations
2
Need proxy
8
Don't know
9
Not applicable
Q1005: Proxy
Q1005: Proxy
Q1005: Proxy
Q1005: Proxy
Q1005: Proxy
We would like to ask someone who knows the respondent a few questions about the respondent's memory and health.
Who is the proxy?
1 Spouse …………………….ProxyQ
2 Non-spouse---------------ProxyQ
1
Spouse
2
Non-spouse
8
Don't know
9
Not applicable
S1000: HH begin
S1000: HH begin
S1000: HH begin
S1000: HH begin
S1000: HH begin
S1000: MM begin
S1000: MM begin
S1000: MM begin
S1000: MM begin
S1000: MM begin
S1000: HH end
S1000: HH end
S1000: HH end
S1000: HH end
S1000: HH end
S1000: MM end
S1000: MM end
S1000: MM end
S1000: MM end
S1000: MM end
Q1006: Household ID number
Q1006: Household ID number
Q1006: Household ID number
Q1006: Household ID number
Q1006: Household ID number
Household ID
-8
Don't know
Q1007: Respondent number
Q1007: Respondent number
Q1007: Respondent number
Q1007: Respondent number
Q1007: Respondent number
Person (HH member) number from HH roster (number from column)
-9
Not applicable
-8
Don't know
Q1008: Mother tongue
Q1008: Mother tongue
Q1008: Mother tongue
Q1008: Mother tongue
Q1008: Mother tongue
What is your mother tongue?
By mother tongue, we mean the language you learned first, the language that you can express yourself fully in, or voluntarily identify with.
1Assamee
2Bengali
3English
4Gujarati
5Hindi
6Kannada
7Kashmiri
8Konkani
9Malayam
10Manipuri
11Marathi
12Nepali
13Oriya
14Punjabi
15Sindhi
16Tamil
17Telugu
18Urdu
87 Other, specify:
1
MT 1
2
MT 2
3
MT 3
4
MT 4
5
MT 5
87
Other
88
Don't know
Q1008A: Master code for Mother Tongue
Q1008A: Master code for Mother Tongue
Q1008A: Master code for Mother Tongue
Q1008A: Master code for Mother Tongue
Q1008A: Master code for Mother Tongue
1
MT 1
2
MT 2
3
MT 3
4
MT 4
5
MT 5
87
Other
88
Don't know
Q1009: Sex
Q1009: Sex
Q1009: Sex
Q1009: Sex
Q1009: Sex
Interviewer:
Record sex of the respondent
1 Male
2 Female
1
Male
2
Female
Q1010: DD
Q1010: DD
Q1010: DD
Q1010: DD
Q1010: DD
What day, month and year were you born?
DD / MM / YYYY
Check birth certificate if available.
8 Don't know
-8
Don't know
Q1010: MM
Q1010: MM
Q1010: MM
Q1010: MM
Q1010: MM
What day, month and year were you born?
DD / MM / YYYY
Check birth certificate if available.
8 Don't know
-8
DK
Q1010: YYYY
Q1010: YYYY
Q1010: YYYY
Q1010: YYYY
Q1010: YYYY
What day, month and year were you born?
DD / MM / YYYY
Check birth certificate if available.
8 Don't know
-8
DK
Q1011: Age in YYYs
Q1011: Age in YYYs
Q1011: Age in YYYs
Q1011: Age in YYYs
Q1011: Age in YYYs
How old are you now?
Age in years
INTERVIEWER: This would be age at last birthday. If don't know - probe.
-8
DK
Q1012: Marital status
Q1012: Marital status
Q1012: Marital status
Q1012: Marital status
Q1012: Marital status
What is your current marital status?
1Never married ……………………Q1015
2currently married ……………Q1014
3cohabiting ……………………Q1014
4separated/divorced ……………Q1013
4 widowed …………………………Q1013
1
Never married
2
Currently married
3
Cohabiting
4
Separated/divorced
5
Widowed
8
Don't know
9
Not applicable
Q1013: Years sep/div/widowed
Q1013: Years sep/div/widowed
Q1013: Years sep/div/widowed
Q1013: Years sep/div/widowed
Q1013: Years sep/div/widowed
For how many years have you been separated, divorced or widowed?
Number of years …………….Q1015
8 Don't Know ………………Q1015
INTERVIEWER: if less than 1 year, enter "00"
-8
DK
Q1014: Years married/living together
Q1014: Years married/living together
Q1014: Years married/living together
Q1014: Years married/living together
Q1014: Years married/living together
For how many years have you been married or living together?
Number of years
-8 Don't Know
INTERVIEWER: if less than 1 year, enter "00"
-8
DK
Q1015: Ever schooled
Q1015: Ever schooled
Q1015: Ever schooled
Q1015: Ever schooled
Q1015: Ever schooled
Have you ever been to school?
1 Yes
2 No........Q1018
1
Yes
2
No
8
Don't know
9
Not applicable
Q1016: Highest level
Q1016: Highest level
Q1016: Highest level
Q1016: Highest level
Q1016: Highest level
What is the highest level of education that you have completed?
1Less than primary school
2Primary school completed
3Secondary school completed
4High school( or equivalent) completed
5College/Pre-university/University completed
6 Post graduate degree completed
1
Less than primary
2
Completed primary
3
Completed secondary
4
Completed HS
5
Completed college/university
6
Completed post-grad
8
Don't know
9
Not applicable
Q1017: Years educated
Q1017: Years educated
Q1017: Years educated
Q1017: Years educated
Q1017: Years educated
How many years of school, including higher education have you completed?
Number of years
-8 Don't Know
-8
DK
Q1018: Ethnic background/caste/tribe
Q1018: Ethnic background/caste/tribe
Q1018: Ethnic background/caste/tribe
Q1018: Ethnic background/caste/tribe
Q1018: Ethnic background/caste/tribe
What is your caste or tribe?
1Scheduled tribe
2Scheduled caste
3No caste or tribe
7 Other, specify:
1
EG 1
2
EG 2
3
EG 3
4
EG 4
5
EG 5
6
EG 6
87
Other
88
Don't know
98
Not applicable
Q1019: Religion
Q1019: Religion
Q1019: Religion
Q1019: Religion
Q1019: Religion
Do you belong to a religious denomination?
1No, none
2Buddhism
3Chinese traditional religion
4Christianity (including Roman Catholic, Protestant, Orthodox, other)
5Hinduism
6Islam
7Jainism
8Judaism
9Primal indigenous (including African traditional and diasporic)
10Sikhism
87 Other , specify:
97 Refused
INTERVIEWER: allow the respondent to reply without reading categories. Clarify as needed.
1
None
2
Buddhism
3
Chinese trad religion
4
Christianity
5
Hinduism
6
Islam
7
Jainism
8
Judaism
9
Primal indigenous
10
Sikhism
87
Other
88
Don't know
97
Refused
98
Not applicable
Q1020: Always here?
Q1020: Always here?
Q1020: Always here?
Q1020: Always here?
Q1020: Always here?
Have you always lived in this village/town/city?
1 Yes.............Q1025
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q1021: How long?
Q1021: How long?
Q1021: How long?
Q1021: How long?
Q1021: How long?
How long have you been living (continuously) in this area?
Years
-8 Don't know
Interviewer: If less than 1 year, enter “00”.
-8
DK
Q1022: Where lived before?
Q1022: Where lived before?
Q1022: Where lived before?
Q1022: Where lived before?
Q1022: Where lived before?
Where were you living before?
1In a different household in same community/locality/neighborhood
2In another city in this state
3In another rural area in this state
4In another city outside this state but in country
5In another rural area outside this state but in country
6 Outside the countr
1
Diff HH, same locality
2
Other city, same state/prov/region
3
Other rural, same state/prov/region
4
Other urban, same country
5
Other rural, same country
6
Other country
8
Don't know
9
Not applicable
Q1023: Where lived most adult life?
Q1023: Where lived most adult life?
Q1023: Where lived most adult life?
Q1023: Where lived most adult life?
Q1023: Where lived most adult life?
Where have you lived for most of your adult life (18+ years)?
1n a different household in same community/locality/neighborhood
2In another city in this state
3In another rural area in this state
4In another city outside this stateoutdieut in country
5In another rural area outside this state but in country
6 Outside the country
1
Diff HH, same locality
2
Other city, same state/prov/reg
3
Other rural, same state/prov/reg
4
Other urban, same country
5
Other rural, same country
6
Other country
8
Don't know
9
Not applicable
Q1024: Childhood residence?
Q1024: Childhood residence?
Q1024: Childhood residence?
Q1024: Childhood residence?
Q1024: Childhood residence?
Where did you live for most of your childhood (before age 10 years)?
1In a different household in same community/locality/neighborhood
2In another city in this state
3In another rural area in this state
4In another city outside this state but in country
5In another rural area outside this state but in country
6 Outside the country
1
Diff HH, same locality
2
Other city, same state/prov/reg
3
Other rural, same state/prov/reg
4
Other urban, same country
5
Other rural, same country
6
Other country
8
Don't know
9
Not applicable
Q1025: Mother ever employed?
Q1025: Mother ever employed?
Q1025: Mother ever employed?
Q1025: Mother ever employed?
Q1025: Mother ever employed?
Before we move onto the next section, I would like to ask you a few questions about your [biological] parents. I would like to know about their level of education and main occupation.
Let's start with your mother.
Was your mother ever employed?
1 Yes.............Q1028
2 No
1
Yes
2
No
8
DK
9
Not applicable
Q1026: Mother's employer?
Q1026: Mother's employer?
Q1026: Mother's employer?
Q1026: Mother's employer?
Q1026: Mother's employer?
Who is/was your mother's main employer over her working life?
1Public sector (Government)
2Private sector (For profit or not for profit)
3Self-employed
4 Informal employment
1
Public
2
Private
3
Self-employed
4
Informal employment
8
Don't know
9
Not applicable
Q1027: Mother occupation
Q1027: Mother occupation
Q1027: Mother occupation
Q1027: Mother occupation
Q1027: Mother occupation
What is/was her main occupation?
INTERVIEWER: write exactly what the respondent says - clarify if you do not understand - write clearly in capital letters
-9
Not applicable
-8
Don't know
Q1028: Mother education
Q1028: Mother education
Q1028: Mother education
Q1028: Mother education
Q1028: Mother education
What is the highest level of education that she completed?
0No formal education
1Less than primary school
2Primary school completed
3Secondary school completed
4High school( or equivalent) completed
5College/Pre-university/University completed
6Post graduate degree completed
8 Don't know
No formal education
1
Less than primary
2
Completed primary
3
Completed secondary
4
Completed HS
5
Completed college/univ
6
Completed post-grad
8
Don't know
9
Not applicable
Q1029: Father ever employed?
Q1029: Father ever employed?
Q1029: Father ever employed?
Q1029: Father ever employed?
Q1029: Father ever employed?
Was your father ever employed?
1 Yes.....Q1032
2 No
1
Yes
2
No
8
DK
9
Not applicable
Q1030: Father's employer?
Q1030: Father's employer?
Q1030: Father's employer?
Q1030: Father's employer?
Q1030: Father's employer?
Who is/was your father's main employer over his working life?
1Public sector (Government)
2Private sector (For profit or Not for profit)
3Self-employed
4 Informal employment
1
Public
2
Private
3
Self-employed
4
Informal employment
8
Don't know
9
Not applicable
Q1031: Father occupation
Q1031: Father occupation
Q1031: Father occupation
Q1031: Father occupation
Q1031: Father occupation
What is/was his main occupation?
INTERVIEWER: write exactly what the respondent says - clarify if you do not understand - write clearly in capital letters
-9
Not applicable
-8
Don't know
Q1032: Father education
Q1032: Father education
Q1032: Father education
Q1032: Father education
Q1032: Father education
What is the highest level of education that he completed?
0No formal education
1Less than primary school
2Primary school completed
3Secondary school completed
4High school( or equivalent) completed
5College/pre-university/University completed
6Post graduate degree completed
8 Don't Know
No formal education
1
Less than primary
2
Completed primary
3
Completed secondary
4
Completed HS
5
Completed college/univ
6
Completed post-grad
8
Don't know
9
Not applicable
Actual result code
Actual result code
Actual result code
Actual result code
Actual result code
-8
Don't know
1
Completed interview
2
Partial interview; no return
3
Contact, initial refusal
4
Contact, uncertain
5
Resistance/refusal
6
Final refusal by respondent
7
Final refusal by HH member
8
Unable to locate respondent
9
No interview; respondent ineligible
10
Language barrier
11
Vacant, residents elsewhere
12
Unsafe area or no access
13
Deceased respondent
14
Respondent in institution
S1500: HH begin
S1500: HH begin
S1500: HH begin
S1500: HH begin
S1500: HH begin
S1500: MM begin
S1500: MM begin
S1500: MM begin
S1500: MM begin
S1500: MM begin
S1500: HH end
S1500: HH end
S1500: HH end
S1500: HH end
S1500: HH end
S1500: MM end
S1500: MM end
S1500: MM end
S1500: MM end
S1500: MM end
Q1501: Ever worked
Q1501: Ever worked
Q1501: Ever worked
Q1501: Ever worked
Q1501: Ever worked
Now I would like to ask you some questions about any work you may be doing now or have done in the past. I will ask some questions about the type and amount of your current or past work, benefits, if any, you may be receiving or have received from your work, and the reasons for why you may not be working currently.
As you know, some people take jobs for which they are paid in cash or kind. Other people sell things, have a small business, or work on the family farm or family business. Have you ever in your life done any of these things or any type of work (not including housework)?
1 Yes...........Q1502
2 No
1
Yes worked
2
Never worked
8
Don't know
9
Not applicable
Q1501a: Why not?
Q1501a: Why not?
Q1501a: Why not?
Q1501a: Why not?
Q1501a: Why not?
What is the main reason that you have never worked?
1Homemaker / caring for family
2Could not find a job
3Do voluntary work
4In Studies / training
5Health problems/Disabled
6Have to take care of family member
7Do not have the economic need
8Parents / spouse did not let me
87 Other, specify:
1
Homemaker
2
Can't find work
3
Do voluntary/unpaid
4
Studies/training
5
Health/disability
6
Care of family member
7
No need
8
Spouse/family object
87
Other
88
Don't know
98
Not applicable
Q1502: Age started
Q1502: Age started
Q1502: Age started
Q1502: Age started
Q1502: Age started
At what age did you start working for pay?
Years of age ...................................Q1503
-8 Don't Know
-9
Not applicable
-8
Don't know
Q1502a: How many years ago start work?
Q1502a: How many years ago start work?
Q1502a: How many years ago start work?
Q1502a: How many years ago start work?
Q1502a: How many years ago start work?
How many years ago did you start working?
Years ago
-9
Not applicable
-8
Don't know
Q1503: Currently working?
Q1503: Currently working?
Q1503: Currently working?
Q1503: Currently working?
Q1503: Currently working?
Have you worked for at least 2 days during the last 7 days?
1 Yes.......................Q1508
2 No
1
Yes working
2
Not working
8
Don't know
9
Not applicable
Q1504: Main reason not working?
Q1504: Main reason not working?
Q1504: Main reason not working?
Q1504: Main reason not working?
Q1504: Main reason not working?
What is the main reason you are not currently working?
1Homemaker / caring for family
2Cannot find a job
3Do voluntary work (not paid or subsistence work)
4In studies / training
5Health problems/Disabled
6Have to take care of family member
7Do not have the economic need
8My family/spouse doesn't want me to work
9Retired / too old to work
10Laid off / made redundant
11Seasonal Work .......Q1508
12Vacation / sick leave / voluntary and temporary time off .............Q1508
87 Other, specify:
Interviewer:
Only one answer allowed
1
Homemaker
2
Can't find work
3
Do voluntary/unpaid
4
Studies/training
5
Health/disability
6
Care of family member
7
No need
8
Spouse/family object
9
Retired/too old
10
Laid off/redundant
11
Seasonal
12
Temporary time off
87
Other
88
Don't know
97
Refused
98
Not applicable
Q1505a: Years ago stopped work
Q1505a: Years ago stopped work
Q1505a: Years ago stopped work
Q1505a: Years ago stopped work
Q1505a: Years ago stopped work
At what age did you stop working?
Q1505a. (only if Q1505 is Don't Know)
How many years ago did you stop working?
Years of age ……………….Q1506
-8 Don't Know
-9
Not applicable
-8
Don't know
Q1506: Looking for work
Q1506: Looking for work
Q1506: Looking for work
Q1506: Looking for work
Q1506: Looking for work
Are you actively looking for work at this time?
1 Yes
2 No........Q1508
1
Yes
2
No
8
Don't know
9
Not applicable
Q1507: Reason looking
Q1507: Reason looking
Q1507: Reason looking
Q1507: Reason looking
Q1507: Reason looking
What is the main reason that you would you like to work at present?
1Need the income
2Want to/need to be active
3Want to feel useful
4Help my family
7 Other, specify:
Interviewer: Only one answer allowed - read categories if needed.
1
Need income
2
Need to be active
3
Need to feel useful
4
Help my family
7
Other
8
Don't know
9
Not applicable
Q1508: Payment type
Q1508: Payment type
Q1508: Payment type
Q1508: Payment type
Q1508: Payment type
Now I will ask you some questions about your current work or your most recent work. Please answer these questions thinking about your current work, or if you are not working currently, think about your most recent work.
Are/were you paid in cash or kind for your work or are/were you not paid at all?
1Cash Only
2In Kind Only
3Cash and Kind
4 Not Paid
1
cash only
2
in kind only
3
cash and kind
4
not paid
8
Don't know
9
Not applicable
Q1509: Main job - employer
Q1509: Main job - employer
Q1509: Main job - employer
Q1509: Main job - employer
Q1509: Main job - employer
Who is/was your employer in your current/most recent MAIN job?
1Public sector (Government)
2Private Sector (For profit and Not for profit)
3Self-employed
4 Informal employment
1
Public
2
Private
3
Self-employed
4
Informal employment
8
Don't know
9
Not applicable
Q1510: Main occupation
Q1510: Main occupation
Q1510: Main occupation
Q1510: Main occupation
Q1510: Main occupation
In the last 12 months, for your main job, what has been your main occupation?
INTERVIEWER: Write exactly what the respondent says - write clearly in capital letters.
-8
Don't know
Q1511: Seasonal work?
Q1511: Seasonal work?
Q1511: Seasonal work?
Q1511: Seasonal work?
Q1511: Seasonal work?
Do/did you usually work throughout the year, or do/did you work seasonally, or only once in a while for your main job?
1Work Throughout the year
2Seasonally/Part of the year
3 Once in a while
1
Work throughout year
2
Seasonally/part of year
3
Once in a while
8
Don't know
9
Not applicable
Q1512: Days worked/week (n)
Q1512: Days worked/week (n)
Q1512: Days worked/week (n)
Q1512: Days worked/week (n)
Q1512: Days worked/week (n)
On average, how many days a week do/did you work in your main job?
Days
8
Don't know
9
Not applicable
Q1513: HHs (n)
Q1513: HHs (n)
Q1513: HHs (n)
Q1513: HHs (n)
Q1513: HHs (n)
On average, how many hours a day do/did you work in your main job?
Hours
-9
Not applicable
-8
Don't know
Q1514a: Benefit - pension
Q1514a: Benefit - pension
Q1514a: Benefit - pension
Q1514a: Benefit - pension
Q1514a: Benefit - pension
In this main job, do/did you receive any of the following benefits in addition to your payment in cash or in kind?
a. Retirement or pension
1 Yes
2 No
1
yes
2
no
8
don't know
9
not applicable
Q1514b: Benefits - medical
Q1514b: Benefits - medical
Q1514b: Benefits - medical
Q1514b: Benefits - medical
Q1514b: Benefits - medical
In this main job, do/did you receive any of the following benefits in addition to your payment in cash or in kind?
b. Medical services/health care
1 Yes
2 No
1
yes
2
no
8
don't know
9
not applicable
Q1514c: Benefits - food
Q1514c: Benefits - food
Q1514c: Benefits - food
Q1514c: Benefits - food
Q1514c: Benefits - food
In this main job, do/did you receive any of the following benefits in addition to your payment in cash or in kind?
c. Food or provisions
1 Yes
2 No
1
yes
2
no
8
don't know
9
not applicable
Q1514d: Benefits - cash
Q1514d: Benefits - cash
Q1514d: Benefits - cash
Q1514d: Benefits - cash
Q1514d: Benefits - cash
In this main job, do/did you receive any of the following benefits in addition to your payment in cash or in kind?
d. Cash bonuses
1 Yes
2 No
1
yes
2
no
8
don't know
9
not applicable
Q1514e: Benefits - no benefits
Q1514e: Benefits - no benefits
Q1514e: Benefits - no benefits
Q1514e: Benefits - no benefits
Q1514e: Benefits - no benefits
In this main job, do/did you receive any of the following benefits in addition to your payment in cash or in kind?
e. No benefits
1 Yes
2 No
1
yes (no benefits)
2
no (does receive benefits - see 'f, other))
8
don't know
9
not applicable
Q1514f: Benefits - other
Q1514f: Benefits - other
Q1514f: Benefits - other
Q1514f: Benefits - other
Q1514f: Benefits - other
In this main job, do/did you receive any of the following benefits in addition to your payment in cash or in kind?
f. Other, specify:
1 Yes
2 No
1
Yes, specify
2
No
8
don't know
9
not applicable
Q1515: Other job?
Q1515: Other job?
Q1515: Other job?
Q1515: Other job?
Q1515: Other job?
Have you worked at more than one job over the last 12 months?
1 Yes
2 No
1
Yes worked other job
2
No other job
8
don't know
9
not applicable
S2000: HH begin
S2000: HH begin
S2000: HH begin
S2000: HH begin
S2000: HH begin
S2000: MM begin
S2000: MM begin
S2000: MM begin
S2000: MM begin
S2000: MM begin
S2000: HH end
S2000: HH end
S2000: HH end
S2000: HH end
S2000: HH end
S2000: MM end
S2000: MM end
S2000: MM end
S2000: MM end
S2000: MM end
Q2000: Health today
Q2000: Health today
Q2000: Health today
Q2000: Health today
Q2000: Health today
Now we will switch to questions specifically about your health. The first questions are about your overall health, including both your physical and your mental health. By difficulty in the second question, I mean requiring increased effort, discomfort or pain, slowness or changes in the way you do the activity.
In general, how would you rate your health today?
1Very good
2Good
3Moderate
4Bad
5 Very bad
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
Q2001: Activities
Q2001: Activities
Q2001: Activities
Q2001: Activities
Q2001: Activities
Overall in the last 30 days, how much difficulty did you have with work or household activities?
1None
2Mild
3Moderate
4Severe
5 Extrem5e/cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2002: Moving around
Q2002: Moving around
Q2002: Moving around
Q2002: Moving around
Q2002: Moving around
Now I would like to review the different functions of your body. When answering these questions, I would like you to think about the last 30 days, taking both good and bad days into account. When I ask about difficulty, I would like you to consider how much difficulty you have had, on average, in the last 30 days, while doing the activity in the way that you usually do it. Let me remind you, by difficulty I mean requiring increased effort, discomfort or pain, slowness or changes in the way you do the activity.
Overall in the last 30 days, how much difficulty did you have with moving around?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot
INTERVIEWER: Read and show scale to respondent.
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2003: Vigorous activities
Q2003: Vigorous activities
Q2003: Vigorous activities
Q2003: Vigorous activities
Q2003: Vigorous activities
Now I would like to review the different functions of your body. When answering these questions, I would like you to think about the last 30 days, taking both good and bad days into account. When I ask about difficulty, I would like you to consider how much difficulty you have had, on average, in the last 30 days, while doing the activity in the way that you usually do it. Let me remind you, by difficulty I mean requiring increased effort, discomfort or pain, slowness or changes in the way you do the activity.
Overall in the last 30 days, how much difficulty did you have n vigorous activities ('vigorous activities' require hard physical effort and cause large increases in breathing or heart rate)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot
INTERVIEWER: Read and show scale to respondent.
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2004: Self-care
Q2004: Self-care
Q2004: Self-care
Q2004: Self-care
Q2004: Self-care
Overall in the last 30 days, how much difficulty did you have with self-care, such as bathing/washing or dressing yourself?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2005: Appearance
Q2005: Appearance
Q2005: Appearance
Q2005: Appearance
Q2005: Appearance
Overall in the last 30 days, how much difficulty did you have in taking care of and maintaining your general appearance (for example, grooming, looking neat and tidy)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2006: Time by yourself
Q2006: Time by yourself
Q2006: Time by yourself
Q2006: Time by yourself
Q2006: Time by yourself
Overall in the last 30 days, how much difficulty did you have in staying by yourself for a few days (3 to 7 days)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2007: Bodily pains
Q2007: Bodily pains
Q2007: Bodily pains
Q2007: Bodily pains
Q2007: Bodily pains
Overall in the last 30 days, how much of bodily aches or pains did you have?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2008: Bodily discomfort
Q2008: Bodily discomfort
Q2008: Bodily discomfort
Q2008: Bodily discomfort
Q2008: Bodily discomfort
Overall in the last 30 days, how much bodily discomfort did you have?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2009: Difficulty b/c pain
Q2009: Difficulty b/c pain
Q2009: Difficulty b/c pain
Q2009: Difficulty b/c pain
Q2009: Difficulty b/c pain
Overall in the last 30 days, how much difficulty did you have in your daily life because of your pain?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2010: Memory
Q2010: Memory
Q2010: Memory
Q2010: Memory
Q2010: Memory
Overall in the last 30 days, how much difficulty… did you have with concentrating or remembering things?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2011: Learning
Q2011: Learning
Q2011: Learning
Q2011: Learning
Q2011: Learning
Overall in the last 30 days, how much difficulty… did you have in learning a new task (for example, learning how to get to a new place, learning a new game, learning a new recipe)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2012: Relationships
Q2012: Relationships
Q2012: Relationships
Q2012: Relationships
Q2012: Relationships
Overall in the last 30 days, how much difficulty did you have, with personal relationships or participation in the community?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2013: Conflicts
Q2013: Conflicts
Q2013: Conflicts
Q2013: Conflicts
Q2013: Conflicts
Overall in the last 30 days, how much difficulty did you have,n dealing with conflicts and tensions with others?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2014: Friendships
Q2014: Friendships
Q2014: Friendships
Q2014: Friendships
Q2014: Friendships
Overall in the last 30 days, how much difficulty did you have, with making new friendships or maintaining current friendships?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2015: Dealing with strangers
Q2015: Dealing with strangers
Q2015: Dealing with strangers
Q2015: Dealing with strangers
Q2015: Dealing with strangers
Overall in the last 30 days, how much difficulty did you have, with dealing with strangers?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2016: Sleep
Q2016: Sleep
Q2016: Sleep
Q2016: Sleep
Q2016: Sleep
Overall in the last 30 days, how much of a problem did you… have with sleeping, such as falling asleep, waking up frequently during the night or waking up too early in the morning?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2017: Rested
Q2017: Rested
Q2017: Rested
Q2017: Rested
Q2017: Rested
Overall in the last 30 days, how much of a problem did you… have due to not feeling rested and refreshed during the day (for example, feeling tired, not having energy)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2018: Depression
Q2018: Depression
Q2018: Depression
Q2018: Depression
Q2018: Depression
Overall in the last 30 days, how much of a problem did you have with feeling sad, low or depressed?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2019: Worry
Q2019: Worry
Q2019: Worry
Q2019: Worry
Q2019: Worry
Overall in the last 30 days, how much of a problem did you have with worry or anxiety?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2020: Years ago eyes examined
Q2020: Years ago eyes examined
Q2020: Years ago eyes examined
Q2020: Years ago eyes examined
Q2020: Years ago eyes examined
When was the last time you had your eyes examined by a medical professional?
years ago
-8 Don't know
98 Never
nterviewer: enter years or months ago. Enter "00" if less than 1 year.
-8
Don't know
98
Never
Q2021: Visual aids
Q2021: Visual aids
Q2021: Visual aids
Q2021: Visual aids
Q2021: Visual aids
Do you use eyeglasses or contact lenses to see far away (for example, across the street)?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q2022: Visual aids
Q2022: Visual aids
Q2022: Visual aids
Q2022: Visual aids
Q2022: Visual aids
Do you use eyeglasses or contact lenses to see up close (for example at arms length, like when you are reading)?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q2023: Visual difficulty
Q2023: Visual difficulty
Q2023: Visual difficulty
Q2023: Visual difficulty
Q2023: Visual difficulty
In the last 30 days, how much difficulty did you have in seeing and recognising an object or a person you know across the road (from a distance of about 20 meters)?
1None
2Mild
3Moderate
4Severe
5 Extreme / cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2024: Visual difficulty
Q2024: Visual difficulty
Q2024: Visual difficulty
Q2024: Visual difficulty
Q2024: Visual difficulty
In the last 30 days, how much difficulty did you have in seeing and recognising an object at arm's length (for example, reading)?
1None
2Mild
3Moderate
4Severe
5 Extreme / cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2025: Sitting
Q2025: Sitting
Q2025: Sitting
Q2025: Sitting
Q2025: Sitting
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have in sitting for long periods?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2026: Walking
Q2026: Walking
Q2026: Walking
Q2026: Walking
Q2026: Walking
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have in walking 100 meters?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2027: Standing up
Q2027: Standing up
Q2027: Standing up
Q2027: Standing up
Q2027: Standing up
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have in standing up from sitting down?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2028: Standing
Q2028: Standing
Q2028: Standing
Q2028: Standing
Q2028: Standing
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have in standing for long periods?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2029: Climbing
Q2029: Climbing
Q2029: Climbing
Q2029: Climbing
Q2029: Climbing
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have with climbing one flight of stairs without resting?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2030: Crouching
Q2030: Crouching
Q2030: Crouching
Q2030: Crouching
Q2030: Crouching
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have with stooping, kneeling or crouching?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2031: Picking up
Q2031: Picking up
Q2031: Picking up
Q2031: Picking up
Q2031: Picking up
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have picking up things with your fingers (such as picking up a coin from a table)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2032: HH responsibilities
Q2032: HH responsibilities
Q2032: HH responsibilities
Q2032: HH responsibilities
Q2032: HH responsibilities
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have in taking care of your household responsibilities?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2033: Activities
Q2033: Activities
Q2033: Activities
Q2033: Activities
Q2033: Activities
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have in joining in community activities (for example, festivities, religious or other activities) in the same way as anyone else can?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2034: Arms over shoulders
Q2034: Arms over shoulders
Q2034: Arms over shoulders
Q2034: Arms over shoulders
Q2034: Arms over shoulders
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have in extending your arms above shoulder level?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2035: Concentration
Q2035: Concentration
Q2035: Concentration
Q2035: Concentration
Q2035: Concentration
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have concentrating on doing something for 10 minutes?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2036: Walking
Q2036: Walking
Q2036: Walking
Q2036: Walking
Q2036: Walking
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have in walking a long distance such as a kilometer?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2037: Washing body
Q2037: Washing body
Q2037: Washing body
Q2037: Washing body
Q2037: Washing body
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have in bathing/washing your whole body?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2038: Dressing
Q2038: Dressing
Q2038: Dressing
Q2038: Dressing
Q2038: Dressing
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have in getting dressed?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2039: Daily work
Q2039: Daily work
Q2039: Daily work
Q2039: Daily work
Q2039: Daily work
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have in your day to day work?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2040: Carrying
Q2040: Carrying
Q2040: Carrying
Q2040: Carrying
Q2040: Carrying
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have with carrying things?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2041: Moving around
Q2041: Moving around
Q2041: Moving around
Q2041: Moving around
Q2041: Moving around
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have with moving around inside your home (such as walking across a room)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2042: Eating
Q2042: Eating
Q2042: Eating
Q2042: Eating
Q2042: Eating
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have with eating (including cutting up your food)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2043: Getting up from lying
Q2043: Getting up from lying
Q2043: Getting up from lying
Q2043: Getting up from lying
Q2043: Getting up from lying
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have with getting up from lying down?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2044: Using toilet
Q2044: Using toilet
Q2044: Using toilet
Q2044: Using toilet
Q2044: Using toilet
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have with getting to and using the toilet?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2045: Getting places
Q2045: Getting places
Q2045: Getting places
Q2045: Getting places
Q2045: Getting places
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have with getting where you want to go, using private or public transport if needed?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2046: Going out
Q2046: Going out
Q2046: Going out
Q2046: Going out
Q2046: Going out
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have getting out of your home?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2047: Emotional effect
Q2047: Emotional effect
Q2047: Emotional effect
Q2047: Emotional effect
Q2047: Emotional effect
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have In the last 30 days, how much have you been emotionally affected by your health condition(s)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2048: Interference with daily life
Q2048: Interference with daily life
Q2048: Interference with daily life
Q2048: Interference with daily life
Q2048: Interference with daily life
Functioning assessment
These next questions ask about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the last 30 days and answer these questions thinking about how much difficulty you had doing the following activities. Some of these questions may seem repetitive, but we do need your attention and it is important to give us answers to each question.
In the last 30 days, how much difficulty did you have Overall, how much did these difficulties interfere with your life?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
9 N/A
Interviewer: For each question, please circle only one response. 'N/A' means 'not applicable'
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2049: Other aids
Q2049: Other aids
Q2049: Other aids
Q2049: Other aids
Q2049: Other aids
Besides any vision aids (eyeglasses or contact lenses) do you use any other assistive devices (cane, walker or other) for any difficulties you experience?
1 Yes
2 No
1
Yes
2
No
8
DK
9
NA
Vignette Set
Vignette Set
Vignette Set
Vignette Set
Vignette Set
S2100: HH begin
S2100: HH begin
S2100: HH begin
S2100: HH begin
S2100: HH begin
S2100: MM begin
S2100: MM begin
S2100: MM begin
S2100: MM begin
S2100: MM begin
S2100: HH end
S2100: HH end
S2100: HH end
S2100: HH end
S2100: HH end
S2100: MM end
S2100: MM end
S2100: MM end
S2100: MM end
S2100: MM end
Q2101: Moving around
Q2101: Moving around
Q2101: Moving around
Q2101: Moving around
Q2101: Moving around
This next section will require additional concentration. I will read to you some stories about people with varying levels of difficulties in different areas of health. I want you to think about these people's experiences as if they were your own. Once I have finished reading each story, I will ask you to rate what happened in the story.
I would like to know how you view each story and rate how much of a problem or difficulty the person described has in that area of health in the same way that you described your own health to me earlier. While giving the rating, think of the person in the story as someone who is of your age and background.
[Yusuf] is able to walk distances of up to 200 metres without any problems but feels tired after walking one kilometre or climbing up more than one flight of stairs. He has no problems with day-to-day physical activities, such as carrying food from the market.
Overall in the last 30 days, how much difficulty did [Yusuf] have with moving around?
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2102: Vigorous action
Q2102: Vigorous action
Q2102: Vigorous action
Q2102: Vigorous action
Q2102: Vigorous action
[Yusuf] is able to walk distances of up to 200 metres without any problems but feels tired after walking one kilometre or climbing up more than one flight of stairs. He has no problems with day-to-day physical activities, such as carrying food from the market.
Overall in the last 30 days, how much difficulty did Yusuf] have in vigorous activities ('vigorous activities' require hard physical effort and cause large increases in breathing or heart rate)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2103: Depression
Q2103: Depression
Q2103: Depression
Q2103: Depression
Q2103: Depression
Lucas] feels nervous and anxious. He worries and thinks negatively about the future, but feels better in the company of people or when doing something that really interests him. When he is alone he tends to feel useless and empty.
Overall in the last 30 days, how much of a problem did Lucas] have with feeling sad, low, or depressed?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2104: Anxiety
Q2104: Anxiety
Q2104: Anxiety
Q2104: Anxiety
Q2104: Anxiety
Lucas] feels nervous and anxious. He worries and thinks negatively about the future, but feels better in the company of people or when doing something that really interests him. When he is alone he tends to feel useless and empty.
Overall in the last 30 days, how much of a problem did Lucas] have with worry or anxiety?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2105: Moving around
Q2105: Moving around
Q2105: Moving around
Q2105: Moving around
Q2105: Moving around
[Gabriel] has a lot of swelling in his legs due to his health condition. He has to make an effort to walk around his home as his legs feel heavy.
Overall in the last 30 days, how much difficulty did [Gabriel] have with moving around?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2106: Vigorous action
Q2106: Vigorous action
Q2106: Vigorous action
Q2106: Vigorous action
Q2106: Vigorous action
[Gabriel] has a lot of swelling in his legs due to his health condition. He has to make an effort to walk around his home as his legs feel heavy.
Overall in the last 30 days, how much difficulty did [Gabriel] have in vigorous activities?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2107: Depression
Q2107: Depression
Q2107: Depression
Q2107: Depression
Q2107: Depression
[Jane] enjoys her work and social activities and is generally satisfied with her life. She gets depressed every 3 weeks for a day or two and loses interest in what she usually enjoys but is able to carry on with her day to day activities.
Overall in the last 30 days, how much of a problem did [Jane] have with feeling sad, low, or depressed?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2108: Anxiety
Q2108: Anxiety
Q2108: Anxiety
Q2108: Anxiety
Q2108: Anxiety
[Jane] enjoys her work and social activities and is generally satisfied with her life. She gets depressed every 3 weeks for a day or two and loses interest in what she usually enjoys but is able to carry on with her day to day activities.
Overall in the last 30 days, how much of a problem did [Jane] have with worry or anxiety?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2109: Moving around
Q2109: Moving around
Q2109: Moving around
Q2109: Moving around
Q2109: Moving around
[Margaret] does not exercise. She cannot climb stairs or do other physical activities because she is obese. She is able to carry the groceries and do some light household work.
Overall in the last 30 days, how much of a problem did [Margaret] have with moving around?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2110: Vigorous action
Q2110: Vigorous action
Q2110: Vigorous action
Q2110: Vigorous action
Q2110: Vigorous action
[Margaret] does not exercise. She cannot climb stairs or do other physical activities because she is obese. She is able to carry the groceries and do some light household work.
Overall in the last 30 days, how much of a problem did [Margaret] have in vigorous activities?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2111: Depression
Q2111: Depression
Q2111: Depression
Q2111: Depression
Q2111: Depression
[Susan] feels depressed most of the time. She weeps frequently and feels hopeless about the future. She feels that she has become a burden on others and that she would be better dead.
Overall in the last 30 days, how much of a problem did [Susan] have with feeling sad, low, or depressed?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2112: Anxiety
Q2112: Anxiety
Q2112: Anxiety
Q2112: Anxiety
Q2112: Anxiety
[Susan] feels depressed most of the time. She weeps frequently and feels hopeless about the future. She feels that she has become a burden on others and that she would be better dead.
Overall in the last 30 days, how much of a problem did [Susan] have with worry or anxiety?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2113: Moving around
Q2113: Moving around
Q2113: Moving around
Q2113: Moving around
Q2113: Moving around
[Mary] has no problems with walking, running or using her hands, arms and legs. She jogs 4 kilometres twice a week.
Overall in the last 30 days, how much difficulty did [Mary] have with moving around?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2114: Vigorous action
Q2114: Vigorous action
Q2114: Vigorous action
Q2114: Vigorous action
Q2114: Vigorous action
[Mary] has no problems with walking, running or using her hands, arms and legs. She jogs 4 kilometres twice a week.
Overall in the last 30 days, how much difficulty did [Mary] have in vigorous activities?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2115: Moving around
Q2115: Moving around
Q2115: Moving around
Q2115: Moving around
Q2115: Moving around
Abdul] is paralyzed from the neck down. He is unable to move his arms and legs or to shift body position. He is confined to bed
Overall in the last 30 days, how much difficulty did [Abdul] have with moving around?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2116: Vigorous action
Q2116: Vigorous action
Q2116: Vigorous action
Q2116: Vigorous action
Q2116: Vigorous action
Abdul] is paralyzed from the neck down. He is unable to move his arms and legs or to shift body position. He is confined to bed
Overall in the last 30 days, how much difficulty did [Abdul] have in vigorous activities?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2117: Depression
Q2117: Depression
Q2117: Depression
Q2117: Depression
Q2117: Depression
[Samson] loves life and is happy all the time. He never worries or gets upset about anything and deals with things as they come.
Overall in the last 30 days, how much of a problem did Samson] have with feeling sad, low, or depressed?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2118: Anxiety
Q2118: Anxiety
Q2118: Anxiety
Q2118: Anxiety
Q2118: Anxiety
[Samson] loves life and is happy all the time. He never worries or gets upset about anything and deals with things as they come.
Overall in the last 30 days, how much of a problem did [Samson] have with worry or anxiety?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2119: Depression
Q2119: Depression
Q2119: Depression
Q2119: Depression
Q2119: Depression
[Scholastica] has already had five admissions into the hospital because she has attempted suicide twice in the past year and has harmed herself on three other occasions. She is very distressed every day for the most part of the day, and sees no hope of things ever getting better. She is thinking of trying to end her life again.
Overall in the last 30 days, how much of a problem did [Scholastica] have with feeling sad, low, or depressed?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2120: Anxiety
Q2120: Anxiety
Q2120: Anxiety
Q2120: Anxiety
Q2120: Anxiety
[Scholastica] has already had five admissions into the hospital because she has attempted suicide twice in the past year and has harmed herself on three other occasions. She is very distressed every day for the most part of the day, and sees no hope of things ever getting better. She is thinking of trying to end her life again.
Overall in the last 30 days, how much of a problem did [Scholastica] have with worry or anxiety?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
S2100: HH begin
S2100: HH begin
S2100: HH begin
S2100: HH begin
S2100: HH begin
S2100: MM begin
S2100: MM begin
S2100: MM begin
S2100: MM begin
S2100: MM begin
S2100: HH end
S2100: HH end
S2100: HH end
S2100: HH end
S2100: HH end
S2100: MM end
S2100: MM end
S2100: MM end
S2100: MM end
S2100: MM end
Q2101: Relationships
Q2101: Relationships
Q2101: Relationships
Q2101: Relationships
Q2101: Relationships
This next section will require additional concentration. I will read to you some stories about people with varying levels of difficulties in different areas of health. I want you to think about these people's experiences as if they were your own. Once I have finished reading each story, I will ask you to rate what happened in the story.
I would like to know how you view each story and rate how much of a problem or difficulty the person described has in that area of health in the same way that you described your own health to me earlier. While giving the rating, think of the person in the story as someone who is of your age and background
[Elizabeth] has difficulty climbing up and down the stairs and walking. She is not able to go out as much as she would like to but has many friends who come and visit her at home. Her friends find her a source of great comfort.
Overall in the last 30 days, how much difficulty did [Elizabeth] have with personal relationships or participation in the community?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2102: Conflicts
Q2102: Conflicts
Q2102: Conflicts
Q2102: Conflicts
Q2102: Conflicts
Overall in the last 30 days, how much difficulty did [Elizabeth] have in dealing with conflicts and tensions with others?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2103: Body pains
Q2103: Body pains
Q2103: Body pains
Q2103: Body pains
Q2103: Body pains
[Markus] has pain in his knees, elbows, wrists and fingers, and the pain is present almost all the time. It gets worse during the first half of the day. Although medication helps, he feels uncomfortable when moving around, holding and lifting things.
Overall in the last 30 days, how much of bodily aches or pains did [Markus] have?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2104: Discomfort
Q2104: Discomfort
Q2104: Discomfort
Q2104: Discomfort
Q2104: Discomfort
[Markus] has pain in his knees, elbows, wrists and fingers, and the pain is present almost all the time. It gets worse during the first half of the day. Although medication helps, he feels uncomfortable when moving around, holding and lifting things.
Overall in the last 30 days, how much bodily discomfort did [Markus] have?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2105: Relationships
Q2105: Relationships
Q2105: Relationships
Q2105: Relationships
Q2105: Relationships
[Nobu] is blind and lives in a remote rural area. His family does not allow him to leave the house because they fear he will get hurt. His family tells him that he is a burden to them. Their criticism upsets him and he cries.
Overall in the last 30 days, how much difficulty did [Nobu] have with personal relationships or participation in the community?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2106: Conflicts
Q2106: Conflicts
Q2106: Conflicts
Q2106: Conflicts
Q2106: Conflicts
[Nobu] is blind and lives in a remote rural area. His family does not allow him to leave the house because they fear he will get hurt. His family tells him that he is a burden to them. Their criticism upsets him and he cries.
Overall in the last 30 days, how much difficulty did [Nobu] have in dealing with conflicts and tensions with others?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2107: Body pains
Q2107: Body pains
Q2107: Body pains
Q2107: Body pains
Q2107: Body pains
[Laura] has a headache once a month that is relieved one hour after taking a pill. During the headache she can carry on with her day to day affairs.
Overall in the last 30 days, how much of bodily aches or pains did [Laura] have?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2108: Discomfort
Q2108: Discomfort
Q2108: Discomfort
Q2108: Discomfort
Q2108: Discomfort
[Laura] has a headache once a month that is relieved one hour after taking a pill. During the headache she can carry on with her day to day affairs.
Overall in the last 30 days, how much bodily discomfort did [Laura] have?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2109: Body pains
Q2109: Body pains
Q2109: Body pains
Q2109: Body pains
Q2109: Body pains
[Isabelle] has pain that radiates down her right arm and wrist during her day at work. This is slightly relieved in the evenings when she is no longer working on her computer
Overall in the last 30 days, how much of bodily aches or pains did [Isabelle] have?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2110: Discomfort
Q2110: Discomfort
Q2110: Discomfort
Q2110: Discomfort
Q2110: Discomfort
[Isabelle] has pain that radiates down her right arm and wrist during her day at work. This is slightly relieved in the evenings when she is no longer working on her computer
Overall in the last 30 days, how much bodily discomfort did [Isabelle] have?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2111: Relationships
Q2111: Relationships
Q2111: Relationships
Q2111: Relationships
Q2111: Relationships
[John] gets on well with the people he knows but has no close friends. He has not spoken to his mother in 5 years and does not want to see her. Because of this tension, his family usually excludes him from family gatherings.
Overall in the last 30 days, how much of a problem did [John] have with personal relationship or participation in the community?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2112: Conflicts
Q2112: Conflicts
Q2112: Conflicts
Q2112: Conflicts
Q2112: Conflicts
[John] gets on well with the people he knows but has no close friends. He has not spoken to his mother in 5 years and does not want to see her. Because of this tension, his family usually excludes him from family gatherings.
Overall in the last 30 days, how much of a problem did John] have in dealing with conflicts and tensions with others?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2113: Relationships
Q2113: Relationships
Q2113: Relationships
Q2113: Relationships
Q2113: Relationships
Amala] suffered a stroke three months ago. Her friends do not come and visit anymore as Amala cannot communicate with them. She is constantly upset and shouts at her family members which cause them to avoid her.
Overall in the last 30 days, how much difficulty did Amala] have with personal relationship or participation in the community?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2114: Conflicts
Q2114: Conflicts
Q2114: Conflicts
Q2114: Conflicts
Q2114: Conflicts
Amala] suffered a stroke three months ago. Her friends do not come and visit anymore as Amala cannot communicate with them. She is constantly upset and shouts at her family members which cause them to avoid her.
Overall in the last 30 days, how much difficulty did [Amala] have in dealing with conflicts and tensions with others?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2115: Body pains
Q2115: Body pains
Q2115: Body pains
Q2115: Body pains
Q2115: Body pains
Nadia] cannot remember when she last felt pain as this has not happened for the last several years now. She does not experience any pain even after hard physical labor or exercise.
Overall in the last 30 days, how much of bodily aches or pains did [Nadia] have?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2116: Discomfort
Q2116: Discomfort
Q2116: Discomfort
Q2116: Discomfort
Q2116: Discomfort
Nadia] cannot remember when she last felt pain as this has not happened for the last several years now. She does not experience any pain even after hard physical labor or exercise.
Overall in the last 30 days, how much bodily discomfort did [Nadia] have?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2117: Relationships
Q2117: Relationships
Q2117: Relationships
Q2117: Relationships
Q2117: Relationships
[Charles] can join in any community activities that interest him, whenever he wants to, without any restrictions. He gets on well with everybody and enjoys meeting new people.
Overall in the last 30 days, how much of a problem did…[Charles] have with personal relationship or participation in the community?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2118: Conflicts
Q2118: Conflicts
Q2118: Conflicts
Q2118: Conflicts
Q2118: Conflicts
[Charles] can join in any community activities that interest him, whenever he wants to, without any restrictions. He gets on well with everybody and enjoys meeting new people.
Overall in the last 30 days, how much of a problem did…Charles] have in dealing with conflicts and tensions with others?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2119: Body pains
Q2119: Body pains
Q2119: Body pains
Q2119: Body pains
Q2119: Body pains
[Steve] has pain in the neck radiating to the arms that is not relieved by any medicines or other treatment. The pain is sharp at all times and keeps him awake most of the night. During the day the pain has made him completely incapacitated. It has necessitated complete confinement to the bed and often makes him think of ending his life.
Overall in the last 30 days, how much of bodily aches or pains did [Steve] have?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2120: Discomfort
Q2120: Discomfort
Q2120: Discomfort
Q2120: Discomfort
Q2120: Discomfort
[Steve] has pain in the neck radiating to the arms that is not relieved by any medicines or other treatment. The pain is sharp at all times and keeps him awake most of the night. During the day the pain has made him completely incapacitated. It has necessitated complete confinement to the bed and often makes him think of ending his life.
Overall in the last 30 days, how much bodily discomfort did [Steve] have?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
S2100: HH begin
S2100: HH begin
S2100: HH begin
S2100: HH begin
S2100: HH begin
S2100: MM begin
S2100: MM begin
S2100: MM begin
S2100: MM begin
S2100: MM begin
S2100: HH end
S2100: HH end
S2100: HH end
S2100: HH end
S2100: HH end
S2100: MM end
S2100: MM end
S2100: MM end
S2100: MM end
S2100: MM end
Q2101: Sleep
Q2101: Sleep
Q2101: Sleep
Q2101: Sleep
Q2101: Sleep
This next section will require additional concentration. I will read to you some stories about people with varying levels of difficulties in different areas of health. I want you to think about these people's experiences as if they were your own. Once I have finished reading each story, I will ask you to rate what happened in the story.
I would like to know how you view each story and rate how much of a problem or difficulty the person described has in that area of health in the same way that you described your own health to me earlier. While giving the rating, think of the person in the story as someone who is of your age and background.
[Damien] wakes up almost once every hour during the night. When he wakes up in the night, it takes around 15 minutes for him to go back to sleep. In the morning he does not feel well-rested and feels slow and tired all day.
Overall in the last 30 days, how much difficulty did [Damien] have with sleeping, such as falling asleep, waking up frequently during the night or waking up too early in the morning?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2102: Energy
Q2102: Energy
Q2102: Energy
Q2102: Energy
Q2102: Energy
This next section will require additional concentration. I will read to you some stories about people with varying levels of difficulties in different areas of health. I want you to think about these people's experiences as if they were your own. Once I have finished reading each story, I will ask you to rate what happened in the story.
I would like to know how you view each story and rate how much of a problem or difficulty the person described has in that area of health in the same way that you described your own health to me earlier. While giving the rating, think of the person in the story as someone who is of your age and background.
[Damien] wakes up almost once every hour during the night. When he wakes up in the night, it takes around 15 minutes for him to go back to sleep. In the morning he does not feel well-rested and feels slow and tired all day.
Overall in the last 30 days, how much of a problem did [Damien] have due to not feeling rested and refreshed during the day (feeling tired, not having energy)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2103: Person
Q2103: Person
Q2103: Person
Q2103: Person
Q2103: Person
[Antonio] can read words in newspaper articles (and can recognize faces on a postcard size photograph). He can recognize shapes and colours from across 20 metres but misses out the fine details
Overall in the last 30 days, how much difficulty did [Antonio] have in seeing and recognizing a person he knows across the road (from a distance of about 20 meters)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2104: Object
Q2104: Object
Q2104: Object
Q2104: Object
Q2104: Object
[Antonio] can read words in newspaper articles (and can recognize faces on a postcard size photograph). He can recognize shapes and colours from across 20 metres but misses out the fine details
Overall in the last 30 days, how much difficulty did [Antonio] have in seeing and recognizing an object at arm's length or in reading?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2105: Sleep
Q2105: Sleep
Q2105: Sleep
Q2105: Sleep
Q2105: Sleep
[Rupa] has no trouble falling asleep at night and does not wake up during the night, but every morning she finds it difficult to wake up. She uses an alarm clock but falls back asleep after the alarm goes off. She is late to work on four out of five days and feels tired in the mornings.
Overall in the last 30 days, how much difficulty did [Rupa] have with sleeping, such as falling asleep, waking up frequently during the night or waking up too early in the morning?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2106: Energy
Q2106: Energy
Q2106: Energy
Q2106: Energy
Q2106: Energy
[Rupa] has no trouble falling asleep at night and does not wake up during the night, but every morning she finds it difficult to wake up. She uses an alarm clock but falls back asleep after the alarm goes off. She is late to work on four out of five days and feels tired in the mornings.
Overall in the last 30 days, how much of a problem did [Rupa] have due to not feeling rested and refreshed during the day (feeling tired, not having energy)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2107: Person
Q2107: Person
Q2107: Person
Q2107: Person
Q2107: Person
[Jennifer] only reads if the text is in very large print, such as 10 lines per page. Otherwise she does not read anything. Even when people are close to her, she sees them blurred.
Overall in the last 30 days, how much difficulty did [Jennifer] have in seeing and recognizing a person she knows across the road (from a distance of about 20 meters)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2108: Object
Q2108: Object
Q2108: Object
Q2108: Object
Q2108: Object
[Jennifer] only reads if the text is in very large print, such as 10 lines per page. Otherwise she does not read anything. Even when people are close to her, she sees them blurred.
Overall in the last 30 days, how much difficulty did [Jennifer] have in seeing and recognizing an object at arm's length or in reading?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2109: Person
Q2109: Person
Q2109: Person
Q2109: Person
Q2109: Person
[Norman] needs a magnifying glass to read small print and look at details on pictures. He also takes a while to recognize objects if they are too far from him
Overall in the last 30 days, how much difficulty did [Norman] have in seeing and recognizing a person she knows across the road (from a distance of about 20 meters)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2110: Object
Q2110: Object
Q2110: Object
Q2110: Object
Q2110: Object
[Norman] needs a magnifying glass to read small print and look at details on pictures. He also takes a while to recognize objects if they are too far from him
Overall in the last 30 days, how much difficulty did [Norman] have in seeing and recognizing an object at arm's length or in reading?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2111: Sleep
Q2111: Sleep
Q2111: Sleep
Q2111: Sleep
Q2111: Sleep
[Noemi] falls asleep easily at night, but two nights a week she wakes up in the middle of the night and cannot go back to sleep for the rest of the night. On these days she is exhausted at work and cannot concentrate on her job.
Overall in the last 30 days, how much difficulty did [Noemi] have with sleeping, such as falling asleep, waking up frequently during the night or waking up too early in the morning?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2112: Energy
Q2112: Energy
Q2112: Energy
Q2112: Energy
Q2112: Energy
[Noemi] falls asleep easily at night, but two nights a week she wakes up in the middle of the night and cannot go back to sleep for the rest of the night. On these days she is exhausted at work and cannot concentrate on her job.
Overall in the last 30 days, how much of a problem did [Noemi] have due to not feeling rested and refreshed during the day (feeling tired, not having energy)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2113: Person
Q2113: Person
Q2113: Person
Q2113: Person
Q2113: Person
[Hector] can read words in newspaper articles (and can recognize faces on a postcard size photograph). He can recognize familiar people's faces all the time and picks out most details in pictures from across 20 metres.
Overall in the last 30 days, how much difficulty did [Hector] have in seeing and recognizing a person she knows across the road (from a distance of about 20 meters)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2114: Object
Q2114: Object
Q2114: Object
Q2114: Object
Q2114: Object
[Hector] can read words in newspaper articles (and can recognize faces on a postcard size photograph). He can recognize familiar people's faces all the time and picks out most details in pictures from across 20 metres.
Overall in the last 30 days, how much difficulty did [Hector] have in seeing and recognizing an object at arm's length or in reading?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2115: Sleep
Q2115: Sleep
Q2115: Sleep
Q2115: Sleep
Q2115: Sleep
[Carmen] takes about two hours every night to fall asleep. She wakes up once or twice a night feeling panicked and takes more than one hour to fall asleep again. Three to four nights a week she wakes up in the middle of the night and cannot go back to sleep for the rest of the night. She is fatigued all day, every day and misses work several times a week. She cannot take part in sports or social activities
Overall in the last 30 days, how much difficulty did [Carmen] have with sleeping, such as falling asleep, waking up frequently during the night or waking up too early in the morning?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2116: Energy
Q2116: Energy
Q2116: Energy
Q2116: Energy
Q2116: Energy
[Carmen] takes about two hours every night to fall asleep. She wakes up once or twice a night feeling panicked and takes more than one hour to fall asleep again. Three to four nights a week she wakes up in the middle of the night and cannot go back to sleep for the rest of the night. She is fatigued all day, every day and misses work several times a week. She cannot take part in sports or social activities
Overall in the last 30 days, how much of a problem did [Carmen] have due to not feeling rested and refreshed during the day (e.g. feeling tired, not having energy)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2117: Person
Q2117: Person
Q2117: Person
Q2117: Person
Q2117: Person
[Annette] cannot detect any movement close to the eyes or even the presence of a light.
Overall in the last 30 days, how much difficulty did [Annette] have in seeing and recognizing a person she knows across the road (from a distance of about 20 meters)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2118: Object
Q2118: Object
Q2118: Object
Q2118: Object
Q2118: Object
[Annette] cannot detect any movement close to the eyes or even the presence of a light.
Overall in the last 30 days, how much difficulty did [Annette] have in seeing and recognizing an object at arm's length or in reading?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2119: Sleep
Q2119: Sleep
Q2119: Sleep
Q2119: Sleep
Q2119: Sleep
[Hamadi] falls asleep every night within five minutes of going to bed. He sleeps soundly during the whole night and wakes up in the morning feeling well-rested and feels full of energy all day.
Overall in the last 30 days, how much difficulty did [Hamadi] have with sleeping, such as falling asleep, waking up frequently during the night or waking up too early in the morning?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2120: Energy
Q2120: Energy
Q2120: Energy
Q2120: Energy
Q2120: Energy
[Hamadi] falls asleep every night within five minutes of going to bed. He sleeps soundly during the whole night and wakes up in the morning feeling well-rested and feels full of energy all day.
Overall in the last 30 days, how much of a problem did [Hamadi] have due to not feeling rested and refreshed during the day (feeling tired, not having energy)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
S2100: HH begin
S2100: HH begin
S2100: HH begin
S2100: HH begin
S2100: HH begin
S2100: MM begin
S2100: MM begin
S2100: MM begin
S2100: MM begin
S2100: MM begin
S2100: HH end
S2100: HH end
S2100: HH end
S2100: HH end
S2100: HH end
S2100: MM end
S2100: MM end
S2100: MM end
S2100: MM end
S2100: MM end
Q2101: Care
Q2101: Care
Q2101: Care
Q2101: Care
Q2101: Care
This next section will require additional concentration. I will read to you some stories about people with varying levels of difficulties in different areas of health. I want you to think about these people's experiences as if they were your own. Once I have finished reading each story, I will ask you to rate what happened in the story.
I would like to know how you view each story and rate how much of a problem or difficulty the person described has in that area of health in the same way that you described your own health to me earlier. While giving the rating, think of the person in the story as someone who is of your age and background.
[Anne] takes twice as long as others to put on and take off clothes, but needs no help with this. Although it requires an effort, she is able to bathe and groom herself, though less frequently than before. She does not require help with feeding.
Overall in the last 30 days, how much difficulty did…did [Anne] have with self-care, such as washing or dressing herself?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2102: Appear
Q2102: Appear
Q2102: Appear
Q2102: Appear
Q2102: Appear
This next section will require additional concentration. I will read to you some stories about people with varying levels of difficulties in different areas of health. I want you to think about these people's experiences as if they were your own. Once I have finished reading each story, I will ask you to rate what happened in the story.
I would like to know how you view each story and rate how much of a problem or difficulty the person described has in that area of health in the same way that you described your own health to me earlier. While giving the rating, think of the person in the story as someone who is of your age and background.
[Anne] takes twice as long as others to put on and take off clothes, but needs no help with this. Although it requires an effort, she is able to bathe and groom herself, though less frequently than before. She does not require help with feeding.
Overall in the last 30 days, how much difficulty did…did [Anne] have in taking care of and maintaining her general appearance (grooming, looking neat and tidy)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2103: Memory
Q2103: Memory
Q2103: Memory
Q2103: Memory
Q2103: Memory
Rama] can find her way around the neighborhood and know where her own belongings are kept, but struggles to remember how to get to a place she has only visited once or twice. She is keen to learn new recipes but finds that she often makes mistakes and has to reread several times before she is able to do them properly.
Overall in the last 30 days, how much difficulty did Rama] have with concentrating or remembering things?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2104: Learn
Q2104: Learn
Q2104: Learn
Q2104: Learn
Q2104: Learn
Rama] can find her way around the neighborhood and know where her own belongings are kept, but struggles to remember how to get to a place she has only visited once or twice. She is keen to learn new recipes but finds that she often makes mistakes and has to reread several times before she is able to do them properly.
Overall in the last 30 days, how much difficulty did did [Rama] have in learning a new task (for example, learning how to get to a new place, learning a new game, learning a new recipe)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2105: Memory
Q2105: Memory
Q2105: Memory
Q2105: Memory
Q2105: Memory
[Theo] cannot concentrate for more than 15 minutes and has difficulty paying attention to what is being said to him. Whenever he starts a task, he never manages to finish it and often forgets what he was doing. He is able to learn the names of people he meets but cannot be trusted to follow directions to a store by himself.
Overall in the last 30 days, how much difficulty did [Theo] have with concentrating or remembering things?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2106: Learn
Q2106: Learn
Q2106: Learn
Q2106: Learn
Q2106: Learn
[Theo] cannot concentrate for more than 15 minutes and has difficulty paying attention to what is being said to him. Whenever he starts a task, he never manages to finish it and often forgets what he was doing. He is able to learn the names of people he meets but cannot be trusted to follow directions to a store by himself.
Overall in the last 30 days, how much difficulty did [Theo] have in learning a new task (for example, learning how to get to a new place, learning a new game, learning a new recipe)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2107: Care
Q2107: Care
Q2107: Care
Q2107: Care
Q2107: Care
[Sandra] lives on her own and has no relatives or friends nearby. Because of her arthritis, she is house-bound. She often stays all day in the same clothes that she has slept in, as changing clothes is too painful. A neighbour helps her wash herself
Overall in the last 30 days, how much difficulty did [Sandra] have with self-care, such as washing or dressing herself?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2108: Appear
Q2108: Appear
Q2108: Appear
Q2108: Appear
Q2108: Appear
[Sandra] lives on her own and has no relatives or friends nearby. Because of her arthritis, she is house-bound. She often stays all day in the same clothes that she has slept in, as changing clothes is too painful. A neighbour helps her wash herself
Overall in the last 30 days, how much difficulty did [Sandra] have in taking care of and maintaining her general appearance (grooming, looking neat and tidy)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2109: Memory
Q2109: Memory
Q2109: Memory
Q2109: Memory
Q2109: Memory
Malcolm] can concentrate while watching TV, reading a magazine or playing a game of cards or chess. He can learn new variations in these games with small effort. Once a week he forgets where his keys or glasses are, but finds them within five minutes.
Overall in the last 30 days, how much difficulty did [Malcolm] have with concentrating or remembering things?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2110: Learn
Q2110: Learn
Q2110: Learn
Q2110: Learn
Q2110: Learn
Malcolm] can concentrate while watching TV, reading a magazine or playing a game of cards or chess. He can learn new variations in these games with small effort. Once a week he forgets where his keys or glasses are, but finds them within five minutes.
Overall in the last 30 days, how much difficulty did [Malcolm] have in learning a new task (learning how to get to a new place, learning a new game, learning a new recipe)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2111: Care
Q2111: Care
Q2111: Care
Q2111: Care
Q2111: Care
[Mohamed] requires no assistance with cleanliness, dressing and eating. He occasionally suffers from back pain and when this happens he needs help with bathing and dressing. He always keeps himself tidy
Overall in the last 30 days, how much difficulty did [Mohamed] have with self-care, such as washing or dressing himself?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2112: Appear
Q2112: Appear
Q2112: Appear
Q2112: Appear
Q2112: Appear
[Mohamed] requires no assistance with cleanliness, dressing and eating. He occasionally suffers from back pain and when this happens he needs help with bathing and dressing. He always keeps himself tidy
Overall in the last 30 days, how much difficulty did [Mohamed] have in taking care of and maintaining his general appearance (grooming, looking neat and tidy)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2113: Care
Q2113: Care
Q2113: Care
Q2113: Care
Q2113: Care
[Helena] pays a lot of attention to the way she looks. She requires no assistance with cleanliness, dressing and eating.
Overall in the last 30 days, how much difficulty did Helena] have with self-care, such as washing or dressing herself?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2114: Appear
Q2114: Appear
Q2114: Appear
Q2114: Appear
Q2114: Appear
[Helena] pays a lot of attention to the way she looks. She requires no assistance with cleanliness, dressing and eating.
Overall in the last 30 days, how much difficulty did [Helena] have in taking care of and maintaining her general appearance (grooming, looking neat and tidy etc)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2115: Care
Q2115: Care
Q2115: Care
Q2115: Care
Q2115: Care
[Manjima] is quadriplegic and must be washed, groomed, dressed and fed by somebody else.
Overall in the last 30 days, how much did [Manjima] have with self-care, such as washing or dressing herself?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2116: Appear
Q2116: Appear
Q2116: Appear
Q2116: Appear
Q2116: Appear
[Manjima] is quadriplegic and must be washed, groomed, dressed and fed by somebody else.
Overall in the last 30 days, how much did [Manjima] have in taking care of and maintaining her general appearance (e.g. grooming, looking neat and tidy)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2117: Memory
Q2117: Memory
Q2117: Memory
Q2117: Memory
Q2117: Memory
[Sanjeev] is very quick to learn new skills at his work. He can pay attention to the task at hand for long uninterrupted periods of time. He can remember names of people, addresses, phone numbers and such details that go back several years.
Overall in the last 30 days, how much difficulty did [Sanjeev] have with concentrating or remembering things?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2118: Learn
Q2118: Learn
Q2118: Learn
Q2118: Learn
Q2118: Learn
[Sanjeev] is very quick to learn new skills at his work. He can pay attention to the task at hand for long uninterrupted periods of time. He can remember names of people, addresses, phone numbers and such details that go back several years.
Overall in the last 30 days, how much difficulty did [Sanjeev] have in learning a new task (for example, learning how to get to a new place, learning a new game, learning a new recipe)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2119: Memory
Q2119: Memory
Q2119: Memory
Q2119: Memory
Q2119: Memory
[Saurabh] does not recognize even close relatives and gets lost when he leaves the house unaccompanied. Even when prompted, he shows no recollection of events or recognition of relatives. It is impossible for him to acquire any new knowledge as even simple instructions leave him confused.
Overall in the last 30 days, how much difficulty did [Saurabh] have with concentrating or remembering things?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q2120: Learn
Q2120: Learn
Q2120: Learn
Q2120: Learn
Q2120: Learn
[Saurabh] does not recognize even close relatives and gets lost when he leaves the house unaccompanied. Even when prompted, he shows no recollection of events or recognition of relatives. It is impossible for him to acquire any new knowledge as even simple instructions leave him confused.
Overall in the last 30 days, how much difficulty did [Saurabh] have in learning a new task (for example, learning how to get to a new place, learning a new game, learning a new recipe)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
S2500: HH begin
S2500: HH begin
S2500: HH begin
S2500: HH begin
S2500: HH begin
S2500: MM begin
S2500: MM begin
S2500: MM begin
S2500: MM begin
S2500: MM begin
S2500: HH end
S2500: HH end
S2500: HH end
S2500: HH end
S2500: HH end
S2500: MM end
S2500: MM end
S2500: MM end
S2500: MM end
S2500: MM end
Q2501: Systolic (1)
Q2501: Systolic (1)
Q2501: Systolic (1)
Q2501: Systolic (1)
Q2501: Systolic (1)
First I would like to measure your blood pressure and pulse rate. Stay seated, and once I put this on your wrist keep it steady and at the level of your heart. We will need to take the blood pressure reading three times. It will squeeze your wrist a bit, but won't hurt. Relax.
INTERVIEWER: respondent should remain seated. Demonstrate to the respondent how to hold their arm while the machine is measuring. Place the monitoring device on the wrist and have the respondent hold it at heart level against his/her chest. When the device is in the correct position and respondent is relaxed, press the button to start. Check to make sure it is working. Collect the blood pressure and pulse 3 times with one minute between each measurement. You do not need to remove the device between measurements.
Time 1 Systolic
-9
Refused
-8
Don't know
Before we ask you more questions, this time about your own health and well-being, we would like to measure a few things, like your blood pressure, your weight and height. We'll also ask you to participate in a few tests to determine your health status.
Q2501: Diastolic (1)
Q2501: Diastolic (1)
Q2501: Diastolic (1)
Q2501: Diastolic (1)
Q2501: Diastolic (1)
Time 1 Diastolic
-9
Refused
-8
Don't know
Q2501a: Pulse (1)
Q2501a: Pulse (1)
Q2501a: Pulse (1)
Q2501a: Pulse (1)
Q2501a: Pulse (1)
Time 1 Pulse rate
Okay, now we can get your second measurement for your blood pressure
INTERVIEWER: Ask the respondent to release the arm and relax. Wait for one minute before time 2. Do not ask the respondent questions. Use this time for quality control checks.
-9
Refused
-8
Don't know
Q2502: Systolic (2)
Q2502: Systolic (2)
Q2502: Systolic (2)
Q2502: Systolic (2)
Q2502: Systolic (2)
Time 2 Systolic
-9
Refused
-8
Don't know
Q2502: Diastolic (2)
Q2502: Diastolic (2)
Q2502: Diastolic (2)
Q2502: Diastolic (2)
Q2502: Diastolic (2)
Time 2 Diastolic
-9
Refused
-8
Don't know
Q2502a: Pulse (2)
Q2502a: Pulse (2)
Q2502a: Pulse (2)
Q2502a: Pulse (2)
Q2502a: Pulse (2)
Time 2 Pulse rate
Okay, now we can get your third measurement for your blood pressure.
INTERVIEWER: Again, remind the respondent to relax. Meanwhile, when waiting to take the third measurement, you can locate and measure out a 4 metre length to prepare for the vision test and timed walk.
-9
Refused
-8
Don't know
Q2503: Systolic (3)
Q2503: Systolic (3)
Q2503: Systolic (3)
Q2503: Systolic (3)
Q2503: Systolic (3)
Time 3 Systolic
-9
Refused
-8
Don't know
Q2503: Diastolic (3)
Q2503: Diastolic (3)
Q2503: Diastolic (3)
Q2503: Diastolic (3)
Q2503: Diastolic (3)
Time 3 Diastolic
-9
Refused
-8
Don't know
Q2503a: Pulse (3)
Q2503a: Pulse (3)
Q2503a: Pulse (3)
Q2503a: Pulse (3)
Q2503a: Pulse (3)
Time 3 Pulse rate
Now that we have your blood pressure measured, can you please tell us:
INTERVIEWER: For the following questions about height and weight, probe if needed to get the respondent's best estimate or guess.
-9
Refused
-8
Don't know
Q2504: Self-reported height
Q2504: Self-reported height
Q2504: Self-reported height
Q2504: Self-reported height
Q2504: Self-reported height
What is your height in centimeters?
-8
Don't know
Q2505: Self-reported weight
Q2505: Self-reported weight
Q2505: Self-reported weight
Q2505: Self-reported weight
Q2505: Self-reported weight
What is your weight in kilograms?
-8
Don't know
Q25xx: Filter for Q2506-Q2513
Q25xx: Filter for Q2506-Q2513
Q25xx: Filter for Q2506-Q2513
Q25xx: Filter for Q2506-Q2513
Q25xx: Filter for Q2506-Q2513
NTERVIEWER: Can respondent stand up, yes or no?
1 Yes.........Q2514
2 No
1
Yes
2
No
Q2506: True height (cm)
Q2506: True height (cm)
Q2506: True height (cm)
Q2506: True height (cm)
Q2506: True height (cm)
I would now like to measure how tall you are. To measure your height I need you to please take off your shoes. Put your feet and heels close together, stand straight and look forward standing with your back, head and heels touching the wall. Look straight ahead.
Measured height
in centimetres
997 Refused
998 Not able
997
Refused
998
Not able
Q2507: True weight (kg)
Q2507: True weight (kg)
Q2507: True weight (kg)
Q2507: True weight (kg)
Q2507: True weight (kg)
Now we want to measure your weight - could you please keep your shoes off and step on this scale. We will also measure your waist and hips using a tape measure.
Measured weight
In kilograms
997 Refused
998 Not able
997
Refused
998
Not able
Q2508: WC centimeters
Q2508: WC centimeters
Q2508: WC centimeters
Q2508: WC centimeters
Q2508: WC centimeters
Waist circumference
997 Refused
998 Not able
NTERVIEWER: identify the top of the hip bone - and make sure the tape measure is parallel to the floor all the way around the body
997
Refused
998
Not able
Q2509: HC centimeters
Q2509: HC centimeters
Q2509: HC centimeters
Q2509: HC centimeters
Q2509: HC centimeters
Hip circumference
997 Refused
998 Not able
NTERVIEWER: measure at the maximum circumference of the hips - and make sure the tape measure is parallel to the floor all the way around the body
997
Refused
998
Not able
Q2510: Normal walk
Q2510: Normal walk
Q2510: Normal walk
Q2510: Normal walk
Q2510: Normal walk
Now I am going to observe how you normally walk. If you use a cane or other walking aid and would be more
comfortable with it, then you may use it. This is the walking course. I want you to walk to the other end of the course at your usual speed, just as if you were walking down the street to go to the store. Walk all the way past the other end of the tape before you stop. I will walk with you.
Did respondent complete the walk at usual pace?
1Yes
2No, refused
3 No, cannot walk, even with support ......Q2514
INTERVIEWER: DEMONSTRATE.
Do you feel this would be safe? If yes, continue.
When I want you to start, I will say: “Ready, begin.”
1
Yes
2
No, refused
3
Cannot walk
8
Don't know
9
Not applicable
Q2511: 4 m. time
Q2511: 4 m. time
Q2511: 4 m. time
Q2511: 4 m. time
Q2511: 4 m. time
Time at 4 metres
-9
Not applicable
-8
Don't know
Q2512: Rapid walk
Q2512: Rapid walk
Q2512: Rapid walk
Q2512: Rapid walk
Q2512: Rapid walk
Now I want to repeat the walk. This time, however, I would like you to walk at a rapid pace, as fast as you safely can, and go all the way past the other end of the course I marked out for you.
Did respondent complete the walk at rapid pace?
1 Yes
2 No, refused/unable ......... Q2514
When I want you to start, I will say: “Ready, begin.”
1
Yes
2
No
8
Don't know
9
Not applicable
Q2513: 4 m. time rapid
Q2513: 4 m. time rapid
Q2513: 4 m. time rapid
Q2513: 4 m. time rapid
Q2513: 4 m. time rapid
Time at 4 metres
-9
Not applicable
-8
Don't know
Q2514: Distance vision left eye
Q2514: Distance vision left eye
Q2514: Distance vision left eye
Q2514: Distance vision left eye
Q2514: Distance vision left eye
To measure acuity in the left eye, the right eye is covered with right palm or an eye patch and the subject is asked to respond to each "E" in a row slowly, row by row, with your guidance. Only one reading of a given "E" is allowed. When the subject has difficulty, he or she is encouraged to guess. Responses can be verbal (Up, Down, Left, Right) or the respondent can indicate with a finger like in the training video.
The right eye can then be tested in the same way. Visual acuity in each eye can be recorded as explained in the Interviewers Manual.
Distance Vision - Left Eye
INTERVIEWER: Invite the respondent to sit again - in a chair positioned so that the respondent's head will be 4 meters from the eye chart. Make sure the person does not lean in closer to the chart during the test.
Distance vision
INTERVIEWER: Start with the distance vision chart - using the 4 metres measured out for the timed walk. If the respondent makes more than 2 errors in one row, and reads all letters in the row, their result is read as the previous row. Select and record the result from the column labeled "DECIMAL" on the left side of the chart.
9
Not applicable
We are now going to test your distance vision and near vision.
Q2515: Distance vision right eye
Q2515: Distance vision right eye
Q2515: Distance vision right eye
Q2515: Distance vision right eye
Q2515: Distance vision right eye
Now cover your left eye with left hand so we can test your right eye.
Please read
Distance Vision - Right Eye
9
Not applicable
Q2516: Near vision left eye
Q2516: Near vision left eye
Q2516: Near vision left eye
Q2516: Near vision left eye
Q2516: Near vision left eye
Okay, now we would like to test your near vision - starting again with your left eye - please cover your right eye with your right hand. Indicate if the "E" is facing Up, Down, Left or Right. Please read….
Near Vision - Left Eye
INTERVIEWER: Have the person place the end of the cord attached to the near vision chart between forefinger and middle finger. Then place the palm over the eye with the same hand. The free hand is used to hold the chart. Responses will be verbal (Up, Down, Left, Right).
9
Not applicable
Q2517: Near vision right eye
Q2517: Near vision right eye
Q2517: Near vision right eye
Q2517: Near vision right eye
Q2517: Near vision right eye
Now cover your left eye with left hand so we can test your right eye.
Please read….
Near Vision - Right Eye
9
Not applicable
Q2518: Pain/surgery on left?
Q2518: Pain/surgery on left?
Q2518: Pain/surgery on left?
Q2518: Pain/surgery on left?
Q2518: Pain/surgery on left?
FILTER: If respondent has obvious problem with hand/arm, skip that side. If problems with both hands/arms, answer 1=yes to Q2518 and Q2519, then è skip to Q2525. Make sure you fit the dynamometer to the respondent's hand size.
We are now going to test the strength in your hands.
Have you had any surgery on your left arm, hand or wrist in the last 3 months OR arthritis or pain in your left hand or wrist?
1 Yes ... Do not test Left hand
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q2519: Pain/surgery on right?
Q2519: Pain/surgery on right?
Q2519: Pain/surgery on right?
Q2519: Pain/surgery on right?
Q2519: Pain/surgery on right?
Have you had any surgery on your right arm, hand or wrist in the last 3 months OR arthritis or pain in your right hand or wrist?
1 Yes ... Do not test Left hand
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q2520: Dominant hand
Q2520: Dominant hand
Q2520: Dominant hand
Q2520: Dominant hand
Q2520: Dominant hand
Which hand do you consider your dominant hand?
Dominant Hand - Check one answer. If a respondent is ambidextrous, the hand that is used for signing/writing is considered the dominant hand.
1Left
2Right
3 Use both the same
1
Right hand
2
Left hand
3
Ambidextrous
8
Don't know
9
Not applicable
Q2521: Left 1
Q2521: Left 1
Q2521: Left 1
Q2521: Left 1
Q2521: Left 1
Remain sitting and let your hand drop to your side. Keep your upper arm against your body and bend your elbow to 90 degrees with palm facing in (like shaking hands). Keep your elbow pressed against your side.
First test left hand
97 Refused .....Q2523
INTERVIEWER: DEMONSTRATE.
Then grab the two pieces of metal together like this.
INTERVIEWER: DEMONSTRATE.
I will ask you to do this two times in each hand. Let's start with your left hand, please take this in your left hand.
If you feel any pain or discomfort, tell me and we will stop.
When I say "squeeze", squeeze as hard as you can.
Interviewer: Check positioning and grip to make sure it is correct. When he or she begins, say: Squeeze, squeeze, squeeze!
Ready? Squeeze, squeeze, squeeze!
-9
Refused
Q2522: Left 2
Q2522: Left 2
Q2522: Left 2
Q2522: Left 2
Q2522: Left 2
Second test left hand
kilograms
-9
Refused
Q2523: Right 1
Q2523: Right 1
Q2523: Right 1
Q2523: Right 1
Q2523: Right 1
Okay, now let's do the same on the other side. Hold the device in your right hand, so we can test your strength on this side also.
First test right hand
INTERVIEWER: Check positioning and grip to make sure it is correct.
Ready? Squeeze, squeeze, squeeze!
-9
Refused
Q2524: Right 2
Q2524: Right 2
Q2524: Right 2
Q2524: Right 2
Q2524: Right 2
Okay, now let's do the same on the other side. Hold the device in your right hand, so we can test your strength on this side also.
Second test right hand
INTERVIEWER: Check positioning and grip to make sure it is correct.
Ready? Squeeze, squeeze, squeeze!
-9
Refused
Q2525: Recall 1
Q2525: Recall 1
Q2525: Recall 1
Q2525: Recall 1
Q2525: Recall 1
We are now going to test your memory. I know these questions may be difficult to answer, but please try to provide an answer. I am going to read you a list of words. Listen to them carefully and try to remember as many of them as you can, not necessarily in order. I will ask you to repeat them again after some time.
Number of words recalled correctly Trial 1
INTERVIEWER: you can use the table below to assist you with scoring.
-9
Not applicable
-8
Don't know
Q2526: Forgot 1
Q2526: Forgot 1
Q2526: Forgot 1
Q2526: Forgot 1
Q2526: Forgot 1
We are now going to test your memory. I know these questions may be difficult to answer, but please try to provide an answer. I am going to read you a list of words. Listen to them carefully and try to remember as many of them as you can, not necessarily in order. I will ask you to repeat them again after some time.
Number of words that respondent failed to recall Trial 1
INTERVIEWER: you can use the table below to assist you with scoring.
-9
Not applicable
-8
Don't know
Q2527: Substitute 1
Q2527: Substitute 1
Q2527: Substitute 1
Q2527: Substitute 1
Q2527: Substitute 1
We are now going to test your memory. I know these questions may be difficult to answer, but please try to provide an answer. I am going to read you a list of words. Listen to them carefully and try to remember as many of them as you can, not necessarily in order. I will ask you to repeat them again after some time.
Number of words substituted Trial 1
INTERVIEWER: you can use the table below to assist you with scoring.
-9
Not applicable
-8
Don't know
Q2528: Recall 2
Q2528: Recall 2
Q2528: Recall 2
Q2528: Recall 2
Q2528: Recall 2
We are now going to test your memory. I know these questions may be difficult to answer, but please try to provide an answer. I am going to read you a list of words. Listen to them carefully and try to remember as many of them as you can, not necessarily in order. I will ask you to repeat them again after some time.
I will read the list to you again, and then again when I am done, repeat them after me.
Number of words recalled correctly Trial 2
INTERVIEWER: you can use the table below to assist you with scoring.
-9
Not applicable
-8
Don't know
Q2529: Forgot 2
Q2529: Forgot 2
Q2529: Forgot 2
Q2529: Forgot 2
Q2529: Forgot 2
We are now going to test your memory. I know these questions may be difficult to answer, but please try to provide an answer. I am going to read you a list of words. Listen to them carefully and try to remember as many of them as you can, not necessarily in order. I will ask you to repeat them again after some time.
Number of words that respondent failed to recall Trial 2
INTERVIEWER: you can use the table below to assist you with scoring.
-9
Not applicable
-8
Don't know
Q2530: Substitute 2
Q2530: Substitute 2
Q2530: Substitute 2
Q2530: Substitute 2
Q2530: Substitute 2
We are now going to test your memory. I know these questions may be difficult to answer, but please try to provide an answer. I am going to read you a list of words. Listen to them carefully and try to remember as many of them as you can, not necessarily in order. I will ask you to repeat them again after some time.
Number of words substituted Trial 2
INTERVIEWER: you can use the table below to assist you with scoring.
-9
Not applicable
-8
Don't know
Q2531: Recall 3
Q2531: Recall 3
Q2531: Recall 3
Q2531: Recall 3
Q2531: Recall 3
We are now going to test your memory. I know these questions may be difficult to answer, but please try to provide an answer. I am going to read you a list of words. Listen to them carefully and try to remember as many of them as you can, not necessarily in order. I will ask you to repeat them again after some time.
One final time - I will read the list and when I am done, you repeat as many as you can remember.
Number of words recalled correctly Trial 3
INTERVIEWER: you can use the table below to assist you with scoring.
-9
Not applicable
-8
Don't know
Q2532: Forgot 3
Q2532: Forgot 3
Q2532: Forgot 3
Q2532: Forgot 3
Q2532: Forgot 3
We are now going to test your memory. I know these questions may be difficult to answer, but please try to provide an answer. I am going to read you a list of words. Listen to them carefully and try to remember as many of them as you can, not necessarily in order. I will ask you to repeat them again after some time.
Number of words that respondent failed to recall Trial 3
INTERVIEWER: you can use the table below to assist you with scoring.
-9
Not applicable
-8
Don't know
Q2533: Substitute 3
Q2533: Substitute 3
Q2533: Substitute 3
Q2533: Substitute 3
Q2533: Substitute 3
We are now going to test your memory. I know these questions may be difficult to answer, but please try to provide an answer. I am going to read you a list of words. Listen to them carefully and try to remember as many of them as you can, not necessarily in order. I will ask you to repeat them again after some time.
Number of words substituted Trial 3
INTERVIEWER: you can use the table below to assist you with scoring.
-9
Not applicable
-8
Don't know
Q2534: Total score - forwards
Q2534: Total score - forwards
Q2534: Total score - forwards
Q2534: Total score - forwards
Q2534: Total score - forwards
I am going to say some numbers to you. Listen carefully, and when I am through, say them right after me. I want you to repeat each set of numbers exactly as I say them to you. For example, if I said "1-2", you would say…?
Total score (enter the series number in the longest series repeated without error in Trial 1 or 2)
(Maximum = 9 points)
INTERVIEWER: For the following tests, digits forward and backward, say the digits at the rate of one per
second, not grouped. Let the pitch of your voice drop with the last digit of each series. In any series if the
subject fails Trial 1 - give Trial 2 of the same series, then proceed to the next series if the respondent responds correctly. Trial 2 is only given if Trial 1 is failed.
INTERVIEWER: Wait for correct response "1-2". If correct, start with Series 3. If response is incorrect, provide the correct response and attempt once more with another example. Okay, let's try another example, repeat after me, "5-3". If correct, continue. If not correct - mark "0" in Q2534 and è skip to Verbal Fluency (Q2536).
Failed (score of 0)
Q2535: Total score - backwards
Q2535: Total score - backwards
Q2535: Total score - backwards
Q2535: Total score - backwards
Q2535: Total score - backwards
Now, I am going to say more numbers, but this time when I stop, I want you to say them to me backwards.
For example, if I said 1-7, what would you say?
Total score (enter the series number in the longest series repeated without error in Trial 1 or 2)
(Maximum = 8 points)
INTERVIEWER: Wait for subject to say 7-1. If response is correct, start with Series 2. If respondent does not reply correctly or fails to understand, give the correct answer and another example, saying Remember, you are to say them backwards. Try this, "3-8". If response is correct, continue. If fails second example, mark "0" in Q2535 and skip to Verbal Fluency (Q2536).
Failed (score of 0)
Q2536: Total score - animals
Q2536: Total score - animals
Q2536: Total score - animals
Q2536: Total score - animals
Q2536: Total score - animals
Now we are going to ask you to think of animals and name as many as you can. I am going to give you one minute and I want to see how many animals you can name.
Total score (number of animals named correctly)
NTERVIEWER: See Interviewers Manual instructions about what is acceptable and what is not. If respondent stops before the end of the minute, encourage them to try to name more animals. If there is a silence of about 15 seconds, prompt them to continue or repeat the basic instructions.
Ready? Start:
INTERVIEWER: Press START/STOP on stopwatch. Time for one minute. Use space below to record.
INTERVIEWER: SAY “FINE” OR “GOOD” when completed the one minute.
-9
Not applicable
-8
Don't know
Q2537: Errors - animals
Q2537: Errors - animals
Q2537: Errors - animals
Q2537: Errors - animals
Q2537: Errors - animals
Now we are going to ask you to think of animals and name as many as you can. I am going to give you one minute and I want to see how many animals you can name.
Number of errors
INTERVIEWER: errors include anything that is not an animal
NTERVIEWER: See Interviewers Manual instructions about what is acceptable and what is not. If respondent stops before the end of the minute, encourage them to try to name more animals. If there is a silence of about 15 seconds, prompt them to continue or repeat the basic instructions.
Ready? Start:
INTERVIEWER: Press START/STOP on stopwatch. Time for one minute. Use space below to record.
INTERVIEWER: SAY “FINE” OR “GOOD” when completed the one minute.
-9
Not applicable
-8
Don't know
Q2538: Lung function/FVC
Q2538: Lung function/FVC
Q2538: Lung function/FVC
Q2538: Lung function/FVC
Q2538: Lung function/FVC
Delayed Verbal Recall
I read you a list of words about 10 minutes ago. I will NOT repeat this list to you now, but could you please repeat to me as many of them as you can remember?
INTERVIEWER: Demonstrate how to do the lung function test.
INTERVIEWER: Make sure to show the respondent that you are using a clean mouthpiece on the spirometer before starting. Take a short break in between each trial to give the respondent a chance to return to normal breathing.
We will ask you to practice once, then we will have you use it three times. Okay, are you ready? Take a deep breath, seal your lips around the mouthpiece and BLOW, BLOW, BLOW!
Q2538: Lung function/FVC
Q2538: Lung function/FVC
Q2538: Lung function/FVC
Q2538: Lung function/FVC
Q2538: Lung function/FVC
Delayed Verbal Recall
I read you a list of words about 10 minutes ago. I will NOT repeat this list to you now, but could you please repeat to me as many of them as you can remember?
INTERVIEWER: Demonstrate how to do the lung function test.
INTERVIEWER: Make sure to show the respondent that you are using a clean mouthpiece on the spirometer before starting. Take a short break in between each trial to give the respondent a chance to return to normal breathing.
We will ask you to practice once, then we will have you use it three times. Okay, are you ready? Take a deep breath, seal your lips around the mouthpiece and BLOW, BLOW, BLOW!
Q2538: Lung function/FVC
Q2538: Lung function/FVC
Q2538: Lung function/FVC
Q2538: Lung function/FVC
Q2538: Lung function/FVC
Delayed Verbal Recall
I read you a list of words about 10 minutes ago. I will NOT repeat this list to you now, but could you please repeat to me as many of them as you can remember?
INTERVIEWER: Demonstrate how to do the lung function test.
INTERVIEWER: Make sure to show the respondent that you are using a clean mouthpiece on the spirometer before starting. Take a short break in between each trial to give the respondent a chance to return to normal breathing.
We will ask you to practice once, then we will have you use it three times. Okay, are you ready? Take a deep breath, seal your lips around the mouthpiece and BLOW, BLOW, BLOW!
Q2539: Lung function/FEV1
Q2539: Lung function/FEV1
Q2539: Lung function/FEV1
Q2539: Lung function/FEV1
Q2539: Lung function/FEV1
Delayed Verbal Recall
I read you a list of words about 10 minutes ago. I will NOT repeat this list to you now, but could you please repeat to me as many of them as you can remember?
INTERVIEWER: Demonstrate how to do the lung function test.
INTERVIEWER: Make sure to show the respondent that you are using a clean mouthpiece on the spirometer before starting. Take a short break in between each trial to give the respondent a chance to return to normal breathing.
We will ask you to practice once, then we will have you use it three times. Okay, are you ready? Take a deep breath, seal your lips around the mouthpiece and BLOW, BLOW, BLOW!
Q2539: Lung function/FEV1
Q2539: Lung function/FEV1
Q2539: Lung function/FEV1
Q2539: Lung function/FEV1
Q2539: Lung function/FEV1
Delayed Verbal Recall
I read you a list of words about 10 minutes ago. I will NOT repeat this list to you now, but could you please repeat to me as many of them as you can remember?
INTERVIEWER: Demonstrate how to do the lung function test.
INTERVIEWER: Make sure to show the respondent that you are using a clean mouthpiece on the spirometer before starting. Take a short break in between each trial to give the respondent a chance to return to normal breathing.
We will ask you to practice once, then we will have you use it three times. Okay, are you ready? Take a deep breath, seal your lips around the mouthpiece and BLOW, BLOW, BLOW!
Q2539: Lung function/FEV1
Q2539: Lung function/FEV1
Q2539: Lung function/FEV1
Q2539: Lung function/FEV1
Q2539: Lung function/FEV1
Delayed Verbal Recall
I read you a list of words about 10 minutes ago. I will NOT repeat this list to you now, but could you please repeat to me as many of them as you can remember?
INTERVIEWER: Demonstrate how to do the lung function test.
INTERVIEWER: Make sure to show the respondent that you are using a clean mouthpiece on the spirometer before starting. Take a short break in between each trial to give the respondent a chance to return to normal breathing.
We will ask you to practice once, then we will have you use it three times. Okay, are you ready? Take a deep breath, seal your lips around the mouthpiece and BLOW, BLOW, BLOW!
Q2540: Lung function/FEV1%
Q2540: Lung function/FEV1%
Q2540: Lung function/FEV1%
Q2540: Lung function/FEV1%
Q2540: Lung function/FEV1%
Delayed Verbal Recall
I read you a list of words about 10 minutes ago. I will NOT repeat this list to you now, but could you please repeat to me as many of them as you can remember?
INTERVIEWER: Demonstrate how to do the lung function test.
INTERVIEWER: Make sure to show the respondent that you are using a clean mouthpiece on the spirometer before starting. Take a short break in between each trial to give the respondent a chance to return to normal breathing.
We will ask you to practice once, then we will have you use it three times. Okay, are you ready? Take a deep breath, seal your lips around the mouthpiece and BLOW, BLOW, BLOW!
Q2540: Lung function/FEV1%
Q2540: Lung function/FEV1%
Q2540: Lung function/FEV1%
Q2540: Lung function/FEV1%
Q2540: Lung function/FEV1%
Delayed Verbal Recall
I read you a list of words about 10 minutes ago. I will NOT repeat this list to you now, but could you please repeat to me as many of them as you can remember?
INTERVIEWER: Demonstrate how to do the lung function test.
INTERVIEWER: Make sure to show the respondent that you are using a clean mouthpiece on the spirometer before starting. Take a short break in between each trial to give the respondent a chance to return to normal breathing.
We will ask you to practice once, then we will have you use it three times. Okay, are you ready? Take a deep breath, seal your lips around the mouthpiece and BLOW, BLOW, BLOW!
Q2540: Lung function/FEV1%
Q2540: Lung function/FEV1%
Q2540: Lung function/FEV1%
Q2540: Lung function/FEV1%
Q2540: Lung function/FEV1%
Delayed Verbal Recall
I read you a list of words about 10 minutes ago. I will NOT repeat this list to you now, but could you please repeat to me as many of them as you can remember?
INTERVIEWER: Demonstrate how to do the lung function test.
INTERVIEWER: Make sure to show the respondent that you are using a clean mouthpiece on the spirometer before starting. Take a short break in between each trial to give the respondent a chance to return to normal breathing.
We will ask you to practice once, then we will have you use it three times. Okay, are you ready? Take a deep breath, seal your lips around the mouthpiece and BLOW, BLOW, BLOW!
Q2541: Lung function/PEF
Q2541: Lung function/PEF
Q2541: Lung function/PEF
Q2541: Lung function/PEF
Q2541: Lung function/PEF
Delayed Verbal Recall
I read you a list of words about 10 minutes ago. I will NOT repeat this list to you now, but could you please repeat to me as many of them as you can remember?
INTERVIEWER: Demonstrate how to do the lung function test.
INTERVIEWER: Make sure to show the respondent that you are using a clean mouthpiece on the spirometer before starting. Take a short break in between each trial to give the respondent a chance to return to normal breathing.
We will ask you to practice once, then we will have you use it three times. Okay, are you ready? Take a deep breath, seal your lips around the mouthpiece and BLOW, BLOW, BLOW!
Q2541: Lung function/PEF
Q2541: Lung function/PEF
Q2541: Lung function/PEF
Q2541: Lung function/PEF
Q2541: Lung function/PEF
Delayed Verbal Recall
I read you a list of words about 10 minutes ago. I will NOT repeat this list to you now, but could you please repeat to me as many of them as you can remember?
INTERVIEWER: Demonstrate how to do the lung function test.
INTERVIEWER: Make sure to show the respondent that you are using a clean mouthpiece on the spirometer before starting. Take a short break in between each trial to give the respondent a chance to return to normal breathing.
We will ask you to practice once, then we will have you use it three times. Okay, are you ready? Take a deep breath, seal your lips around the mouthpiece and BLOW, BLOW, BLOW!
Q2541: Lung function/PEF
Q2541: Lung function/PEF
Q2541: Lung function/PEF
Q2541: Lung function/PEF
Q2541: Lung function/PEF
Delayed Verbal Recall
I read you a list of words about 10 minutes ago. I will NOT repeat this list to you now, but could you please repeat to me as many of them as you can remember?
INTERVIEWER: Demonstrate how to do the lung function test.
INTERVIEWER: Make sure to show the respondent that you are using a clean mouthpiece on the spirometer before starting. Take a short break in between each trial to give the respondent a chance to return to normal breathing.
We will ask you to practice once, then we will have you use it three times. Okay, are you ready? Take a deep breath, seal your lips around the mouthpiece and BLOW, BLOW, BLOW!
Q2542: Lung function/FEF25-75
Q2542: Lung function/FEF25-75
Q2542: Lung function/FEF25-75
Q2542: Lung function/FEF25-75
Q2542: Lung function/FEF25-75
Delayed Verbal Recall
I read you a list of words about 10 minutes ago. I will NOT repeat this list to you now, but could you please repeat to me as many of them as you can remember?
INTERVIEWER: Demonstrate how to do the lung function test.
INTERVIEWER: Make sure to show the respondent that you are using a clean mouthpiece on the spirometer before starting. Take a short break in between each trial to give the respondent a chance to return to normal breathing.
We will ask you to practice once, then we will have you use it three times. Okay, are you ready? Take a deep breath, seal your lips around the mouthpiece and BLOW, BLOW, BLOW!
Q2542: Lung function/FEF25-75
Q2542: Lung function/FEF25-75
Q2542: Lung function/FEF25-75
Q2542: Lung function/FEF25-75
Q2542: Lung function/FEF25-75
Delayed Verbal Recall
I read you a list of words about 10 minutes ago. I will NOT repeat this list to you now, but could you please repeat to me as many of them as you can remember?
INTERVIEWER: Demonstrate how to do the lung function test.
INTERVIEWER: Make sure to show the respondent that you are using a clean mouthpiece on the spirometer before starting. Take a short break in between each trial to give the respondent a chance to return to normal breathing.
We will ask you to practice once, then we will have you use it three times. Okay, are you ready? Take a deep breath, seal your lips around the mouthpiece and BLOW, BLOW, BLOW!
Q2542: Lung function/FEF25-75
Q2542: Lung function/FEF25-75
Q2542: Lung function/FEF25-75
Q2542: Lung function/FEF25-75
Q2542: Lung function/FEF25-75
Delayed Verbal Recall
I read you a list of words about 10 minutes ago. I will NOT repeat this list to you now, but could you please repeat to me as many of them as you can remember?
INTERVIEWER: Demonstrate how to do the lung function test.
INTERVIEWER: Make sure to show the respondent that you are using a clean mouthpiece on the spirometer before starting. Take a short break in between each trial to give the respondent a chance to return to normal breathing.
We will ask you to practice once, then we will have you use it three times. Okay, are you ready? Take a deep breath, seal your lips around the mouthpiece and BLOW, BLOW, BLOW!
Q2543: Lung function/FET
Q2543: Lung function/FET
Q2543: Lung function/FET
Q2543: Lung function/FET
Q2543: Lung function/FET
Delayed Verbal Recall
I read you a list of words about 10 minutes ago. I will NOT repeat this list to you now, but could you please repeat to me as many of them as you can remember?
INTERVIEWER: Demonstrate how to do the lung function test.
INTERVIEWER: Make sure to show the respondent that you are using a clean mouthpiece on the spirometer before starting. Take a short break in between each trial to give the respondent a chance to return to normal breathing.
We will ask you to practice once, then we will have you use it three times. Okay, are you ready? Take a deep breath, seal your lips around the mouthpiece and BLOW, BLOW, BLOW!
Q2543: Lung function/FET
Q2543: Lung function/FET
Q2543: Lung function/FET
Q2543: Lung function/FET
Q2543: Lung function/FET
Delayed Verbal Recall
I read you a list of words about 10 minutes ago. I will NOT repeat this list to you now, but could you please repeat to me as many of them as you can remember?
INTERVIEWER: Demonstrate how to do the lung function test.
INTERVIEWER: Make sure to show the respondent that you are using a clean mouthpiece on the spirometer before starting. Take a short break in between each trial to give the respondent a chance to return to normal breathing.
We will ask you to practice once, then we will have you use it three times. Okay, are you ready? Take a deep breath, seal your lips around the mouthpiece and BLOW, BLOW, BLOW!
Q2543: Lung function/FET
Q2543: Lung function/FET
Q2543: Lung function/FET
Q2543: Lung function/FET
Q2543: Lung function/FET
Delayed Verbal Recall
I read you a list of words about 10 minutes ago. I will NOT repeat this list to you now, but could you please repeat to me as many of them as you can remember?
INTERVIEWER: Demonstrate how to do the lung function test.
INTERVIEWER: Make sure to show the respondent that you are using a clean mouthpiece on the spirometer before starting. Take a short break in between each trial to give the respondent a chance to return to normal breathing.
We will ask you to practice once, then we will have you use it three times. Okay, are you ready? Take a deep breath, seal your lips around the mouthpiece and BLOW, BLOW, BLOW!
Q2544: Words recalled
Q2544: Words recalled
Q2544: Words recalled
Q2544: Words recalled
Q2544: Words recalled
Okay, return to normal breathing, while I record the results.
Delayed Verbal Recall
I read you a list of words about 10 minutes ago. I will NOT repeat this list to you now, but could you please repeat to me as many of them as you can remember?
Number of words recalled correctly
NTERVIEWER - DO NOT read the list again to the respondent - the list below is for your own use.
-9
Not applicable
-8
Don't know
Q2545: Words forgotten
Q2545: Words forgotten
Q2545: Words forgotten
Q2545: Words forgotten
Q2545: Words forgotten
Okay, return to normal breathing, while I record the results.
Delayed Verbal Recall
I read you a list of words about 10 minutes ago. I will NOT repeat this list to you now, but could you please repeat to me as many of them as you can remember?
Number of words that respondent failed to recall
NTERVIEWER - DO NOT read the list again to the respondent - the list below is for your own use.
-9
Not applicable
-8
Don't know
Q2546: Words substituted
Q2546: Words substituted
Q2546: Words substituted
Q2546: Words substituted
Q2546: Words substituted
Okay, return to normal breathing, while I record the results.
Delayed Verbal Recall
I read you a list of words about 10 minutes ago. I will NOT repeat this list to you now, but could you please repeat to me as many of them as you can remember?
Number of words substituted
NTERVIEWER - DO NOT read the list again to the respondent - the list below is for your own use.
-9
Not applicable
-8
Don't know
Q2547: Blood test consent
Q2547: Blood test consent
Q2547: Blood test consent
Q2547: Blood test consent
Q2547: Blood test consent
I would like to get your consent/agreement to give a blood sample. We will only prick your finger to get blood. If you decide not to have the test done, it is your right and we will respect your decision and continue with the other parts of the survey.
INTERVIEWER: Indicate whether the respondent agrees or not.
1 Respondent agrees to provide blood sample
2 Respondent does NOT agree to provide blood sample ...... Next section
INTERVIEWER: go to the INFORMED CONSENT FORM FOR BLOOD SAMPLE
1
Resp. agrees
2
Does not agree
8
Don't know
9
Not applicable
Q2548: Blood sample obtained?
Q2548: Blood sample obtained?
Q2548: Blood sample obtained?
Q2548: Blood sample obtained?
Q2548: Blood sample obtained?
I would like to get your consent/agreement to give a blood sample. We will only prick your finger to get blood. If you decide not to have the test done, it is your right and we will respect your decision and continue with the other parts of the survey.
INTERVIEWER: circle one
1 Blood sample obtained
2 Blood sample NOT obtained
INTERVIEWER: go to the INFORMED CONSENT FORM FOR BLOOD SAMPLE
1
Blood sample obtained
2
Not obtained
8
Don't know
9
Not applicable
S3000: HH begin
S3000: HH begin
S3000: HH begin
S3000: HH begin
S3000: HH begin
S3000: MM begin
S3000: MM begin
S3000: MM begin
S3000: MM begin
S3000: MM begin
S3000: HH end
S3000: HH end
S3000: HH end
S3000: HH end
S3000: HH end
S3000: MM end
S3000: MM end
S3000: MM end
S3000: MM end
S3000: MM end
Q3001: Ever used tobacco?
Q3001: Ever used tobacco?
Q3001: Ever used tobacco?
Q3001: Ever used tobacco?
Q3001: Ever used tobacco?
We would now like to ask you some questions about your habits, health behaviours and awareness about health. This includes things like smoking, drinking alcohol, eating enough fruits and vegetables as part of your diet and your levels of physical activity. I will start with questions about smoking habits.
Have you ever smoked tobacco or used smokeless tobacco?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q3002: Currently use tobacco?
Q3002: Currently use tobacco?
Q3002: Currently use tobacco?
Q3002: Currently use tobacco?
Q3002: Currently use tobacco?
Do you currently use (smoke, sniff or chew) any tobacco products such as cigarettes, cigars, pipes, chewing tobacco or snuff?
1Yes, daily
2Yes, but not daily ….........Q3005
3 No, not at all .........Q3005
1
Yes, daily
2
Yes, not daily
3
Not at all
8
Don't know
9
Not applicable
Q3003a: Years (n)
Q3003a: Years (n)
Q3003a: Years (n)
Q3003a: Years (n)
Q3003a: Years (n)
For how long have you been smoking or using tobacco daily?
8 Don't Know
INTERVIEWER: If less than one month - enter “00” for years and "00" for months.
-8
DK
Q3003a: Months (n)
Q3003a: Months (n)
Q3003a: Months (n)
Q3003a: Months (n)
Q3003a: Months (n)
For how long have you been smoking or using tobacco daily?
8 Don't Know
INTERVIEWER: If less than one month - enter “00” for years and "00" for months.
-8
DK
Q3004a: Manufact. cigarettes
Q3004a: Manufact. cigarettes
Q3004a: Manufact. cigarettes
Q3004a: Manufact. cigarettes
Q3004a: Manufact. cigarettes
On average, how many of the following products do you smoke or use each day?
Include number below:
Manufactured cigarettes
-9
Not applicable
-8
Don't know
Q3004b: Hand-rolled cigarettes
Q3004b: Hand-rolled cigarettes
Q3004b: Hand-rolled cigarettes
Q3004b: Hand-rolled cigarettes
Q3004b: Hand-rolled cigarettes
On average, how many of the following products do you smoke or use each day?
Include number below:
Hand-rolled cigarettes
-9
Not applicable
-8
Don't know
Q3004c: Pipes
Q3004c: Pipes
Q3004c: Pipes
Q3004c: Pipes
Q3004c: Pipes
On average, how many of the following products do you smoke or use each day?
Include number below:
Pipefuls of tobacco
-9
Not applicable
-8
Don't know
Q3004d: Cigars etc.
Q3004d: Cigars etc.
Q3004d: Cigars etc.
Q3004d: Cigars etc.
Q3004d: Cigars etc.
On average, how many of the following products do you smoke or use each day?
Include number below:
Cigars, cheroots, cigarillos, bidis
-9
Not applicable
-8
Don't know
Q3004e: Smokeless tobacco
Q3004e: Smokeless tobacco
Q3004e: Smokeless tobacco
Q3004e: Smokeless tobacco
Q3004e: Smokeless tobacco
On average, how many of the following products do you smoke or use each day?
Include number below:
Smokeless tobacco
-9
Not applicable
-8
Don't know
Q3004f: Other tobacco
Q3004f: Other tobacco
Q3004f: Other tobacco
Q3004f: Other tobacco
Q3004f: Other tobacco
On average, how many of the following products do you smoke or use each day?
Include number below:
Other, specify:
-9
Not applicable
-8
Don't know
Q3005: Past use tobacco
Q3005: Past use tobacco
Q3005: Past use tobacco
Q3005: Past use tobacco
Q3005: Past use tobacco
In the past, did you ever smoke tobacco or use smokeless tobacco daily?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q3006: Age stop tobacco
Q3006: Age stop tobacco
Q3006: Age stop tobacco
Q3006: Age stop tobacco
Q3006: Age stop tobacco
How old were you when you stopped smoking or using tobacco daily?
-9
NA
-8
DK
Q3006a: When stop tobacco Y
Q3006a: When stop tobacco Y
Q3006a: When stop tobacco Y
Q3006a: When stop tobacco Y
Q3006a: When stop tobacco Y
How long ago did you stop smoking or using tobacco daily?
8 Don't Know
INTERVIEWER: If less than one month - enter “00” for months.
-9
NA
-8
DK
Q3006a: When stop tobacco M
Q3006a: When stop tobacco M
Q3006a: When stop tobacco M
Q3006a: When stop tobacco M
Q3006a: When stop tobacco M
How long ago did you stop smoking or using tobacco daily?
8 Don't Know
INTERVIEWER: If less than one month - enter “00” for months.
-9
Not applicable
-8
DK
Q3007: Ever used alcohol?
Q3007: Ever used alcohol?
Q3007: Ever used alcohol?
Q3007: Ever used alcohol?
Q3007: Ever used alcohol?
Have you ever consumed a drink that contains alcohol (such as beer, wine, spirits, etc.)?
1 Yes
2 No, Never ………………. Q3012
1
Yes
2
No
8
Don't know
9
Not applicable
Q3008: Alcohol used recently?
Q3008: Alcohol used recently?
Q3008: Alcohol used recently?
Q3008: Alcohol used recently?
Q3008: Alcohol used recently?
Have you consumed alcohol in the last 30 days?
1 Yes
2 No …………... Q3010
1
Yes
2
No
8
Don't know
9
Not applicable
Q3009a: Monday
Q3009a: Monday
Q3009a: Monday
Q3009a: Monday
Q3009a: Monday
During the past 7 days, how many drinks of any alcoholic beverage did you have each day?
USE SHOWCARD Appendix A3000B.
Monday
INTERVIEWER: Want respondent to tell you the number of "standard" drinks. By standard drink - refer to Appendix. Include number below:
-9
Not applicable
-8
Don't know
Q3009b: Tuesday
Q3009b: Tuesday
Q3009b: Tuesday
Q3009b: Tuesday
Q3009b: Tuesday
During the past 7 days, how many drinks of any alcoholic beverage did you have each day?
USE SHOWCARD Appendix A3000B.
Tuesday
INTERVIEWER: Want respondent to tell you the number of "standard" drinks. By standard drink - refer to Appendix. Include number below:
-9
Not applicable
-8
Don't know
Q3009c: Wednesday
Q3009c: Wednesday
Q3009c: Wednesday
Q3009c: Wednesday
Q3009c: Wednesday
During the past 7 days, how many drinks of any alcoholic beverage did you have each day?
USE SHOWCARD Appendix A3000B.
Wednesday
INTERVIEWER: Want respondent to tell you the number of "standard" drinks. By standard drink - refer to Appendix. Include number below:
-9
Not applicable
-8
Don't know
Q3009d: Thursday
Q3009d: Thursday
Q3009d: Thursday
Q3009d: Thursday
Q3009d: Thursday
During the past 7 days, how many drinks of any alcoholic beverage did you have each day?
USE SHOWCARD Appendix A3000B.
Thursday
INTERVIEWER: Want respondent to tell you the number of "standard" drinks. By standard drink - refer to Appendix. Include number below:
-9
Not applicable
-8
Don't know
Q3009e: Friday
Q3009e: Friday
Q3009e: Friday
Q3009e: Friday
Q3009e: Friday
During the past 7 days, how many drinks of any alcoholic beverage did you have each day?
USE SHOWCARD Appendix A3000B.
Friday
INTERVIEWER: Want respondent to tell you the number of "standard" drinks. By standard drink - refer to Appendix. Include number below:
-9
Not applicable
-8
Don't know
Q3009f: Saturday
Q3009f: Saturday
Q3009f: Saturday
Q3009f: Saturday
Q3009f: Saturday
During the past 7 days, how many drinks of any alcoholic beverage did you have each day?
USE SHOWCARD Appendix A3000B.
Saturday
INTERVIEWER: Want respondent to tell you the number of "standard" drinks. By standard drink - refer to Appendix. Include number below:
-9
Not applicable
-8
Don't know
Q3009g: Sunday
Q3009g: Sunday
Q3009g: Sunday
Q3009g: Sunday
Q3009g: Sunday
During the past 7 days, how many drinks of any alcoholic beverage did you have each day?
USE SHOWCARD Appendix A3000B.
Sunday
INTERVIEWER: Want respondent to tell you the number of "standard" drinks. By standard drink - refer to Appendix. Include number below:
-9
Not applicable
-8
Don't know
Q3010: Drinking pattern
Q3010: Drinking pattern
Q3010: Drinking pattern
Q3010: Drinking pattern
Q3010: Drinking pattern
In the last 12 months, how frequently [on how many days] on average have you had at least one alcoholic drink?
1No days ………………..….…. Q3012
2Less than once a month
3One to three days per month
4One to four days per week
5 Five or more days per week
No days
1
< 1 per Month
2
1-3 Days per Month
3
1-4 Days per week
4
5+ Days per week
8
Don't know
9
Not applicable
Q3011: Daily
Q3011: Daily
Q3011: Daily
Q3011: Daily
Q3011: Daily
n the last 12 months, on the days you drank alcoholic beverages, how many drinks did you have on average?
8 Don't know
-8
DK
Q3012: Fruits
Q3012: Fruits
Q3012: Fruits
Q3012: Fruits
Q3012: Fruits
Studies have shown that nutrition and life-style are very important health factors. I want to ask you a few questions about your diet. I am going to ask you about the fruit and vegetables you usually eat.
(Show Nutrition card to respondent -- see Appendix A3000C)
How many servings of fruit do you eat on a typical day?
-8
DK
Q3013: Veg
Q3013: Veg
Q3013: Veg
Q3013: Veg
Q3013: Veg
Studies have shown that nutrition and life-style are very important health factors. I want to ask you a few questions about your diet. I am going to ask you about the fruit and vegetables you usually eat.
(Show Nutrition card to respondent -- see Appendix A3000C)
How many servings of vegetables do you eat on a typical day?
-8
DK
Q3014: Eat less?
Q3014: Eat less?
Q3014: Eat less?
Q3014: Eat less?
Q3014: Eat less?
Studies have shown that nutrition and life-style are very important health factors. I want to ask you a few questions about your diet. I am going to ask you about the fruit and vegetables you usually eat.
(Show Nutrition card to respondent -- see Appendix A3000C)
In the last 12 months, how often did you ever eat less than you felt you should because there wasn't enough food?
1Every month
2Almost every month
3Some months, but not every month
4Only in 1 or 2 months
5 Never
1
Every month
2
Almost every month
3
Some months, but not every month
4
Only 1 or 2 months
5
Never
8
Don't know
9
Not applicable
Q3015: Hungry, no money to buy?
Q3015: Hungry, no money to buy?
Q3015: Hungry, no money to buy?
Q3015: Hungry, no money to buy?
Q3015: Hungry, no money to buy?
Studies have shown that nutrition and life-style are very important health factors. I want to ask you a few questions about your diet. I am going to ask you about the fruit and vegetables you usually eat.
(Show Nutrition card to respondent -- see Appendix A3000C)
In the last 12 months, were you ever hungry, but didn't eat because you couldn't afford enough food?
1Every month
2Almost every month
3Some months, but not every month
4Only in 1 or 2 months
5 Never
1
Every month
2
Almost every month
3
Some months, but not every month
4
Only 1 or 2 months
5
Never
8
Don't know
9
Not applicable
Q3016: Vigorous work
Q3016: Vigorous work
Q3016: Vigorous work
Q3016: Vigorous work
Q3016: Vigorous work
Next I am going to ask you about the time you spend doing different types of physical activity in a typical week. Please answer these questions even if you do not consider yourself to be an active person. Think first about the time you spend doing work. Think of work as the things that you have to do such as paid or unpaid work, household chores, harvesting food/crops, fishing or hunting for food, providing care or seeking employment.
In answering the following questions 'vigorous activities' require hard physical effort and cause large increases in breathing or heart rate, 'moderate activities' require moderate physical effort and cause small increases in breathing or heart rate.
Does your work involve vigorous-intensity activity that causes large increases in breathing or heart rate, [like heavy lifting, digging or chopping wood] for at least 10 minutes continuously?
INSERT EXAMPLES & USE SHOWCARD
1
Yes
2
No
8
Don't know
9
Not applicable
Q3017: Days vigorous work
Q3017: Days vigorous work
Q3017: Days vigorous work
Q3017: Days vigorous work
Q3017: Days vigorous work
Next I am going to ask you about the time you spend doing different types of physical activity in a typical week. Please answer these questions even if you do not consider yourself to be an active person. Think first about the time you spend doing work. Think of work as the things that you have to do such as paid or unpaid work, household chores, harvesting food/crops, fishing or hunting for food, providing care or seeking employment.
In answering the following questions 'vigorous activities' require hard physical effort and cause large increases in breathing or heart rate, 'moderate activities' require moderate physical effort and cause small increases in breathing or heart rate.
In a typical week, on how many days do you do vigorous-intensity activities as part of your work?
8
Don't know
9
Not applicable
Q3018: Time vig work hours
Q3018: Time vig work hours
Q3018: Time vig work hours
Q3018: Time vig work hours
Q3018: Time vig work hours
Next I am going to ask you about the time you spend doing different types of physical activity in a typical week. Please answer these questions even if you do not consider yourself to be an active person. Think first about the time you spend doing work. Think of work as the things that you have to do such as paid or unpaid work, household chores, harvesting food/crops, fishing or hunting for food, providing care or seeking employment.
In answering the following questions 'vigorous activities' require hard physical effort and cause large increases in breathing or heart rate, 'moderate activities' require moderate physical effort and cause small increases in breathing or heart rate.
How much time do you spend doing vigorous-intensity activities at work on a typical day?
-9
Not applicable
-8
Don't know
Q3018: Time vig work minutes
Q3018: Time vig work minutes
Q3018: Time vig work minutes
Q3018: Time vig work minutes
Q3018: Time vig work minutes
Next I am going to ask you about the time you spend doing different types of physical activity in a typical week. Please answer these questions even if you do not consider yourself to be an active person. Think first about the time you spend doing work. Think of work as the things that you have to do such as paid or unpaid work, household chores, harvesting food/crops, fishing or hunting for food, providing care or seeking employment.
In answering the following questions 'vigorous activities' require hard physical effort and cause large increases in breathing or heart rate, 'moderate activities' require moderate physical effort and cause small increases in breathing or heart rate.
How much time do you spend doing vigorous-intensity activities at work on a typical day?
-9
Not applicable
-8
Don't know
Q3019: Moderate work
Q3019: Moderate work
Q3019: Moderate work
Q3019: Moderate work
Q3019: Moderate work
Next I am going to ask you about the time you spend doing different types of physical activity in a typical week. Please answer these questions even if you do not consider yourself to be an active person. Think first about the time you spend doing work. Think of work as the things that you have to do such as paid or unpaid work, household chores, harvesting food/crops, fishing or hunting for food, providing care or seeking employment.
In answering the following questions 'vigorous activities' require hard physical effort and cause large increases in breathing or heart rate, 'moderate activities' require moderate physical effort and cause small increases in breathing or heart rate.
Does your work involve moderate-intensity activity that causes small increases in breathing or heart rate [such as brisk walking, carrying light loads, cleaning, cooking, or washing clothes] for at least 10 minutes continuously?
INSERT EXAMPLES & USE SHOWCARD
1
Yes
2
No
8
Don't know
9
Not applicable
Q3020: Days moderate work
Q3020: Days moderate work
Q3020: Days moderate work
Q3020: Days moderate work
Q3020: Days moderate work
Next I am going to ask you about the time you spend doing different types of physical activity in a typical week. Please answer these questions even if you do not consider yourself to be an active person. Think first about the time you spend doing work. Think of work as the things that you have to do such as paid or unpaid work, household chores, harvesting food/crops, fishing or hunting for food, providing care or seeking employment.
In answering the following questions 'vigorous activities' require hard physical effort and cause large increases in breathing or heart rate, 'moderate activities' require moderate physical effort and cause small increases in breathing or heart rate.
In a typical week, on how many days do you do moderate-intensity activities as part of your work?
8
Don't know
9
Not applicable
Q3021: Time mod work hours
Q3021: Time mod work hours
Q3021: Time mod work hours
Q3021: Time mod work hours
Q3021: Time mod work hours
Next I am going to ask you about the time you spend doing different types of physical activity in a typical week. Please answer these questions even if you do not consider yourself to be an active person. Think first about the time you spend doing work. Think of work as the things that you have to do such as paid or unpaid work, household chores, harvesting food/crops, fishing or hunting for food, providing care or seeking employment.
In answering the following questions 'vigorous activities' require hard physical effort and cause large increases in breathing or heart rate, 'moderate activities' require moderate physical effort and cause small increases in breathing or heart rate.
How much time do you spend doing moderate-intensity activities at work on a typical day?
-9
Not applicable
-8
Don't know
Q3021: Time mod work minutes
Q3021: Time mod work minutes
Q3021: Time mod work minutes
Q3021: Time mod work minutes
Q3021: Time mod work minutes
Next I am going to ask you about the time you spend doing different types of physical activity in a typical week. Please answer these questions even if you do not consider yourself to be an active person. Think first about the time you spend doing work. Think of work as the things that you have to do such as paid or unpaid work, household chores, harvesting food/crops, fishing or hunting for food, providing care or seeking employment.
In answering the following questions 'vigorous activities' require hard physical effort and cause large increases in breathing or heart rate, 'moderate activities' require moderate physical effort and cause small increases in breathing or heart rate.
How much time do you spend doing moderate-intensity activities at work on a typical day?
-9
Not applicable
-8
Don't know
Q3022: Walk/bike
Q3022: Walk/bike
Q3022: Walk/bike
Q3022: Walk/bike
Q3022: Walk/bike
The next questions exclude the physical activities at work that you've already mentioned.
Now I would like to ask you about the usual way you travel to and from places. For example, getting to work, to shopping, to the market, to place of worship. [Insert other examples if needed]
Do you walk or use a bicycle (pedal cycle) for at least 10 minutes continuously to get to and from places?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q3023: Days walk/bike
Q3023: Days walk/bike
Q3023: Days walk/bike
Q3023: Days walk/bike
Q3023: Days walk/bike
The next questions exclude the physical activities at work that you've already mentioned.
Now I would like to ask you about the usual way you travel to and from places. For example, getting to work, to shopping, to the market, to place of worship. [Insert other examples if needed]
In a typical week, on how many days do you walk or bicycle for at least 10 minutes continuously to get to and from places?
8
Don't know
9
Not applicable
Q3024: Time/d hours
Q3024: Time/d hours
Q3024: Time/d hours
Q3024: Time/d hours
Q3024: Time/d hours
The next questions exclude the physical activities at work that you've already mentioned.
Now I would like to ask you about the usual way you travel to and from places. For example, getting to work, to shopping, to the market, to place of worship. [Insert other examples if needed]
How much time would you spend walking or bicycling for travel on a typical day?
-9
Not applicable
-8
Don't know
Q3024: Time/d minutes
Q3024: Time/d minutes
Q3024: Time/d minutes
Q3024: Time/d minutes
Q3024: Time/d minutes
The next questions exclude the physical activities at work that you've already mentioned.
Now I would like to ask you about the usual way you travel to and from places. For example, getting to work, to shopping, to the market, to place of worship. [Insert other examples if needed]
How much time would you spend walking or bicycling for travel on a typical day?
-9
Not applicable
-8
Don't know
Q3025: Vigorous fitness/leisure
Q3025: Vigorous fitness/leisure
Q3025: Vigorous fitness/leisure
Q3025: Vigorous fitness/leisure
Q3025: Vigorous fitness/leisure
The next questions exclude the work and transport activities that you have already mentioned. Now I would like to ask you about sports, fitness, leisure and recreational activities [insert relevant terms].
Do you do any vigorous intensity sports, fitness or recreational (leisure) activities that cause large increases in breathing or heart rate [like running or football], for at least 10 minutes continuously?
INSERT EXAMPLES & USE SHOWCARD
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q3026: Days vig fitness/leisure
Q3026: Days vig fitness/leisure
Q3026: Days vig fitness/leisure
Q3026: Days vig fitness/leisure
Q3026: Days vig fitness/leisure
The next questions exclude the work and transport activities that you have already mentioned. Now I would like to ask you about sports, fitness, leisure and recreational activities [insert relevant terms].
In a typical week, on how many days do you do vigorous intensity sports, fitness or recreational (leisure) activities?
8
Don't know
9
Not applicable
Q3027: Time vig fit/leisure hours
Q3027: Time vig fit/leisure hours
Q3027: Time vig fit/leisure hours
Q3027: Time vig fit/leisure hours
Q3027: Time vig fit/leisure hours
The next questions exclude the work and transport activities that you have already mentioned. Now I would like to ask you about sports, fitness, leisure and recreational activities [insert relevant terms].
How much time do you spend doing vigorous intensity sports, fitness or recreational activities on a typical day?
-9
Not applicable
-8
Don't know
Q3027: Time vig fit/leisure minutes
Q3027: Time vig fit/leisure minutes
Q3027: Time vig fit/leisure minutes
Q3027: Time vig fit/leisure minutes
Q3027: Time vig fit/leisure minutes
The next questions exclude the work and transport activities that you have already mentioned. Now I would like to ask you about sports, fitness, leisure and recreational activities [insert relevant terms].
How much time do you spend doing vigorous intensity sports, fitness or recreational activities on a typical day?
-9
Not applicable
-8
Don't know
Q3028: Moderate fitness/leisure
Q3028: Moderate fitness/leisure
Q3028: Moderate fitness/leisure
Q3028: Moderate fitness/leisure
Q3028: Moderate fitness/leisure
The next questions exclude the work and transport activities that you have already mentioned. Now I would like to ask you about sports, fitness, leisure and recreational activities [insert relevant terms].
Do you do any moderate-intensity sports, fitness or recreational (leisure) activities that causes a small increase in breathing or heart rate [such as brisk walking, cycling or swimming] for at least 10 minutes at a time?
INSERT EXAMPLES & USE SHOWCARD
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q3029: Days mod fitness/leisure
Q3029: Days mod fitness/leisure
Q3029: Days mod fitness/leisure
Q3029: Days mod fitness/leisure
Q3029: Days mod fitness/leisure
The next questions exclude the work and transport activities that you have already mentioned. Now I would like to ask you about sports, fitness, leisure and recreational activities [insert relevant terms].
In a typical week, on how many days do you do moderate-intensity sports, fitness or recreational (leisure) activities?
8
Don't know
9
Not applicable
Q3030: Time mod fit/leisure hours
Q3030: Time mod fit/leisure hours
Q3030: Time mod fit/leisure hours
Q3030: Time mod fit/leisure hours
Q3030: Time mod fit/leisure hours
The next questions exclude the work and transport activities that you have already mentioned. Now I would like to ask you about sports, fitness, leisure and recreational activities [insert relevant terms].
How much time do you spend doing moderate intensity sports, fitness or recreational (leisure) activities on a typical day?
-9
Not applicable
-8
Don't know
Q3030: Time mod fit/leisure minutes
Q3030: Time mod fit/leisure minutes
Q3030: Time mod fit/leisure minutes
Q3030: Time mod fit/leisure minutes
Q3030: Time mod fit/leisure minutes
The next questions exclude the work and transport activities that you have already mentioned. Now I would like to ask you about sports, fitness, leisure and recreational activities [insert relevant terms].
How much time do you spend doing moderate intensity sports, fitness or recreational (leisure) activities on a typical day?
-9
Not applicable
-8
Don't know
Q3031: Leisure hours/d
Q3031: Leisure hours/d
Q3031: Leisure hours/d
Q3031: Leisure hours/d
Q3031: Leisure hours/d
The following question is about sitting or reclining at work, at home, getting to and from places, or with friends including time spent [sitting at a desk, sitting with friends, travelling in car, bus, train, reading, playing cards or watching television], but do not include time spent sleeping.
INSERT EXAMPLES & USE SHOWCARD
How much time do you usually spend sitting or reclining on a typical day?
-9
Not applicable
-8
Don't know
Q3031: Leisure ave minutes/d
Q3031: Leisure ave minutes/d
Q3031: Leisure ave minutes/d
Q3031: Leisure ave minutes/d
Q3031: Leisure ave minutes/d
The following question is about sitting or reclining at work, at home, getting to and from places, or with friends including time spent [sitting at a desk, sitting with friends, travelling in car, bus, train, reading, playing cards or watching television], but do not include time spent sleeping.
INSERT EXAMPLES & USE SHOWCARD
How much time do you usually spend sitting or reclining on a typical day?
-9
Not applicable
-8
Don't know
S4000: HH begin
S4000: HH begin
S4000: HH begin
S4000: HH begin
S4000: HH begin
S4000: MM begin
S4000: MM begin
S4000: MM begin
S4000: MM begin
S4000: MM begin
S4000: HH end
S4000: HH end
S4000: HH end
S4000: HH end
S4000: HH end
S4000: MM end
S4000: MM end
S4000: MM end
S4000: MM end
S4000: MM end
Q4001: Arthritis
Q4001: Arthritis
Q4001: Arthritis
Q4001: Arthritis
Q4001: Arthritis
Now I would like to read you questions about some health problems or health care needs that you may have experienced, and the treatment or medical care that you may have received.
Have you ever been diagnosed with/told you have arthritis (a disease of the joints, or by other names rheumatism or osteoarthritis)?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4002a: during last 2 weeks
Q4002a: during last 2 weeks
Q4002a: during last 2 weeks
Q4002a: during last 2 weeks
Q4002a: during last 2 weeks
Have you been taking medications or other treatment for it during the last 2 weeks?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4002b: during last 12 months
Q4002b: during last 12 months
Q4002b: during last 12 months
Q4002b: during last 12 months
Q4002b: during last 12 months
Have you been taking medications or other treatment for it during the last 12 months?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4003: Pain
Q4003: Pain
Q4003: Pain
Q4003: Pain
Q4003: Pain
During the last 12 months, have you experienced, pain, aching, stiffness or swelling in or around the joints (like arms, hands, legs or feet) which were not related to an injury and lasted for more than a month?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4004: Stiffness
Q4004: Stiffness
Q4004: Stiffness
Q4004: Stiffness
Q4004: Stiffness
During the last 12 months, have you experienced stiffness in the joint in the morning after getting up from bed, or after a long rest of the joint without movement?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4005: How long last in a.m.
Q4005: How long last in a.m.
Q4005: How long last in a.m.
Q4005: How long last in a.m.
Q4005: How long last in a.m.
If Q4003 and Q4004 are both "No" (that is, no symptoms of arthritis), skip to Q4008
How long did this stiffness last?
1About 30 minutes or less
2 More than 30 Minutes
1
<= 30 MMs.
2
> 30 MMs.
8
Don't know
9
Not applicable
Q4006: Stiffness go away
Q4006: Stiffness go away
Q4006: Stiffness go away
Q4006: Stiffness go away
Q4006: Stiffness go away
Did this stiffness go away after exercise or movement in the joint?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4007: in past 2 weeks?
Q4007: in past 2 weeks?
Q4007: in past 2 weeks?
Q4007: in past 2 weeks?
Q4007: in past 2 weeks?
These symptoms that you have said you experienced in the last 12 months, have you experienced them in the last 2 weeks?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4008: Back pain
Q4008: Back pain
Q4008: Back pain
Q4008: Back pain
Q4008: Back pain
Have you experienced back pain during the last 30 days?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4009: Days in pain
Q4009: Days in pain
Q4009: Days in pain
Q4009: Days in pain
Q4009: Days in pain
On how many days did you have this back pain during the last 30 days?
-9
Not applicable
-8
Don't know
Q4010: Stroke
Q4010: Stroke
Q4010: Stroke
Q4010: Stroke
Q4010: Stroke
Have you ever been told by a health professional that you have had a stroke?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4011a: during last 2 weeks
Q4011a: during last 2 weeks
Q4011a: during last 2 weeks
Q4011a: during last 2 weeks
Q4011a: during last 2 weeks
Have you been taking any medications or other treatment for it…during the last 2 weeks?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4011b: during last 12 months
Q4011b: during last 12 months
Q4011b: during last 12 months
Q4011b: during last 12 months
Q4011b: during last 12 months
Have you been taking any medications or other treatment for it…during the last 12 months?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4012: Paralysis
Q4012: Paralysis
Q4012: Paralysis
Q4012: Paralysis
Q4012: Paralysis
Have you ever suffered from sudden onset of paralysis or weakness in your arms or legs on one side of your body for more than 24 hours?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4013: Loss of feeling
Q4013: Loss of feeling
Q4013: Loss of feeling
Q4013: Loss of feeling
Q4013: Loss of feeling
Have you ever had, for more than 24 hours, sudden onset of loss of feeling on one side of your body, without anything having happened to you immediately before?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4014: Angina
Q4014: Angina
Q4014: Angina
Q4014: Angina
Q4014: Angina
Have you ever been diagnosed with angina or angina pectoris (a heart disease)?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4015a: during last 2 weeks
Q4015a: during last 2 weeks
Q4015a: during last 2 weeks
Q4015a: during last 2 weeks
Q4015a: during last 2 weeks
Have you been taking any medications or other treatment for it…during the last 2 weeks?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4015b: during last 12 months
Q4015b: during last 12 months
Q4015b: during last 12 months
Q4015b: during last 12 months
Q4015b: during last 12 months
Have you been taking any medications or other treatment for it…during the last 12 months?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4016: Pain in chest uphill/hurry
Q4016: Pain in chest uphill/hurry
Q4016: Pain in chest uphill/hurry
Q4016: Pain in chest uphill/hurry
Q4016: Pain in chest uphill/hurry
During the last 12 months, have you experienced any pain or discomfort in your chest when you walk uphill or hurry?
1Yes
2No
3 Never walks uphill or hurries
1
Yes
2
No
3
Never exerts
8
Don't know
9
Not applicable
Q4017: Pain in chest normal
Q4017: Pain in chest normal
Q4017: Pain in chest normal
Q4017: Pain in chest normal
Q4017: Pain in chest normal
During the last 12 months, have you experienced any pain or discomfort in your chest when you walk at an ordinary pace on level ground?
1 Yes
2 No ...............Q4022
1
Yes
2
No
8
Don't know
9
Not applicable
Q4018: Response to CP
Q4018: Response to CP
Q4018: Response to CP
Q4018: Response to CP
Q4018: Response to CP
What do you do if you get the pain or discomfort when you are walking?
Read choices
1Stop or slow down
2Carry on after taking a pain relieving medicine that dissolves in your mouth
3 Carry on walking
1
Stop/slow down
2
Medicate/carry on
3
Carry on
8
Don't know
9
Not applicable
Q4019: Stand still
Q4019: Stand still
Q4019: Stand still
Q4019: Stand still
Q4019: Stand still
If you stand still, what happens to the pain or discomfort?
Read choices
1Relieved
2 Not relieved
1
Relieved
2
Not relieved
8
Don't know
9
Not applicable
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Will you show me where you usually experience the pain or discomfort?
Circle number in each of the boxes in the areas of body mentioned or shown by the respondent.
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Will you show me where you usually experience the pain or discomfort?
Circle number in each of the boxes in the areas of body mentioned or shown by the respondent.
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Will you show me where you usually experience the pain or discomfort?
Circle number in each of the boxes in the areas of body mentioned or shown by the respondent.
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Will you show me where you usually experience the pain or discomfort?
Circle number in each of the boxes in the areas of body mentioned or shown by the respondent.
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Will you show me where you usually experience the pain or discomfort?
Circle number in each of the boxes in the areas of body mentioned or shown by the respondent.
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Will you show me where you usually experience the pain or discomfort?
Circle number in each of the boxes in the areas of body mentioned or shown by the respondent.
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Will you show me where you usually experience the pain or discomfort?
Circle number in each of the boxes in the areas of body mentioned or shown by the respondent.
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Will you show me where you usually experience the pain or discomfort?
Circle number in each of the boxes in the areas of body mentioned or shown by the respondent.
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Will you show me where you usually experience the pain or discomfort?
Circle number in each of the boxes in the areas of body mentioned or shown by the respondent.
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Will you show me where you usually experience the pain or discomfort?
Circle number in each of the boxes in the areas of body mentioned or shown by the respondent.
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Will you show me where you usually experience the pain or discomfort?
Circle number in each of the boxes in the areas of body mentioned or shown by the respondent.
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Will you show me where you usually experience the pain or discomfort?
Circle number in each of the boxes in the areas of body mentioned or shown by the respondent.
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Will you show me where you usually experience the pain or discomfort?
Circle number in each of the boxes in the areas of body mentioned or shown by the respondent.
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Will you show me where you usually experience the pain or discomfort?
Circle number in each of the boxes in the areas of body mentioned or shown by the respondent.
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Will you show me where you usually experience the pain or discomfort?
Circle number in each of the boxes in the areas of body mentioned or shown by the respondent.
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Will you show me where you usually experience the pain or discomfort?
Circle number in each of the boxes in the areas of body mentioned or shown by the respondent.
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Will you show me where you usually experience the pain or discomfort?
Circle number in each of the boxes in the areas of body mentioned or shown by the respondent.
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Q4020: Location of pain
Will you show me where you usually experience the pain or discomfort?
Circle number in each of the boxes in the areas of body mentioned or shown by the respondent.
Q4021: past 2 weeks
Q4021: past 2 weeks
Q4021: past 2 weeks
Q4021: past 2 weeks
Q4021: past 2 weeks
These symptoms that you have said you experienced in the last 12 months, have you experienced them in the last 2 weeks?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4022: Diabetes
Q4022: Diabetes
Q4022: Diabetes
Q4022: Diabetes
Q4022: Diabetes
Have you ever been diagnosed with diabetes (high blood sugar)?
(Not including diabetes associated with a pregnancy)
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4023a: during last 2 weeks
Q4023a: during last 2 weeks
Q4023a: during last 2 weeks
Q4023a: during last 2 weeks
Q4023a: during last 2 weeks
Have you been taking insulin or other blood sugar lowering medications in the last 2 weeks?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4023b: during last 12 months
Q4023b: during last 12 months
Q4023b: during last 12 months
Q4023b: during last 12 months
Q4023b: during last 12 months
Have you been taking insulin or other blood sugar lowering medications in the last 12 months?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4024: Diet
Q4024: Diet
Q4024: Diet
Q4024: Diet
Q4024: Diet
Have you been following a special diet, exercise regime or weight control program for diabetes during the last 2 weeks?
(As recommended by health professional)
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4025: Chronic lung disease
Q4025: Chronic lung disease
Q4025: Chronic lung disease
Q4025: Chronic lung disease
Q4025: Chronic lung disease
Have you ever been diagnosed with chronic lung disease (emphysema, bronchitis, COPD)?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4026a: during last 2 weeks
Q4026a: during last 2 weeks
Q4026a: during last 2 weeks
Q4026a: during last 2 weeks
Q4026a: during last 2 weeks
Have you been taking any medications or other treatment (like oxygen) for it in the last 2 weeks?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4026b: during last 12 months
Q4026b: during last 12 months
Q4026b: during last 12 months
Q4026b: during last 12 months
Q4026b: during last 12 months
Have you been taking any medications or other treatment (like oxygen) for it n the last 12 months?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4027: Shortness of breath
Q4027: Shortness of breath
Q4027: Shortness of breath
Q4027: Shortness of breath
Q4027: Shortness of breath
During the last 12 months, have you experienced any shortness of breath at rest? (while awake)
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4028: Coughing/wheezing
Q4028: Coughing/wheezing
Q4028: Coughing/wheezing
Q4028: Coughing/wheezing
Q4028: Coughing/wheezing
During the last 12 months, have you experienced any coughing or wheezing for ten minutes or more at a time?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4029: Sputum/phlegm
Q4029: Sputum/phlegm
Q4029: Sputum/phlegm
Q4029: Sputum/phlegm
Q4029: Sputum/phlegm
During the last 12 months, have you experienced any coughing up sputum or phlegm for most days of the month for at least 3 months?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4030: during last 2 weeks
Q4030: during last 2 weeks
Q4030: during last 2 weeks
Q4030: during last 2 weeks
Q4030: during last 2 weeks
These symptoms that you said you experienced in the last 12 months, have you experienced them in the last 2 weeks?
1 Yes
2 No
Interviewer: If Q4027, Q4028 and Q4029 are "No" …to Skip to Q4031
1
Yes
2
No
8
Don't know
9
Not applicable
Q4031: TB test
Q4031: TB test
Q4031: TB test
Q4031: TB test
Q4031: TB test
n the last 12 months, have you had a tuberculosis (TB) test? I mean, has a doctor examined your sputum (taken a sample of the substance spit out from a deep cough and sent it to a laboratory for analysis) or made an x-ray of your chest?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4032a: during last 2 weeks
Q4032a: during last 2 weeks
Q4032a: during last 2 weeks
Q4032a: during last 2 weeks
Q4032a: during last 2 weeks
Have you been taking any medications or other treatment for it during the last 2 weeks?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4032b: during last 12 months
Q4032b: during last 12 months
Q4032b: during last 12 months
Q4032b: during last 12 months
Q4032b: during last 12 months
Have you been taking any medications or other treatment for it during the last 12 months?
1 Yes
2 No
INTERVIEWER: if Q4029 is "No", skip to Q4032
1
Yes
2
No
8
Don't know
9
Not applicable
Q4032c: cough blood
Q4032c: cough blood
Q4032c: cough blood
Q4032c: cough blood
Q4032c: cough blood
Have you had blood in your phlegm or have you coughed blood?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4033: Asthma
Q4033: Asthma
Q4033: Asthma
Q4033: Asthma
Q4033: Asthma
Have you ever been diagnosed with asthma (an allergic respiratory disease)?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4034a: during last 2 weeks
Q4034a: during last 2 weeks
Q4034a: during last 2 weeks
Q4034a: during last 2 weeks
Q4034a: during last 2 weeks
Have you been taking any medications or other treatment for it n the last 2 weeks?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4034b: during last 12 months
Q4034b: during last 12 months
Q4034b: during last 12 months
Q4034b: during last 12 months
Q4034b: during last 12 months
Have you been taking any medications or other treatment for it in the last 12 months?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4035: Wheezing attacks
Q4035: Wheezing attacks
Q4035: Wheezing attacks
Q4035: Wheezing attacks
Q4035: Wheezing attacks
During the last 12 months, have you experienced any of the following:
Attacks of wheezing or whistling breathing?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4036: Wheezing after activity
Q4036: Wheezing after activity
Q4036: Wheezing after activity
Q4036: Wheezing after activity
Q4036: Wheezing after activity
Attack of wheezing that came on after you stopped exercising or some other physical activity?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4037: Tightness in chest
Q4037: Tightness in chest
Q4037: Tightness in chest
Q4037: Tightness in chest
Q4037: Tightness in chest
A feeling of tightness in your chest?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4038: Tightness on awakening
Q4038: Tightness on awakening
Q4038: Tightness on awakening
Q4038: Tightness on awakening
Q4038: Tightness on awakening
Have you woken up with a feeling of tightness in your chest in the morning or any other time?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4039: Shortness of breath
Q4039: Shortness of breath
Q4039: Shortness of breath
Q4039: Shortness of breath
Q4039: Shortness of breath
Have you had an attack of shortness of breath that came on without obvious cause when you were not exercising or doing some physical activity?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4039a: in past 2 weeks
Q4039a: in past 2 weeks
Q4039a: in past 2 weeks
Q4039a: in past 2 weeks
Q4039a: in past 2 weeks
IF Q4035 to Q4039 are all 'No', skip to ……………………………………………………………………………..Q4040
If one of the symptom questions (Q4035 to Q4039) is 'Yes', continue with Q4039a.
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4040: Depression diagnosis
Q4040: Depression diagnosis
Q4040: Depression diagnosis
Q4040: Depression diagnosis
Q4040: Depression diagnosis
Have you ever been diagnosed with depression?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4041a: during last 2 weeks
Q4041a: during last 2 weeks
Q4041a: during last 2 weeks
Q4041a: during last 2 weeks
Q4041a: during last 2 weeks
Have you been taking any medications or other treatment for it …
(Other treatment can include attending therapy or counseling sessions.) during the last 2 weeks?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4041b: during last 12 months
Q4041b: during last 12 months
Q4041b: during last 12 months
Q4041b: during last 12 months
Q4041b: during last 12 months
Have you been taking any medications or other treatment for it …
(Other treatment can include attending therapy or counseling sessions.) during the last 12 months?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4042: Several days
Q4042: Several days
Q4042: Several days
Q4042: Several days
Q4042: Several days
During the last 12 months, have you had a period lasting several days when you felt sad, empty or depressed?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4043: Loss of interest
Q4043: Loss of interest
Q4043: Loss of interest
Q4043: Loss of interest
Q4043: Loss of interest
During the last 12 months, have you had a period lasting several days when you lost interest in most things you usually enjoy such as personal relationships, work or hobbies/recreation?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4044: Lack of energy
Q4044: Lack of energy
Q4044: Lack of energy
Q4044: Lack of energy
Q4044: Lack of energy
During the last 12 months, have you had a period lasting several days when you have been feeling your energy decreased or that you are tired all the time?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4045: More than 2 weeks?
Q4045: More than 2 weeks?
Q4045: More than 2 weeks?
Q4045: More than 2 weeks?
Q4045: More than 2 weeks?
Was this period [of sadness/loss of interest/low energy] for more than 2 weeks?
1 Yes
2 No
Interviewer: If any one of Q4042, Q4043 or Q4044 is "Yes" , Continue to Q4045
If all 3 (Q4042, Q4043 AND Q4044) are "No", skip to ..........Q4060
1
Yes
2
No
8
Don't know
9
Not applicable
Q4046: Daily?
Q4046: Daily?
Q4046: Daily?
Q4046: Daily?
Q4046: Daily?
Was this period [of sadness/loss of interest/low energy] most of the day, nearly every day?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4047: Loss of appetite
Q4047: Loss of appetite
Q4047: Loss of appetite
Q4047: Loss of appetite
Q4047: Loss of appetite
During this period, did you lose your appetite?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4048: Slow thinking
Q4048: Slow thinking
Q4048: Slow thinking
Q4048: Slow thinking
Q4048: Slow thinking
Did you notice any slowing down in your thinking?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4049: Falling asleep
Q4049: Falling asleep
Q4049: Falling asleep
Q4049: Falling asleep
Q4049: Falling asleep
Did you notice any problems falling asleep?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4050: Waking up
Q4050: Waking up
Q4050: Waking up
Q4050: Waking up
Q4050: Waking up
Did you notice any problems waking up too early?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4051: Difficulty concentrating
Q4051: Difficulty concentrating
Q4051: Difficulty concentrating
Q4051: Difficulty concentrating
Q4051: Difficulty concentrating
During this period, did you have any difficulties concentrating; for example, listening to others, working, watching TV, listening to the radio?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4052: Moving slowly
Q4052: Moving slowly
Q4052: Moving slowly
Q4052: Moving slowly
Q4052: Moving slowly
Did you notice any slowing down in your moving around?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4053: Anxiety, worry
Q4053: Anxiety, worry
Q4053: Anxiety, worry
Q4053: Anxiety, worry
Q4053: Anxiety, worry
During this period, did you feel anxious and worried most days?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4054: Restlessness, jitters
Q4054: Restlessness, jitters
Q4054: Restlessness, jitters
Q4054: Restlessness, jitters
Q4054: Restlessness, jitters
During this period, were you so restless or jittery nearly every day that you paced up and down and couldn't sit still?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4055: Low self-esteem
Q4055: Low self-esteem
Q4055: Low self-esteem
Q4055: Low self-esteem
Q4055: Low self-esteem
During this period, did you feel negative about yourself or like you had lost confidence?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4056: Hopelessness
Q4056: Hopelessness
Q4056: Hopelessness
Q4056: Hopelessness
Q4056: Hopelessness
Did you frequently feel hopeless - that there was no way to improve things?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4057: Sexual drive
Q4057: Sexual drive
Q4057: Sexual drive
Q4057: Sexual drive
Q4057: Sexual drive
During this period, did your interest in sex decrease?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4058: Morbid thoughts
Q4058: Morbid thoughts
Q4058: Morbid thoughts
Q4058: Morbid thoughts
Q4058: Morbid thoughts
Did you think of death, or wish you were dead?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4059: Suicide attempts
Q4059: Suicide attempts
Q4059: Suicide attempts
Q4059: Suicide attempts
Q4059: Suicide attempts
During this period, did you ever try to end your life?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4060: Hypertension
Q4060: Hypertension
Q4060: Hypertension
Q4060: Hypertension
Q4060: Hypertension
Have you ever been diagnosed with high blood pressure (hypertension)?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4061a: during last 2 weeks
Q4061a: during last 2 weeks
Q4061a: during last 2 weeks
Q4061a: during last 2 weeks
Q4061a: during last 2 weeks
Have you been taking any medications or other treatment for it during …
(Other treatment might include weight loss program or change in eating habits.) the last 2 weeks?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4061b: during last 12 months
Q4061b: during last 12 months
Q4061b: during last 12 months
Q4061b: during last 12 months
Q4061b: during last 12 months
Have you been taking any medications or other treatment for it during …
(Other treatment might include weight loss program or change in eating habits.) the last 12 months?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4062: Cataracts
Q4062: Cataracts
Q4062: Cataracts
Q4062: Cataracts
Q4062: Cataracts
In the last 5 years, were you diagnosed with a cataract in one or both of your eyes (a cloudiness in the lens of the eye)?
1 Yes
2 No................Q4064
8 Don't know
1
Yes
2
No
8
Don't know
9
Not applicable
Q4063: Cataract surgery
Q4063: Cataract surgery
Q4063: Cataract surgery
Q4063: Cataract surgery
Q4063: Cataract surgery
In the last 5 years, have you had eye surgery to remove this cataract(s)?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4064: Cloudy vision
Q4064: Cloudy vision
Q4064: Cloudy vision
Q4064: Cloudy vision
Q4064: Cloudy vision
In the last 12 months have you experienced any of the following
cloudy or blurry vision?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4065: Haloed vision
Q4065: Haloed vision
Q4065: Haloed vision
Q4065: Haloed vision
Q4065: Haloed vision
In the last 12 months have you experienced any of the following
vision problems with light, such as glare from bright lights, or halos around lights?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4066: Lost all teeth?
Q4066: Lost all teeth?
Q4066: Lost all teeth?
Q4066: Lost all teeth?
Q4066: Lost all teeth?
Have you lost all of your natural teeth?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4067: Probs with mouth/teeth
Q4067: Probs with mouth/teeth
Q4067: Probs with mouth/teeth
Q4067: Probs with mouth/teeth
Q4067: Probs with mouth/teeth
During the last 12 months, have you had any problems with your mouth and/or teeth, including problems with swallowing?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4068a: during last 2 weeks
Q4068a: during last 2 weeks
Q4068a: during last 2 weeks
Q4068a: during last 2 weeks
Q4068a: during last 2 weeks
Have you received any medications or treatment from a dentist or other oral health specialist during the last 2 weeks?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4068b: during last 12 months
Q4068b: during last 12 months
Q4068b: during last 12 months
Q4068b: during last 12 months
Q4068b: during last 12 months
Have you received any medications or treatment from a dentist or other oral health specialist during the last 12 months?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4069: Road accident
Q4069: Road accident
Q4069: Road accident
Q4069: Road accident
Q4069: Road accident
In the last 12 months, have you been involved in a road traffic accident where you suffered from bodily injury?
PROBE: This could have been an accident in which you were involved either as the occupant of a motor vehicle, or when you were riding a motorcycle/scooter, rickshaw or bicycle or walking.
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4070: How did happen?
Q4070: How did happen?
Q4070: How did happen?
Q4070: How did happen?
Q4070: How did happen?
How did the injury happen? Was it an accident, did someone else do this to you, or did you do this to yourself?
1It was an accident (unintentional)
2Someone else did it to me deliberately (intentional)
3I did it to myself deliberately (self-inflicted)
8 Don't know
1
Unintentional
2
Intentional
3
Self-inflicted
8
Don't know
9
Not applicable
Q4071: Treatment
Q4071: Treatment
Q4071: Treatment
Q4071: Treatment
Q4071: Treatment
Did you receive any medical care or treatment for your injuries?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4072: Disability?
Q4072: Disability?
Q4072: Disability?
Q4072: Disability?
Q4072: Disability?
Did you suffer a physical disability as a result of being injured?
INTERVIEWER: Disability is any restriction or lack of ability to perform an activity as before the injury
1 Yes
2 No..............Q4073
1
Yes
2
No
8
Don't know
9
Not applicable
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
In what ways were you physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify
INTERVIEWER: Circle allthat respondent selects.
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
In what ways were you physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify
INTERVIEWER: Circle allthat respondent selects.
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
In what ways were you physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify
INTERVIEWER: Circle allthat respondent selects.
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
In what ways were you physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify
INTERVIEWER: Circle allthat respondent selects.
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
In what ways were you physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify
INTERVIEWER: Circle allthat respondent selects.
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
In what ways were you physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify
INTERVIEWER: Circle allthat respondent selects.
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
In what ways were you physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify
INTERVIEWER: Circle allthat respondent selects.
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
In what ways were you physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify
INTERVIEWER: Circle allthat respondent selects.
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
Q4072a: What type of disab
In what ways were you physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify
INTERVIEWER: Circle allthat respondent selects.
Q4073: Other bodily injury?
Q4073: Other bodily injury?
Q4073: Other bodily injury?
Q4073: Other bodily injury?
Q4073: Other bodily injury?
In the last 12 months, have you had any other event where you suffered from bodily injury?
1Yes (if more than one event, select the most recent to ask about in more detail below)
2 No ........................Q4078
NTERVIEWER: If more than one, ask respondent to think of the most recent event.
1
Yes
2
No
8
Don't know
9
Not applicable
Q4073a: Where did injury occur
Q4073a: Where did injury occur
Q4073a: Where did injury occur
Q4073a: Where did injury occur
Q4073a: Where did injury occur
Where were you when you were injured?
1Home
2School
3Work
7 Other, specify :
8 Don't know
1
Home
2
School
3
Work
7
Other
8
Don't know
9
Not applicable
Q4074: Cause of event
Q4074: Cause of event
Q4074: Cause of event
Q4074: Cause of event
Q4074: Cause of event
What was the cause of this injury?
1Fall
2Struck/hit by person or object
3Stabbed
4Gun shot
5Fire, flames or heat (burn)
6Drowning or near-drowning
7Poisoning
8Animal bite
9Electricity shock
87 Other, specify:
88 Don't know
-9
Not applicable
-8
DK
1
Fall
2
Struck/hit by person
3
Stabbed
4
Gunshot
5
Fire, flames or heat
6
Drowning or near
7
Poisoning
8
Animal bite
9
Electric shock
87
Other
88
Don't know
98
Not applicable
Q4075: How did happen?
Q4075: How did happen?
Q4075: How did happen?
Q4075: How did happen?
Q4075: How did happen?
How did the injury happen? Was it an accident, did someone else do this to you, or did you do this to yourself?
1It was an accident (unintentional)
2Someone else did it to me deliberately (intentional)
3I did it to myself deliberately (self-inflicted)
8 Don't know
1
Unintentional
2
Intentional
3
Self-inflicted
8
Don't know
9
Not applicable
Q4076: Treatment
Q4076: Treatment
Q4076: Treatment
Q4076: Treatment
Q4076: Treatment
Did you receive any medical care or treatment for your injuries?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4077: Disability?
Q4077: Disability?
Q4077: Disability?
Q4077: Disability?
Q4077: Disability?
Did you suffer a physical disability as a result of being injured?
1 Yes
2 No................Q4078
INTERVIEWER: disability is any restriction or lack of ability to perform an activity as before the injury.
1
Yes
2
No
8
Don't know
9
Not applicable
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
In what ways were you physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
NTERVIEWER: Circle all that respondent indicates.
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
In what ways were you physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
NTERVIEWER: Circle all that respondent indicates.
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
In what ways were you physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
NTERVIEWER: Circle all that respondent indicates.
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
In what ways were you physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
NTERVIEWER: Circle all that respondent indicates.
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
In what ways were you physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
NTERVIEWER: Circle all that respondent indicates.
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
In what ways were you physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
NTERVIEWER: Circle all that respondent indicates.
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
In what ways were you physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
NTERVIEWER: Circle all that respondent indicates.
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
In what ways were you physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
NTERVIEWER: Circle all that respondent indicates.
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
Q4077a: What type of disab?
In what ways were you physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
NTERVIEWER: Circle all that respondent indicates.
Q4078: Pelvic exam
Q4078: Pelvic exam
Q4078: Pelvic exam
Q4078: Pelvic exam
Q4078: Pelvic exam
Cervical cancer and breast cancer screening (Women only)
Questions to be asked to FEMALE respondents only.
Female …..è Q4078
Male …..…..è GO TO NEXT SECTION
Now I would like to ask you about some of the kinds of medical care or tests that you may have received
When was the last time you had a pelvic examination, if ever?
(By pelvic examination, I mean when a doctor or nurse examined your vagina and uterus?)
Enter "00" if less than 1 year ago.
98 Never had exam
-8
Don't know
98
Never
Q4079: PAP smear
Q4079: PAP smear
Q4079: PAP smear
Q4079: PAP smear
Q4079: PAP smear
The last time you had the pelvic examination, did you have a PAP smear test?
(By PAP smear test, I mean did a doctor or nurse use a swab or stick to wipe from inside your vagina, take a sample and send it to a laboratory?)
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q4080: Mammogram
Q4080: Mammogram
Q4080: Mammogram
Q4080: Mammogram
Q4080: Mammogram
When was the last time you had a mammography, if ever?
(That is, an x-ray of your breasts taken to detect breast cancer at an early stage.)
Enter "00" if less than 1 year ago.
98 Never had exam
-8
Don't know
98
Never
S5000: HH begin
S5000: HH begin
S5000: HH begin
S5000: HH begin
S5000: HH begin
S5000: MM begin
S5000: MM begin
S5000: MM begin
S5000: MM begin
S5000: MM begin
S5000: HH end
S5000: HH end
S5000: HH end
S5000: HH end
S5000: HH end
S5000: MM end
S5000: MM end
S5000: MM end
S5000: MM end
S5000: MM end
Q5001: Needed care YY ago
Q5001: Needed care YY ago
Q5001: Needed care YY ago
Q5001: Needed care YY ago
Q5001: Needed care YY ago
When was the last time that you needed health care?
INTERVIEWER: this can be inpatient or outpatient care. If less than one month ago, enter “00” for years and "00" for months.
98 Never ..……………………………. Q5046
-8 Don't know
-9
Not applicable
-8
Don't know
88
DK
98
0000Never
Q5001: Needed care MM ago
Q5001: Needed care MM ago
Q5001: Needed care MM ago
Q5001: Needed care MM ago
Q5001: Needed care MM ago
When was the last time that you needed health care?
INTERVIEWER: this can be inpatient or outpatient care. If less than one month ago, enter “00” for years and "00" for months.
98 Never ..……………………………. Q5046
-8 Don't know
-9
Not applicable
-8
Don't know
88
DK
98
0000Never
Q5001a: More than 3 yrs?
Q5001a: More than 3 yrs?
Q5001a: More than 3 yrs?
Q5001a: More than 3 yrs?
Q5001a: More than 3 yrs?
Q5001a. If 'don't know',
Was it more than 3 years ago?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q5002: Got care?
Q5002: Got care?
Q5002: Got care?
Q5002: Got care?
Q5002: Got care?
The last time you needed health care, did you get health care?
1 Yes
2 No
INTERVIEWER: If person did not get health care, Q5002 = "No", ask Q5003a and Q5003b, then skip to Q5046.
1
Yes
2
No
8
Don't know
9
Not applicable
Q5003a: Why needed care
Q5003a: Why needed care
Q5003a: Why needed care
Q5003a: Why needed care
Q5003a: Why needed care
What was the main reason you needed care, even if you did not get care?
1 Communicable disease (infections, malaria, tuberculosis, HIV)
2 Maternal and perinatal conditions (pregnancy) 3 Nutritional deficiencies
4 Acute conditions (diarrhoea, fever, flu, headaches, cough, other)
5 Injury (not work related, see 8 below)
6 Surgery
7 Sleep problems
8 Occupation/work related condition/injury
9 Chronic pain in your joints/arthritis (joints, back, neck)
10 Diabetes or related complications
11 Problems with your heart including unexplained pain in chest
12 Problems with your mouth, teeth or swallowing
13 Problems with your breathing
14 High blood pressure / hypertension
15 Stroke/sudden paralysis of one side of body 16 Generalized pain (stomach, muscle or other nonspecific pain)
17 Depression or anxiety
18 Cancer
87 Other, specify:
Interviewer: Respondent can select ONLY one main reason for visit. USE SHOWCARD (APPENDIX RESPONSE SCALES)
1
Communicable
2
Maternal
3
Nutrition
4
Acute condition
5
Injury
6
Surgery
7
Sleep probs
8
Occupation
9
Pain in joints
10
Diabetes
11
Probs with heart
12
Probs with mouth
13
Probs with breathing
14
High BP
15
Stroke
16
Generalized pain
17
Depression or anxiety
18
Cancer
87
Other
88
Don't know
98
Not applicable
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Which reason(s) best explains why you did not get health care?
1Could not afford the cost of the visit
2No transport available
3Could not afford the cost of transport
4You were previously badly treated
5Could not take time off work or had other commitments
6The health care provider's drugs or equipment were inadequate
7The health care provider's skills were inadequate
8You did not know where to go
9You tried but were denied health care
10You thought you were not sick enough
87 Other, specify:
Circle all that the respondent indicates
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Which reason(s) best explains why you did not get health care?
1Could not afford the cost of the visit
2No transport available
3Could not afford the cost of transport
4You were previously badly treated
5Could not take time off work or had other commitments
6The health care provider's drugs or equipment were inadequate
7The health care provider's skills were inadequate
8You did not know where to go
9You tried but were denied health care
10You thought you were not sick enough
87 Other, specify:
Circle all that the respondent indicates
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Which reason(s) best explains why you did not get health care?
1Could not afford the cost of the visit
2No transport available
3Could not afford the cost of transport
4You were previously badly treated
5Could not take time off work or had other commitments
6The health care provider's drugs or equipment were inadequate
7The health care provider's skills were inadequate
8You did not know where to go
9You tried but were denied health care
10You thought you were not sick enough
87 Other, specify:
Circle all that the respondent indicates
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Which reason(s) best explains why you did not get health care?
1Could not afford the cost of the visit
2No transport available
3Could not afford the cost of transport
4You were previously badly treated
5Could not take time off work or had other commitments
6The health care provider's drugs or equipment were inadequate
7The health care provider's skills were inadequate
8You did not know where to go
9You tried but were denied health care
10You thought you were not sick enough
87 Other, specify:
Circle all that the respondent indicates
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Which reason(s) best explains why you did not get health care?
1Could not afford the cost of the visit
2No transport available
3Could not afford the cost of transport
4You were previously badly treated
5Could not take time off work or had other commitments
6The health care provider's drugs or equipment were inadequate
7The health care provider's skills were inadequate
8You did not know where to go
9You tried but were denied health care
10You thought you were not sick enough
87 Other, specify:
Circle all that the respondent indicates
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Which reason(s) best explains why you did not get health care?
1Could not afford the cost of the visit
2No transport available
3Could not afford the cost of transport
4You were previously badly treated
5Could not take time off work or had other commitments
6The health care provider's drugs or equipment were inadequate
7The health care provider's skills were inadequate
8You did not know where to go
9You tried but were denied health care
10You thought you were not sick enough
87 Other, specify:
Circle all that the respondent indicates
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Which reason(s) best explains why you did not get health care?
1Could not afford the cost of the visit
2No transport available
3Could not afford the cost of transport
4You were previously badly treated
5Could not take time off work or had other commitments
6The health care provider's drugs or equipment were inadequate
7The health care provider's skills were inadequate
8You did not know where to go
9You tried but were denied health care
10You thought you were not sick enough
87 Other, specify:
Circle all that the respondent indicates
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Which reason(s) best explains why you did not get health care?
1Could not afford the cost of the visit
2No transport available
3Could not afford the cost of transport
4You were previously badly treated
5Could not take time off work or had other commitments
6The health care provider's drugs or equipment were inadequate
7The health care provider's skills were inadequate
8You did not know where to go
9You tried but were denied health care
10You thought you were not sick enough
87 Other, specify:
Circle all that the respondent indicates
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Which reason(s) best explains why you did not get health care?
1Could not afford the cost of the visit
2No transport available
3Could not afford the cost of transport
4You were previously badly treated
5Could not take time off work or had other commitments
6The health care provider's drugs or equipment were inadequate
7The health care provider's skills were inadequate
8You did not know where to go
9You tried but were denied health care
10You thought you were not sick enough
87 Other, specify:
Circle all that the respondent indicates
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Which reason(s) best explains why you did not get health care?
1Could not afford the cost of the visit
2No transport available
3Could not afford the cost of transport
4You were previously badly treated
5Could not take time off work or had other commitments
6The health care provider's drugs or equipment were inadequate
7The health care provider's skills were inadequate
8You did not know where to go
9You tried but were denied health care
10You thought you were not sick enough
87 Other, specify:
Circle all that the respondent indicates
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Q5003b: Reason(s) why not (Y or N)
Which reason(s) best explains why you did not get health care?
1Could not afford the cost of the visit
2No transport available
3Could not afford the cost of transport
4You were previously badly treated
5Could not take time off work or had other commitments
6The health care provider's drugs or equipment were inadequate
7The health care provider's skills were inadequate
8You did not know where to go
9You tried but were denied health care
10You thought you were not sick enough
87 Other, specify:
Circle all that the respondent indicates
Q5004: Where
Q5004: Where
Q5004: Where
Q5004: Where
Q5004: Where
Thinking about health care you needed in the last 3 years, where did you go most often when you felt sick or needed to consult someone about your health?
1Private doctor's office
2Private clinic or health care facility
3Private hospital
4Public clinic or health care facility
5Public hospital
6Charity or church run clinic
7Charity or church run hospital
8Traditional healer [use local term]
9Pharmacy or dispensary
87 Other, specify:
interviewer: Only one answer allowed.
1
Private doctor
2
Private clinic
3
Private hospital
4
Public clinic
5
Public hospital
6
Charity clinic
7
Charity hospital
8
Traditional healer
9
Pharmacy/dispensary
87
Other
88
Don't know
98
Not applicable
Q5005: Overnight stay
Q5005: Overnight stay
Q5005: Overnight stay
Q5005: Overnight stay
Q5005: Overnight stay
inpatient hospital care
The next two questions ask about any overnight stay in a hospital or other health care facility you have had in the last 3 years
In the last 3 years, have you ever stayed overnight in a hospital or long-term care facility?
1Yes, a hospital
2Yes, long term care facility
3Both ( hospital and long term care facility)
4 No .............................Q5026
1
Yes, hospital
2
Yes, long-term care
3
Yes, both
4
No
8
Don't know
9
Not applicable
Q5006: YY ago (n)
Q5006: YY ago (n)
Q5006: YY ago (n)
Q5006: YY ago (n)
Q5006: YY ago (n)
inpatient hospital care
The next two questions ask about any overnight stay in a hospital or other health care facility you have had in the last 3 years
When was the last overnight stay in a hospital or long-term care facility?
88 Don't know
If more than 3 years ago ..........Q5026
INTERVIEWER: If less than one month ago, enter “00” for years and "00" for months.
-9
Not applicable
-8
DK
88
Don't know
98
Not applicable
Q5006: MM ago (n)
Q5006: MM ago (n)
Q5006: MM ago (n)
Q5006: MM ago (n)
Q5006: MM ago (n)
When was the last overnight stay in a hospital or long-term care facility?
88 Don't know
If more than 3 years ago ..........Q5026
INTERVIEWER: If less than one month ago, enter “00” for years and "00" for months.
-9
Not applicable
-8
DK
88
Don't know
98
Not applicable
Q5007: 12-mo. overnight
Q5007: 12-mo. overnight
Q5007: 12-mo. overnight
Q5007: 12-mo. overnight
Q5007: 12-mo. overnight
Now I would like to know about more recent times - if you've had any overnight stays in a hospital or other type of health care facility in the last 12 months
Over the last 12 months, how many different times were you a patient in a hospital/long-term care facility for at least one night?
88 Don't know
If "00" (no overnight stays) …Q5026
-9
NA
-8
DK
88
Don't know
98
Not applicable
Q5008: Type of facility
Q5008: Type of facility
Q5008: Type of facility
Q5008: Type of facility
Q5008: Type of facility
I want to know more about why you needed an overnight stay in a health care facility. Starting with the most recent stay, I want to know more about your overnight stays, including why you needed an overnight stay each time. But first I would like you to come back to thinking about your last overnight hospital stay only.
What type of hospital or facility was it? Remember we are asking now about your last (most recent) overnight stay.
1Public hospital
2Private hospital
3Charity or church-run hospital
4Old person's home or long-term care facility
7 Other, specify:
INTERVIEWER: One answer only.
1
Public hosp
2
Private hosp
3
Charity hosp
4
Old person's home
7
Other
8
Don't know
9
Not applicable
Q5008aa: Hospital/facility name?
Q5008aa: Hospital/facility name?
Q5008aa: Hospital/facility name?
Q5008aa: Hospital/facility name?
Q5008aa: Hospital/facility name?
What was the name of this hospital or facility?
Q5008ab: Hospital/facility code (if available)
Q5008ab: Hospital/facility code (if available)
Q5008ab: Hospital/facility code (if available)
Q5008ab: Hospital/facility code (if available)
Q5008ab: Hospital/facility code (if available)
Hospital or facility code
-9
Not applicable
-8
Don't know
Q5008ac: City/village name in location of hospital/facility?
Q5008ac: City/village name in location of hospital/facility?
Q5008ac: City/village name in location of hospital/facility?
Q5008ac: City/village name in location of hospital/facility?
Q5008ac: City/village name in location of hospital/facility?
What is the name of the city/village where the hospital/facility is located?
Q5008b: Reason for last overnight
Q5008b: Reason for last overnight
Q5008b: Reason for last overnight
Q5008b: Reason for last overnight
Q5008b: Reason for last overnight
Which reason best describes why you were last hospitalised?
1Communicable disease (infections, malaria, tuberculosis, HIV)
2Maternal and perinatal conditions (pregnancy)
3Nutritional deficiencies
4Acute conditions (diarrhoea, fever, flu, headaches, cough, other)
5Injury (not occupation related)
6Surgery
7Sleep problems
8Occupation/work related condition/injury
9 Chronic pain in your joints/arthritis (joints, back, neck)
10Diabetes or related complications
11Problems with your heart including unexplained pain in chest
12Problems with your mouth, teeth or swallowing
13Problems with your breathing
14High blood pressure / hypertension
15Stroke/sudden paralysis of one side of body
16Generalized pain (stomach, muscle or other nonspecific pain)
17Depression or anxiety
18Cancer
87 Other, specify:
Interviewer: Respondent can select only ONE main reason for visit. USE SHOWCARD in APPENDIX.
-9
NA
-8
DK
1
Communicable
2
Maternal
3
Nutrition
4
Acute condition
5
Injury
6
Surgery
7
Sleep probs
8
Occupation
9
Pain in joints
10
Diabetes
11
Probs with heart
12
Probs with mouth
13
Probs with breathing
14
High BP
15
Stroke
16
Generalized pain
17
Depression or anxiety
18
Cancer
87
Other
88
Don't know
98
Not applicable
Q5009: Transport type
Q5009: Transport type
Q5009: Transport type
Q5009: Transport type
Q5009: Transport type
How did you get there?
1Private vehicle
2Public transportation
3Taxicab
4Ambulance or emergency vehicle
5Bicycle
6Walked
8 Don't know
Interviewer: Circle all that the respondent mentions.
Q5009: Transport type
Q5009: Transport type
Q5009: Transport type
Q5009: Transport type
Q5009: Transport type
How did you get there?
1Private vehicle
2Public transportation
3Taxicab
4Ambulance or emergency vehicle
5Bicycle
6Walked
8 Don't know
Interviewer: Circle all that the respondent mentions.
Q5009: Transport type
Q5009: Transport type
Q5009: Transport type
Q5009: Transport type
Q5009: Transport type
How did you get there?
1Private vehicle
2Public transportation
3Taxicab
4Ambulance or emergency vehicle
5Bicycle
6Walked
8 Don't know
Interviewer: Circle all that the respondent mentions.
Q5009: Transport type
Q5009: Transport type
Q5009: Transport type
Q5009: Transport type
Q5009: Transport type
How did you get there?
1Private vehicle
2Public transportation
3Taxicab
4Ambulance or emergency vehicle
5Bicycle
6Walked
8 Don't know
Interviewer: Circle all that the respondent mentions.
Q5009: Transport type
Q5009: Transport type
Q5009: Transport type
Q5009: Transport type
Q5009: Transport type
How did you get there?
1Private vehicle
2Public transportation
3Taxicab
4Ambulance or emergency vehicle
5Bicycle
6Walked
8 Don't know
Interviewer: Circle all that the respondent mentions.
Q5009: Transport type
Q5009: Transport type
Q5009: Transport type
Q5009: Transport type
Q5009: Transport type
How did you get there?
1Private vehicle
2Public transportation
3Taxicab
4Ambulance or emergency vehicle
5Bicycle
6Walked
8 Don't know
Interviewer: Circle all that the respondent mentions.
Q5009: Transport type
Q5009: Transport type
Q5009: Transport type
Q5009: Transport type
Q5009: Transport type
How did you get there?
1Private vehicle
2Public transportation
3Taxicab
4Ambulance or emergency vehicle
5Bicycle
6Walked
8 Don't know
Interviewer: Circle all that the respondent mentions.
Q5009a: Hours
Q5009a: Hours
Q5009a: Hours
Q5009a: Hours
Q5009a: Hours
About how long did it take you to get there?
88 Don't know
-9
NA
-8
DK
Q5009a: Minutes
Q5009a: Minutes
Q5009a: Minutes
Q5009a: Minutes
Q5009a: Minutes
About how long did it take you to get there?
88 Don't know
-9
NA
-8
DK
88
Don't know
Q5009b: City/village started trip from?
Q5009b: City/village started trip from?
Q5009b: City/village started trip from?
Q5009b: City/village started trip from?
Q5009b: City/village started trip from?
How did you get there?
1Private vehicle
2Public transportation
3Taxicab
4Ambulance or emergency vehicle
5Bicycle
6Walked
8 Don't know
Circle all that the respondent mentions.
Q5009c: Location started trip from (home, work, other)?
Q5009c: Location started trip from (home, work, other)?
Q5009c: Location started trip from (home, work, other)?
Q5009c: Location started trip from (home, work, other)?
Q5009c: Location started trip from (home, work, other)?
How did you get there?
1Private vehicle
2Public transportation
3Taxicab
4Ambulance or emergency vehicle
5Bicycle
6Walked
8 Don't know
nterviewer: Circle all that the respondent mentions.
1
Home
2
Work
7
Other
8
Don't know
9
Not applicable
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Who paid for this hospitalisation?
Anyone else?
1Respondent
2Spouse/partner
3Son/daughter
4Other family member
5Non-family member
6Mandatory Insurance scheme
7Voluntary Insurance Scheme
8 Hospitalisation was free .......Q5013
interviewer: Circle all responses. Probe to see if anyone else paid or contributed to paying for the care?
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Who paid for this hospitalisation?
Anyone else?
1Respondent
2Spouse/partner
3Son/daughter
4Other family member
5Non-family member
6Mandatory Insurance scheme
7Voluntary Insurance Scheme
8 Hospitalisation was free .......Q5013
interviewer: Circle all responses. Probe to see if anyone else paid or contributed to paying for the care?
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Who paid for this hospitalisation?
Anyone else?
1Respondent
2Spouse/partner
3Son/daughter
4Other family member
5Non-family member
6Mandatory Insurance scheme
7Voluntary Insurance Scheme
8 Hospitalisation was free .......Q5013
interviewer: Circle all responses. Probe to see if anyone else paid or contributed to paying for the care?
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Who paid for this hospitalisation?
Anyone else?
1Respondent
2Spouse/partner
3Son/daughter
4Other family member
5Non-family member
6Mandatory Insurance scheme
7Voluntary Insurance Scheme
8 Hospitalisation was free .......Q5013
interviewer: Circle all responses. Probe to see if anyone else paid or contributed to paying for the care?
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Who paid for this hospitalisation?
Anyone else?
1Respondent
2Spouse/partner
3Son/daughter
4Other family member
5Non-family member
6Mandatory Insurance scheme
7Voluntary Insurance Scheme
8 Hospitalisation was free .......Q5013
interviewer: Circle all responses. Probe to see if anyone else paid or contributed to paying for the care?
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Who paid for this hospitalisation?
Anyone else?
1Respondent
2Spouse/partner
3Son/daughter
4Other family member
5Non-family member
6Mandatory Insurance scheme
7Voluntary Insurance Scheme
8 Hospitalisation was free .......Q5013
interviewer: Circle all responses. Probe to see if anyone else paid or contributed to paying for the care?
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Who paid for this hospitalisation?
Anyone else?
1Respondent
2Spouse/partner
3Son/daughter
4Other family member
5Non-family member
6Mandatory Insurance scheme
7Voluntary Insurance Scheme
8 Hospitalisation was free .......Q5013
interviewer: Circle all responses. Probe to see if anyone else paid or contributed to paying for the care?
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Q5010: Who paid (single)
Who paid for this hospitalisation?
Anyone else?
1Respondent
2Spouse/partner
3Son/daughter
4Other family member
5Non-family member
6Mandatory Insurance scheme
7Voluntary Insurance Scheme
8 Hospitalisation was free .......Q5013
interviewer: Circle all responses. Probe to see if anyone else paid or contributed to paying for the care?
Q5011a: Health care provider
Q5011a: Health care provider
Q5011a: Health care provider
Q5011a: Health care provider
Q5011a: Health care provider
Thinking about your last [hospital] stay, how much did you or your family/household members pay out-of-pocket for: [Health care provider's] fees
Interviewer: write "0" if the service was free - If a person did not have medicines or tests, enter 99998 for “Not applicable, did not have”.
[use local currency]
-8
DK
Free
Q5011b: Medicines
Q5011b: Medicines
Q5011b: Medicines
Q5011b: Medicines
Q5011b: Medicines
Thinking about your last [hospital] stay, how much did you or your family/household members pay out-of-pocket for: Medicines
Interviewer: write "0" if the service was free - If a person did not have medicines or tests, enter 99998 for “Not applicable, did not have”.
[use local currency]
-8
DK
Free
Q5011c: Tests
Q5011c: Tests
Q5011c: Tests
Q5011c: Tests
Q5011c: Tests
Thinking about your last [hospital] stay, how much did you or your family/household members pay out-of-pocket for: Tests
Interviewer: write "0" if the service was free - If a person did not have medicines or tests, enter 99998 for “Not applicable, did not have”.
[use local currency]
-8
DK
Free
Q5011d: Transport
Q5011d: Transport
Q5011d: Transport
Q5011d: Transport
Q5011d: Transport
Thinking about your last [hospital] stay, how much did you or your family/household members pay out-of-pocket for: Transport
Interviewer: write "0" if the service was free - If a person did not have medicines or tests, enter 99998 for “Not applicable, did not have”.
[use local currency]
-8
DK
Free
Q5011e: Other specify amount
Q5011e: Other specify amount
Q5011e: Other specify amount
Q5011e: Other specify amount
Q5011e: Other specify amount
Thinking about your last [hospital] stay, how much did you or your family/household members pay out-of-pocket for: Other
Interviewer: write "0" if the service was free - If a person did not have medicines or tests, enter 99998 for “Not applicable, did not have”.
[use local currency]
-8
DK
Free
Q5012: Total cost
Q5012: Total cost
Q5012: Total cost
Q5012: Total cost
Q5012: Total cost
About how much in total did you or a family/household member pay out-of-pocket for this hospitalisation?
-9
NA
-8
DK
Free
Q5013: How satisfied
Q5013: How satisfied
Q5013: How satisfied
Q5013: How satisfied
Q5013: How satisfied
Overall, how satisfied were you with the care you received during your last [hospital] stay?
1Very satisfied
2Satisfied
3Neither satisfied nor dissatisfied
4Dissatisfied
5 Very dissatisfied
1
Very satisfied
2
Satisfied
3
Neutral
4
Dissatisfied
5
Very dissatisfied
8
Don't know
9
Not applicable
Q5014: Outcome
Q5014: Outcome
Q5014: Outcome
Q5014: Outcome
Q5014: Outcome
What was the outcome or result of your visit to the [hospital]? Did your condition
1Get much better
2Get better
3No change
4Get worse
5 Get much worse
1
Greatly improve
2
Improve
3
No change
4
Worse
5
Greatly worse
8
Don't know
9
Not applicable
Q5015: Outcome expected
Q5015: Outcome expected
Q5015: Outcome expected
Q5015: Outcome expected
Q5015: Outcome expected
Was this the outcome or result you had expected?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q5016: Second visit - facility type
Q5016: Second visit - facility type
Q5016: Second visit - facility type
Q5016: Second visit - facility type
Q5016: Second visit - facility type
I have asked you many questions about your last overnight stay, but now I want to know about other overnight stays you have had in the last 12 months. Think now of the overnight stay the time before the one you just described to me. This would be your second overnight stay in the last 12 months
What type of hospital or facility was it?
1Public hospital
2Private hospital
3Charity or church-run hospital
4Old person's home or long-term care facility
7 Other, specify:
1
Public hosp
2
Private hosp
3
Charity hosp
4
Old person's home
7
Other
8
Don't know
9
Not applicable
Q5016a: Reason for 2nd overnight
Q5016a: Reason for 2nd overnight
Q5016a: Reason for 2nd overnight
Q5016a: Reason for 2nd overnight
Q5016a: Reason for 2nd overnight
I have asked you many questions about your last overnight stay, but now I want to know about other overnight stays you have had in the last 12 months. Think now of the overnight stay the time before the one you just described to me. This would be your second overnight stay in the last 12 months
Which reason best describes why you were last hospitalised?
1 Communicable disease (infections, malaria, tuberculosis, HIV)
2 Maternal and perinatal conditions (pregnancy) 3 Nutritional deficiencies
4 Acute conditions (diarrhoea, fever, flu, headaches, cough, other)
5 Injury
6 Surgery
7 Sleep problems
8 Occupation/work related condition/injury
9 Chronic pain in your joints/arthritis (joints, back, neck)
10 Diabetes or related complications
11 Problems with your heart including unexplained pain in chest
12 Problems with your mouth, teeth or swallowing
13 Problems with your breathing
14 High blood pressure / hypertension
15 Stroke/sudden paralysis of one side of body 16 Generalized pain (stomach, muscle or other nonspecific pain)
17 Depression or anxiety
18 Cancer
87 Other, specify:
Interviewer: Respondent may select only ONE main reason for visit. USE SHOWCARD in APPENDIX
NTERVIEWER: if only TWO overnight stays in the last 12 months, skip now to Q5018
-9
NA
-8
DK
1
Communicable
2
Maternal
3
Nutrition
4
Acute condition
5
Injury
6
Surgery
7
Sleep probs
8
Occupation
9
Pain in joints
10
Diabetes
11
Probs with heart
12
Probs with mouth
13
Probs with breathing
14
High BP
15
Stroke
16
Generalized pain
17
Depression or anxiety
18
Cancer
87
Other
88
Don't know
98
Not applicable
Q5017: Third visit - facility type
Q5017: Third visit - facility type
Q5017: Third visit - facility type
Q5017: Third visit - facility type
Q5017: Third visit - facility type
And now think of the overnight stay the time before the one you just described to me. This would be your third overnight stay in the last 12 months.
What type of hospital or facility was it?
1Public hospital
2Private hospital
3Charity or church-run hospital
4Old person's home or long-term care facility
7 Other, specify:
1
Public hosp
2
Private hosp
3
Charity hosp
4
Old person's home
7
Other
8
Don't know
9
Not applicable
Q5017a: Reason for 3rd overnight
Q5017a: Reason for 3rd overnight
Q5017a: Reason for 3rd overnight
Q5017a: Reason for 3rd overnight
Q5017a: Reason for 3rd overnight
Which reason best describes why you were last hospitalised?
1 Communicable disease (infections, malaria, tuberculosis, HIV)
2 Maternal and perinatal conditions (pregnancy) 3 Nutritional deficiencies
4 Acute conditions (diarrhoea, fever, flu, headaches, cough, other)
5 Injury
6 Surgery
7 Sleep problems
8 Occupation/work related condition/injury
9 Chronic pain in your joints/arthritis (joints, back, neck)
10 Diabetes or related complications
11 Problems with your heart including unexplained pain in chest
12 Problems with your mouth, teeth or swallowing
13 Problems with your breathing
14 High blood pressure / hypertension
15 Stroke/sudden paralysis of one side of body 16 Generalized pain (stomach, muscle or other nonspecific pain)
17 Depression or anxiety
18 Cancer
87 Other, specify:
Interviewer: Respondent can select only ONE main reason for visit. USE SHOWCARD in APPENDIX.
-9
NA
-8
DK
1
Communicable
2
Maternal
3
Nutrition
4
Acute condition
5
Injury
6
Surgery
7
Sleep probs
8
Occupation
9
Pain in joints
10
Diabetes
11
Probs with heart
12
Probs with mouth
13
Probs with breathing
14
High BP
15
Stroke
16
Generalized pain
17
Depression or anxiety
18
Cancer
87
Other
88
Don't know
98
Not applicable
Q5018: Time waited
Q5018: Time waited
Q5018: Time waited
Q5018: Time waited
Q5018: Time waited
Now I want you to think again about your most recent overnight stay. I would like to ask you about your impressions of your last overnight stay. I would like you to rate your experiences using the following questions.
For your last overnight visit to a hospital or long-term care facility, how would you rate the following:For your last overnight visit to a hospital or long-term care facility, how would you rate the following:
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
INTERVIEWER: Q5025 blank.
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
Q5019: Treated respectfully
Q5019: Treated respectfully
Q5019: Treated respectfully
Q5019: Treated respectfully
Q5019: Treated respectfully
Now I want you to think again about your most recent overnight stay. I would like to ask you about your impressions of your last overnight stay. I would like you to rate your experiences using the following questions.
For your last overnight visit to a hospital or long-term care facility, how would you rate the following:For your last overnight visit to a hospital or long-term care facility, how would you rate the following:
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
INTERVIEWER: Q5025 blank.
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
Q5020: Clear explanations
Q5020: Clear explanations
Q5020: Clear explanations
Q5020: Clear explanations
Q5020: Clear explanations
Now I want you to think again about your most recent overnight stay. I would like to ask you about your impressions of your last overnight stay. I would like you to rate your experiences using the following questions.
For your last overnight visit to a hospital or long-term care facility, how would you rate the following:For your last overnight visit to a hospital or long-term care facility, how would you rate the following:
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
INTERVIEWER: Q5025 blank.
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
Q5021: Involved in decisions
Q5021: Involved in decisions
Q5021: Involved in decisions
Q5021: Involved in decisions
Q5021: Involved in decisions
Now I want you to think again about your most recent overnight stay. I would like to ask you about your impressions of your last overnight stay. I would like you to rate your experiences using the following questions.
For your last overnight visit to a hospital or long-term care facility, how would you rate the following:For your last overnight visit to a hospital or long-term care facility, how would you rate the following:
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
INTERVIEWER: Q5025 blank.
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
Q5022: Talk privately
Q5022: Talk privately
Q5022: Talk privately
Q5022: Talk privately
Q5022: Talk privately
Now I want you to think again about your most recent overnight stay. I would like to ask you about your impressions of your last overnight stay. I would like you to rate your experiences using the following questions.
For your last overnight visit to a hospital or long-term care facility, how would you rate the following:For your last overnight visit to a hospital or long-term care facility, how would you rate the following:
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
INTERVIEWER: Q5025 blank.
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
Q5023: Ease of finding
Q5023: Ease of finding
Q5023: Ease of finding
Q5023: Ease of finding
Q5023: Ease of finding
Now I want you to think again about your most recent overnight stay. I would like to ask you about your impressions of your last overnight stay. I would like you to rate your experiences using the following questions.
For your last overnight visit to a hospital or long-term care facility, how would you rate the following:For your last overnight visit to a hospital or long-term care facility, how would you rate the following:
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
INTERVIEWER: Q5025 blank.
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
Q5024: Cleanliness
Q5024: Cleanliness
Q5024: Cleanliness
Q5024: Cleanliness
Q5024: Cleanliness
Now I want you to think again about your most recent overnight stay. I would like to ask you about your impressions of your last overnight stay. I would like you to rate your experiences using the following questions.
For your last overnight visit to a hospital or long-term care facility, how would you rate the following:For your last overnight visit to a hospital or long-term care facility, how would you rate the following:
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
INTERVIEWER: Q5025 blank.
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
Q5026: Outpatient
Q5026: Outpatient
Q5026: Outpatient
Q5026: Outpatient
Q5026: Outpatient
1
Yes
2
No
8
Don't know
9
Not applicable
Q5027: Times
Q5027: Times
Q5027: Times
Q5027: Times
Q5027: Times
Outpatient care and Care at Home
Now I will shift away from questions about overnight stays - to questions about health care you received that did not include an overnight hospital stay. The following questions are about care you received at a hospital, health centre, clinic, private office or at home from a health care worker, but where you did not stay overnight
In total, how many times did you receive health care or consultation in the last 12 months?
1 Yes
2 No
-9
Not applicable
-8
Don't know
Q5028: Last facility
Q5028: Last facility
Q5028: Last facility
Q5028: Last facility
Q5028: Last facility
Outpatient care and Care at Home
Now I will shift away from questions about overnight stays - to questions about health care you received that did not include an overnight hospital stay. The following questions are about care you received at a hospital, health centre, clinic, private office or at home from a health care worker, but where you did not stay overnight
What was the last (most recent) health care facility you visited in the last 12 months?
1Private doctor's office
2Private clinic or health care facility
3Private hospital
4Public clinic or health care facility
5Public hospital
6Charity or church run clinic
7Charity or church run hospital
8Home visit
87 Other, specify:
nterviewer:
read out responses, circle one option only
1
Private doctor
2
Private clinic
3
Private hospital
4
Public clinic
5
Public hospital
6
Charity clinic
7
Charity hospital
8
Home visit
87
Other
88
Don't know
98
Not applicable
Q5028a: Name of last facility/provider
Q5028a: Name of last facility/provider
Q5028a: Name of last facility/provider
Q5028a: Name of last facility/provider
Q5028a: Name of last facility/provider
What was the name of this health care facility or provider?
Q5029: Provider
Q5029: Provider
Q5029: Provider
Q5029: Provider
Q5029: Provider
Which was the last (most recent) health care provider you visited?
1Medical doctor (including surgeon, gynecologist, psychiatrist, ophthalmologist,…)
2Nurse/Midwife
3Dentist
4Physiotherapist or chiropractor
5Traditional medicine practitioner (use local name)
6Pharmacist, druggist
7Home health care worker
8 Don't know
Interviewer:
After Q5029 substitute the type of health care provider selected by the patient when you see [health care provider] in parentheses
1
Medical doctor
2
Nurse/midwife
3
Dentist
4
Physiotherapist
5
Traditional healer
6
Pharmacist
7
Home health care worker
8
Don't know
9
Not applicable
Q5029a: Sex of provider
Q5029a: Sex of provider
Q5029a: Sex of provider
Q5029a: Sex of provider
Q5029a: Sex of provider
What was the sex of the [health care provider]?
1 Yes
2 No
1
Male
2
Female
Q5029b: Chronic, new, both
Q5029b: Chronic, new, both
Q5029b: Chronic, new, both
Q5029b: Chronic, new, both
Q5029b: Chronic, new, both
Was this visit to [health care provider] for a chronic (ongoing) condition, new condition or both?
1Chronic
2New
3Both
7 Other, specify…
1
Chronic
2
New
3
Both
4
Routine check-up
Q5029c: Reason for last outpt
Q5029c: Reason for last outpt
Q5029c: Reason for last outpt
Q5029c: Reason for last outpt
Q5029c: Reason for last outpt
Which reason best describes why you needed this visit?
1COMMUNICABLE DISEASE (INFECTIONS, MALARIA, TUBERCULOSIS, HIV)
2MATERNAL AND PERINATAL CONDITIONS (PREGNANCY)
3NUTRITIONAL DEFICIENCIES
4ACUTE CONDITIONS (DIARRHOEA, FEVER, FLU, HEADACHES, COUGH, OTHER)
5INJURY
6SURGERY
7SLEEP PROBLEMS
8OCCUPATION/WORK RELATED CONDITION/INJURY
9CHRONIC PAIN IN YOUR JOINTS/ARTHRITIS (JOINTS, BACK, NECK)
10DIABETES OR RELATED COMPLICATIONS
11PROBLEMS WITH YOUR HEART INCLUDING UNEXPLAINED PAIN IN CHEST
12PROBLEMS WITH YOUR MOUTH, TEETH OR SWALLOWING
13PROBLEMS WITH YOUR BREATHING
14HIGH BLOOD PRESSURE / HYPERTENSION
15STROKE/SUDDEN PARALYSIS OF ONE SIDE OF BODY
16GENERALIZED PAIN (STOMACH, MUSCLE OR OTHER NONSPECIFIC PAIN)
17DEPRESSION OR ANXIETY
18CANCER
87 OTHER, SPECIFY:
Respondent can select only ONE main reason for visit. USE SHOWCARD IN APPENDIX
1
Communicable
2
Maternal
3
Nutrition
4
Acute condition
5
Injury
6
Surgery
7
Sleep probs
8
Occupation
9
Pain in joints
10
Diabetes
11
Probs with heart
12
Probs with mouth
13
Probs with breathing
14
High BP
15
Stroke
16
Generalized pain
17
Depression or anxiety
18
Cancer
87
Other
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Thinking about your last visit, how did you get there?
1Private vehicle
2Public transportation
3Taxicab
4Ambulance or emergency vehicle
5Bicycle
6Walked
8 Don't know
9 Not applicable
Circle all that the respondent mentions.
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Thinking about your last visit, how did you get there?
1Private vehicle
2Public transportation
3Taxicab
4Ambulance or emergency vehicle
5Bicycle
6Walked
8 Don't know
9 Not applicable
Circle all that the respondent mentions.
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Thinking about your last visit, how did you get there?
1Private vehicle
2Public transportation
3Taxicab
4Ambulance or emergency vehicle
5Bicycle
6Walked
8 Don't know
9 Not applicable
Circle all that the respondent mentions.
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Thinking about your last visit, how did you get there?
1Private vehicle
2Public transportation
3Taxicab
4Ambulance or emergency vehicle
5Bicycle
6Walked
8 Don't know
9 Not applicable
Circle all that the respondent mentions.
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Thinking about your last visit, how did you get there?
1Private vehicle
2Public transportation
3Taxicab
4Ambulance or emergency vehicle
5Bicycle
6Walked
8 Don't know
9 Not applicable
Circle all that the respondent mentions.
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Thinking about your last visit, how did you get there?
1Private vehicle
2Public transportation
3Taxicab
4Ambulance or emergency vehicle
5Bicycle
6Walked
8 Don't know
9 Not applicable
Circle all that the respondent mentions.
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Thinking about your last visit, how did you get there?
1Private vehicle
2Public transportation
3Taxicab
4Ambulance or emergency vehicle
5Bicycle
6Walked
8 Don't know
9 Not applicable
Circle all that the respondent mentions.
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Q5030: Means of transport (single)
Thinking about your last visit, how did you get there?
1Private vehicle
2Public transportation
3Taxicab
4Ambulance or emergency vehicle
5Bicycle
6Walked
8 Don't know
9 Not applicable
Circle all that the respondent mentions.
Q5031: Time (hours)
Q5031: Time (hours)
Q5031: Time (hours)
Q5031: Time (hours)
Q5031: Time (hours)
About how long did it take you to get there?
-9
NA
-8
DK
Q5031: Time (minutes)
Q5031: Time (minutes)
Q5031: Time (minutes)
Q5031: Time (minutes)
Q5031: Time (minutes)
About how long did it take you to get there?
-9
NA
-8
DK
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Who paid for this most recent visit?
Anyone else?
1Respondent
2Spouse/partner
3Son/daughter
4Other family member
5Non-family member
6Mandatory Insurance Scheme
7Voluntary Insurance Scheme
8 It was free .............Q5034
nterviewer: circle all responses. Probe to see if anyone else paid or contributed to paying for the care?
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Who paid for this most recent visit?
Anyone else?
1Respondent
2Spouse/partner
3Son/daughter
4Other family member
5Non-family member
6Mandatory Insurance Scheme
7Voluntary Insurance Scheme
8 It was free .............Q5034
nterviewer: circle all responses. Probe to see if anyone else paid or contributed to paying for the care?
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Who paid for this most recent visit?
Anyone else?
1Respondent
2Spouse/partner
3Son/daughter
4Other family member
5Non-family member
6Mandatory Insurance Scheme
7Voluntary Insurance Scheme
8 It was free .............Q5034
nterviewer: circle all responses. Probe to see if anyone else paid or contributed to paying for the care?
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Who paid for this most recent visit?
Anyone else?
1Respondent
2Spouse/partner
3Son/daughter
4Other family member
5Non-family member
6Mandatory Insurance Scheme
7Voluntary Insurance Scheme
8 It was free .............Q5034
nterviewer: circle all responses. Probe to see if anyone else paid or contributed to paying for the care?
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Who paid for this most recent visit?
Anyone else?
1Respondent
2Spouse/partner
3Son/daughter
4Other family member
5Non-family member
6Mandatory Insurance Scheme
7Voluntary Insurance Scheme
8 It was free .............Q5034
nterviewer: circle all responses. Probe to see if anyone else paid or contributed to paying for the care?
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Who paid for this most recent visit?
Anyone else?
1Respondent
2Spouse/partner
3Son/daughter
4Other family member
5Non-family member
6Mandatory Insurance Scheme
7Voluntary Insurance Scheme
8 It was free .............Q5034
nterviewer: circle all responses. Probe to see if anyone else paid or contributed to paying for the care?
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Who paid for this most recent visit?
Anyone else?
1Respondent
2Spouse/partner
3Son/daughter
4Other family member
5Non-family member
6Mandatory Insurance Scheme
7Voluntary Insurance Scheme
8 It was free .............Q5034
nterviewer: circle all responses. Probe to see if anyone else paid or contributed to paying for the care?
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Q5032: Who paid? (single)
Who paid for this most recent visit?
Anyone else?
1Respondent
2Spouse/partner
3Son/daughter
4Other family member
5Non-family member
6Mandatory Insurance Scheme
7Voluntary Insurance Scheme
8 It was free .............Q5034
nterviewer: circle all responses. Probe to see if anyone else paid or contributed to paying for the care?
Q5033A: Fees
Q5033A: Fees
Q5033A: Fees
Q5033A: Fees
Q5033A: Fees
Thinking about your last visit, how much did you or your household pay for:a. [Health care provider's] fees
Interviewer: Only write "0" if the service was free. If a person did not have tests or drugs, enter 99998 for “Not applicable, did not have”.
(local currency)
-8
DK
Free
Q5033B: Medicines
Q5033B: Medicines
Q5033B: Medicines
Q5033B: Medicines
Q5033B: Medicines
Thinking about your last visit, how much did you or your household pay for:b. Medicines
Interviewer: Only write "0" if the service was free. If a person did not have tests or drugs, enter 99998 for “Not applicable, did not have”.
(local currency)
-8
DK
Free
Q5033C: Tests
Q5033C: Tests
Q5033C: Tests
Q5033C: Tests
Q5033C: Tests
Thinking about your last visit, how much did you or your household pay for:Tests
Interviewer: Only write "0" if the service was free. If a person did not have tests or drugs, enter 99998 for “Not applicable, did not have”.
(local currency)
-8
DK
Free
Q5033D: Transport
Q5033D: Transport
Q5033D: Transport
Q5033D: Transport
Q5033D: Transport
Thinking about your last visit, how much did you or your household pay for:d. Transport
Interviewer: Only write "0" if the service was free. If a person did not have tests or drugs, enter 99998 for “Not applicable, did not have”.
(local currency)
-8
DK
Free
Q5033E: Other
Q5033E: Other
Q5033E: Other
Q5033E: Other
Q5033E: Other
Thinking about your last visit, how much did you or your household pay for:e. Other
Interviewer: Only write "0" if the service was free. If a person did not have tests or drugs, enter 99998 for “Not applicable, did not have”.
(local currency)
-8
DK
Q5033F: Total costs
Q5033F: Total costs
Q5033F: Total costs
Q5033F: Total costs
Q5033F: Total costs
Thinking about your last visit, how much did you or your household pay for:
F. Total costs
nterviewer: Only write "0" if the service was free. If a person did not have tests or drugs, enter 99998 for “Not applicable, did not have”.
(local currency)
-8
DK
Free
Q5034: Satisfaction
Q5034: Satisfaction
Q5034: Satisfaction
Q5034: Satisfaction
Q5034: Satisfaction
Overall, how satisfied were you with the care you received during your last visit?
1Very satisfied
2Satisfied
3Neither satisfied nor dissatisfied
4Dissatisfied
5 Very dissatisfied
1
Very satisfied
2
Satisfied
3
Neutral
4
Dissatisfied
5
Very dissatisfied
8
Don't know
9
Not applicable
Q5035: Condition
Q5035: Condition
Q5035: Condition
Q5035: Condition
Q5035: Condition
What was the outcome of your visit to the health care provider? Did your condition….?
1Get much better
2Get better
3No change
4Get worse
5 Get much worse
1
Greatly improve
2
Improve
3
No change
4
Worsen
5
Greatly worsen
8
Don't know
9
Not applicable
Q5036: Expected?
Q5036: Expected?
Q5036: Expected?
Q5036: Expected?
Q5036: Expected?
Was this the outcome/result you had expected?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q5037: Provider 2nd
Q5037: Provider 2nd
Q5037: Provider 2nd
Q5037: Provider 2nd
Q5037: Provider 2nd
I will ask you about up to two more encounters/visits with health professionals in addition to the last visit you just described. So could you please tell us now about the visit prior to the last (most recent) visit you just described. This would describe your second to last visit.
Which was the health care provider you visited?
1Medical doctor (including surgeon, gynecologist, psychiatrist, ophthalmologist, etc)
2Nurse/Midwife
3Dentist
4Physiotherapist or chiropractor
5Traditional medicine practitioner (use local name)
6Pharmacist, druggist
7Home health care worker
8 Don't know
Interviewer:
After Q5037 substitute the type of health care provider selected by the patient when you see [health care provider] in parentheses
1
Medical doctor
2
Nurse/midwife
3
Dentist
4
Physiotherapist
5
Traditional healer
6
Pharmacist
7
Home health care worker
8
Don't know
9
Not applicable
Q5037a: Sex of provider
Q5037a: Sex of provider
Q5037a: Sex of provider
Q5037a: Sex of provider
Q5037a: Sex of provider
What was the sex of the [health care provider]?
1 Male
2 Female
1
Male
2
Female
Q5037b: Chronic, new, both
Q5037b: Chronic, new, both
Q5037b: Chronic, new, both
Q5037b: Chronic, new, both
Q5037b: Chronic, new, both
Was this visit to [health care provider] for a chronic (ongoing) condition, new condition or both?
1Chronic
2New
3Both
7 Other, specify
1
Chronic
2
New
3
Both
4
Routine check-up
8
Don't know
9
Not applicable
Q5037c: Reason for 2nd outpt
Q5037c: Reason for 2nd outpt
Q5037c: Reason for 2nd outpt
Q5037c: Reason for 2nd outpt
Q5037c: Reason for 2nd outpt
Which reason best describes why you needed this visit?
1COMMUNICABLE DISEASE (INFECTIONS, MALARIA, TUBERCULOSIS, HIV)
2MATERNAL AND PERINATAL CONDITIONS (PREGNANCY)
3NUTRITIONAL DEFICIENCIES
4ACUTE CONDITIONS (DIARRHOEA, FEVER, FLU, HEADACHES, COUGH, OTHER)
5INJURY
6SURGERY
7SLEEP PROBLEMS
8OCCUPATION/WORK RELATED CONDITION/INJURY
9CHRONIC PAIN IN YOUR JOINTS/ARTHRITIS (JOINTS, BACK, NECK)
10DIABETES OR RELATED COMPLICATIONS
11PROBLEMS WITH YOUR HEART INCLUDING UNEXPLAINED PAIN IN CHEST
12PROBLEMS WITH YOUR MOUTH, TEETH OR SWALLOWING
13PROBLEMS WITH YOUR BREATHING
14HIGH BLOOD PRESSURE / HYPERTENSION
15STROKE/SUDDEN PARALYSIS OF ONE SIDE OF BODY
16GENERALIZED PAIN (STOMACH, MUSCLE OR OTHER NONSPECIFIC PAIN)
17DEPRESSION OR ANXIETY
18CANCER
87 OTHER, SPECIFY:
Interviewer: Respondent may select only ONE main reason for visit. USE SHOWCARD in APPENDIX.
1
Communicable
2
Maternal
3
Nutrition
4
Acute condition
5
Injury
6
Surgery
7
Sleep probs
8
Occupation
9
Pain in joints
10
Diabetes
11
Probs with heart
12
Probs with mouth
13
Probs with breathing
14
High BP
15
Stroke
16
Generalized pain
17
Depression or anxiety
18
Cancer
87
Other
88
Don't know
98
Not applicable
Q5038: Provider 3rd
Q5038: Provider 3rd
Q5038: Provider 3rd
Q5038: Provider 3rd
Q5038: Provider 3rd
And now think of the visit the time before the one you just described to me. This would be your third visit in the last 12 months
Which was the health care provider you visited?
1Medical doctor (including surgeon, gynecologist, psychiatrist, ophthalmologist, etc)
2Nurse/Midwife
3Dentist
4Physiotherapist or chiropractor
5Traditional medicine practitioner (use local name)
6Pharmacist, druggist
7Home health care worker
8 Don't know
INTERVIEWER: if just TWO visits in last 12 months, skip to Q5039.
Interviewer:
After Q5038 substitute the type of health care provider selected by the patient when you see [health care provider] in parentheses
1
Medical doctor
2
Nurse/midwife
3
Dentist
4
Physiotherapist
5
Traditional healer
6
Pharmacist
7
Home health care worker
8
Don't know
9
Not applicable
Q5038a: Sex of provider
Q5038a: Sex of provider
Q5038a: Sex of provider
Q5038a: Sex of provider
Q5038a: Sex of provider
What was the sex of the [health care provider]?
1Male
2 Female
1
Male
2
Female
Q5038b: Chronic, new, both
Q5038b: Chronic, new, both
Q5038b: Chronic, new, both
Q5038b: Chronic, new, both
Q5038b: Chronic, new, both
Was this visit to [health care provider] for a chronic (ongoing) condition, new condition or both?
1Chronic
2New
3Both
7 Other, specify
1
Chronic
2
New
3
Both
4
Routine check-up
8
Don't know
9
Not applicable
Q5038c: Reason for 3rd outpt
Q5038c: Reason for 3rd outpt
Q5038c: Reason for 3rd outpt
Q5038c: Reason for 3rd outpt
Q5038c: Reason for 3rd outpt
Which reason best describes why you needed this visit?
1COMMUNICABLE DISEASE (INFECTIONS, MALARIA, TUBERCULOSIS, HIV)
2MATERNAL AND PERINATAL CONDITIONS (PREGNANCY)
3NUTRITIONAL DEFICIENCIES
4ACUTE CONDITIONS (DIARRHOEA, FEVER, FLU, HEADACHES, COUGH, OTHER)
5INJURY
6SURGERY
7SLEEP PROBLEMS
8OCCUPATION/WORK RELATED CONDITION/INJURY
9CHRONIC PAIN IN YOUR JOINTS/ARTHRITIS (JOINTS, BACK, NECK)
10DIABETES OR RELATED COMPLICATIONS
11PROBLEMS WITH YOUR HEART INCLUDING UNEXPLAINED PAIN IN CHEST
12PROBLEMS WITH YOUR MOUTH, TEETH OR SWALLOWING
13PROBLEMS WITH YOUR BREATHING
14HIGH BLOOD PRESSURE / HYPERTENSION
15STROKE/SUDDEN PARALYSIS OF ONE SIDE OF BODY
16GENERALIZED PAIN (STOMACH, MUSCLE OR OTHER NONSPECIFIC PAIN)
17DEPRESSION OR ANXIETY
18CANCER
87 OTHER, SPECIFY:
Interviewer: Respondent can select only one main reason for visit. USE SHOWCARD in APPENDIX.
1
Communicable
2
Maternal
3
Nutrition
4
Acute condition
5
Injury
6
Surgery
7
Sleep probs
8
Occupation
9
Pain in joints
10
Diabetes
11
Probs with heart
12
Probs with mouth
13
Probs with breathing
14
High BP
15
Stroke
16
Generalized pain
17
Depression or anxiety
18
Cancer
87
Other
88
Don't know
98
Not applicable
Q5039: Time waited
Q5039: Time waited
Q5039: Time waited
Q5039: Time waited
Q5039: Time waited
Now I would like you to think about your most recent visit again. I want to know your impressions of your most recent visit for health care. I would like you to rate your experiences using the following questions
For your last visit to a health care provider, how would you rate the following the amount of time you waited before being attended to?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
Q5040: Treated respectfully
Q5040: Treated respectfully
Q5040: Treated respectfully
Q5040: Treated respectfully
Q5040: Treated respectfully
Now I would like you to think about your most recent visit again. I want to know your impressions of your most recent visit for health care. I would like you to rate your experiences using the following questions
For your last visit to a health care provider, how would you rate the following:your experience of being treated respectfully?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
Q5041: Clear explanations
Q5041: Clear explanations
Q5041: Clear explanations
Q5041: Clear explanations
Q5041: Clear explanations
Now I would like you to think about your most recent visit again. I want to know your impressions of your most recent visit for health care. I would like you to rate your experiences using the following questions
For your last visit to a health care provider, how would you rate the following:how clearly health care providers explained things to you?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
Q5042: Involved in decisions
Q5042: Involved in decisions
Q5042: Involved in decisions
Q5042: Involved in decisions
Q5042: Involved in decisions
Now I would like you to think about your most recent visit again. I want to know your impressions of your most recent visit for health care. I would like you to rate your experiences using the following questions
For your last visit to a health care provider, how would you rate the following: your experience of being involved in making decisions for your treatment?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
Q5043: Talk privately
Q5043: Talk privately
Q5043: Talk privately
Q5043: Talk privately
Q5043: Talk privately
Now I would like you to think about your most recent visit again. I want to know your impressions of your most recent visit for health care. I would like you to rate your experiences using the following questions
For your last visit to a health care provider, how would you rate the following:.the way the health services ensured that you could talk privately to providers?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
Q5044: Ease of finding
Q5044: Ease of finding
Q5044: Ease of finding
Q5044: Ease of finding
Q5044: Ease of finding
Now I would like you to think about your most recent visit again. I want to know your impressions of your most recent visit for health care. I would like you to rate your experiences using the following questions
For your last visit to a health care provider, how would you rate the following:the ease with which you could see a health care provider you were happy with?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
Q5045: Cleanliness
Q5045: Cleanliness
Q5045: Cleanliness
Q5045: Cleanliness
Q5045: Cleanliness
Now I would like you to think about your most recent visit again. I want to know your impressions of your most recent visit for health care. I would like you to rate your experiences using the following questions
For your last visit to a health care provider, how would you rate the following:the cleanliness in the health facility?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
Q5046: Vignette 1
Q5046: Vignette 1
Q5046: Vignette 1
Q5046: Vignette 1
Q5046: Vignette 1
[Stan] broke his leg. It took an hour to be driven to the nearest hospital. He was in pain but had to wait an hour for the surgeon and was only operated on the next day.
How would you rate the amount of time [Stan] waited before being attended to?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
I am now going to read you stories about people's experiences with health care services. I want you to think about these people's experiences as if they were your own. Once I have finished reading each story, I will ask you to rate what happened in the story as very good, good, moderate, bad or very bad.
Q5047: Vignette 2
Q5047: Vignette 2
Q5047: Vignette 2
Q5047: Vignette 2
Q5047: Vignette 2
[Patricia] went to a crowded clinic. No-one greeted her. She waited for 30 minutes when a nurse called for her for an examination behind a screen that separated the waiting area from the examination area.
How would you rate [Patricia's] experience of being greeted and talked to respectfully?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
I am now going to read you stories about people's experiences with health care services. I want you to think about these people's experiences as if they were your own. Once I have finished reading each story, I will ask you to rate what happened in the story as very good, good, moderate, bad or very bad.
Q5048: Vignette 3
Q5048: Vignette 3
Q5048: Vignette 3
Q5048: Vignette 3
Q5048: Vignette 3
[Mario] has been told that he has epilepsy and that he needs to take medication. The doctor has very briefly explained what the condition is. He is very busy and there is a queue of patients waiting to see him. Mario would like to know more about what he has, but feels that there is no time to ask questions. The doctor says goodbye to Mario, and Mario leaves the office.
How would you rate [Mario's] experience of how clearly health care providers explained things to him?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
I am now going to read you stories about people's experiences with health care services. I want you to think about these people's experiences as if they were your own. Once I have finished reading each story, I will ask you to rate what happened in the story as very good, good, moderate, bad or very bad.
Q5049: Vignette 4
Q5049: Vignette 4
Q5049: Vignette 4
Q5049: Vignette 4
Q5049: Vignette 4
[José] shared a hospital room with four other persons. There was a toilet for his ward located along the outside corridor. The room was cleaned once a week, was occasionally dusty, and had only 1 or 2 chairs for visitors.
How would you rate the cleanliness of [José's] room inside the facility and provision for toilets?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
I am now going to read you stories about people's experiences with health care services. I want you to think about these people's experiences as if they were your own. Once I have finished reading each story, I will ask you to rate what happened in the story as very good, good, moderate, bad or very bad.
Q5050: Vignette 5
Q5050: Vignette 5
Q5050: Vignette 5
Q5050: Vignette 5
Q5050: Vignette 5
When the clinic is not busy. [Mamadou] can choose which doctor he sees. But most often it is busy and then he gets sent to whoever is free.
How would you rate [Mamadou's] freedom to choose his health care provider?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
I am now going to read you stories about people's experiences with health care services. I want you to think about these people's experiences as if they were your own. Once I have finished reading each story, I will ask you to rate what happened in the story as very good, good, moderate, bad or very bad.
Q5051: Vignette 6
Q5051: Vignette 6
Q5051: Vignette 6
Q5051: Vignette 6
Q5051: Vignette 6
[Alouine] has his consultation behind a screen separating the consultation area from the waiting area. He has to speak very quietly to avoid other people hearing his conversation.
How would you rate the way the health services ensured [Alouine] could talk privately to the health care providers?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
I am now going to read you stories about people's experiences with health care services. I want you to think about these people's experiences as if they were your own. Once I have finished reading each story, I will ask you to rate what happened in the story as very good, good, moderate, bad or very bad.
Q5052: Vignette 7
Q5052: Vignette 7
Q5052: Vignette 7
Q5052: Vignette 7
Q5052: Vignette 7
[Robert] had a broken arm. The doctor explained different ways of fixing it and then ordered some blood tests. [Robert] didn't know why he needed blood tests and was worried until the doctor explained what they were for.
How would you rate [Robert's] experience of being involved in making decisions about his health care or treatment?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
I am now going to read you stories about people's experiences with health care services. I want you to think about these people's experiences as if they were your own. Once I have finished reading each story, I will ask you to rate what happened in the story as very good, good, moderate, bad or very bad.
Q5053: Satisfaction
Q5053: Satisfaction
Q5053: Satisfaction
Q5053: Satisfaction
Q5053: Satisfaction
We would like to finish this section by asking you two questions about your satisfaction with the health system in your country. If you received health care, think about the health care service(s) you received in the last 12 months when answering the questions.
In general, how satisfied are you with how the health care services are run in your country [in your area] - are you very satisfied, satisfied, neither satisfied nor dissatisfied, fairly dissatisfied, or very dissatisfied?
1Very satisfied
2Satisfied
3Neither satisfied nor dissatisfied
4Dissatisfied
5Very Dissatisfied
1
Very satisfied
2
Satisfied
3
Neutral
4
Dissatisfied
5
Very dissatisfied
8
Don't know
9
Not applicable
Q5054: Health care
Q5054: Health care
Q5054: Health care
Q5054: Health care
Q5054: Health care
How would you rate the way health care in your country involves you in deciding what services it provides and where it provides them?
1Very good
2Good
3Moderate
4Bad
5Very bad
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
S6000: HH begin
S6000: HH begin
S6000: HH begin
S6000: HH begin
S6000: HH begin
S6000: MM begin
S6000: MM begin
S6000: MM begin
S6000: MM begin
S6000: MM begin
S6000: HH end
S6000: HH end
S6000: HH end
S6000: HH end
S6000: HH end
S6000: MM end
S6000: MM end
S6000: MM end
S6000: MM end
S6000: MM end
Q6001: Public meeting
Q6001: Public meeting
Q6001: Public meeting
Q6001: Public meeting
Q6001: Public meeting
We would like to shift away from questions about your direct health. This section of the survey asks your opinions about other areas and issues in your life. The following questions are to get your opinions about community, social and political aspects in your life.
We'd like to know about some of your involvement in your community. For all of these, I want you just to give me your best guess.
How often in the last 12 months have you attended any public meeting in which there was discussion of local or school affairs?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
Never
2
1/2x per yr
3
1/2x per mo
4
1/2x per wk
5
Daily
8
Don't know
9
Not applicable
Q6002: Meet leader
Q6002: Meet leader
Q6002: Meet leader
Q6002: Meet leader
Q6002: Meet leader
We would like to shift away from questions about your direct health. This section of the survey asks your opinions about other areas and issues in your life. The following questions are to get your opinions about community, social and political aspects in your life.
We'd like to know about some of your involvement in your community. For all of these, I want you just to give me your best guess.
How often in the last 12 months have you met personally with someone you consider to be a community leader?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
Never
2
1/2x per yr
3
1/2x per mo
4
1/2x per wk
5
Daily
8
Don't know
9
Not applicable
Q6003: Club
Q6003: Club
Q6003: Club
Q6003: Club
Q6003: Club
We would like to shift away from questions about your direct health. This section of the survey asks your opinions about other areas and issues in your life. The following questions are to get your opinions about community, social and political aspects in your life.
We'd like to know about some of your involvement in your community. For all of these, I want you just to give me your best guess.
How often in the last 12 months have you attended any group, club, society, union or organizational meeting?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
Never
2
1/2x per yr
3
1/2x per mo
4
1/2x per wk
5
Daily
8
Don't know
9
Not applicable
Q6004: Neighborhood
Q6004: Neighborhood
Q6004: Neighborhood
Q6004: Neighborhood
Q6004: Neighborhood
We would like to shift away from questions about your direct health. This section of the survey asks your opinions about other areas and issues in your life. The following questions are to get your opinions about community, social and political aspects in your life.
We'd like to know about some of your involvement in your community. For all of these, I want you just to give me your best guess.
How often in the last 12 months have you worked with other people in your neighborhood to fix or improve something?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
Never
2
1/2x per yr
3
1/2x per mo
4
1/2x per wk
5
Daily
8
Don't know
9
Not applicable
Q6005: Friends
Q6005: Friends
Q6005: Friends
Q6005: Friends
Q6005: Friends
We would like to shift away from questions about your direct health. This section of the survey asks your opinions about other areas and issues in your life. The following questions are to get your opinions about community, social and political aspects in your life.
We'd like to know about some of your involvement in your community. For all of these, I want you just to give me your best guess.
How often in the last 12 months have you had friends over to your home?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
Never
2
1/2x per yr
3
1/2x per mo
4
1/2x per wk
5
Daily
8
Don't know
9
Not applicable
Q6006: In other home
Q6006: In other home
Q6006: In other home
Q6006: In other home
Q6006: In other home
We would like to shift away from questions about your direct health. This section of the survey asks your opinions about other areas and issues in your life. The following questions are to get your opinions about community, social and political aspects in your life.
We'd like to know about some of your involvement in your community. For all of these, I want you just to give me your best guess.
How often in the last 12 months have you been in the home of someone who lives in a different neighbourhood than you do or had them in your home?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
Never
2
1/2x per yr
3
1/2x per mo
4
1/2x per wk
5
Daily
8
Don't know
9
Not applicable
Q6007: Coworkers
Q6007: Coworkers
Q6007: Coworkers
Q6007: Coworkers
Q6007: Coworkers
We would like to shift away from questions about your direct health. This section of the survey asks your opinions about other areas and issues in your life. The following questions are to get your opinions about community, social and political aspects in your life.
We'd like to know about some of your involvement in your community. For all of these, I want you just to give me your best guess.
How often in the last 12 months have you socialized with coworkers outside of work?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
Never
2
1/2x per yr
3
1/2x per mo
4
1/2x per wk
5
Daily
8
Don't know
9
Not applicable
Q6008: Religious services
Q6008: Religious services
Q6008: Religious services
Q6008: Religious services
Q6008: Religious services
We would like to shift away from questions about your direct health. This section of the survey asks your opinions about other areas and issues in your life. The following questions are to get your opinions about community, social and political aspects in your life.
We'd like to know about some of your involvement in your community. For all of these, I want you just to give me your best guess.
How often in the last 12 months have you attended religious services (not including weddings and funerals)?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
Never
2
1/2x per yr
3
1/2x per mo
4
1/2x per wk
5
Daily
8
Don't know
9
Not applicable
Q6009: How often go out?
Q6009: How often go out?
Q6009: How often go out?
Q6009: How often go out?
Q6009: How often go out?
We would like to shift away from questions about your direct health. This section of the survey asks your opinions about other areas and issues in your life. The following questions are to get your opinions about community, social and political aspects in your life.
We'd like to know about some of your involvement in your community. For all of these, I want you just to give me your best guess.
How often in the last 12 months have you gotten out of the house/your dwelling to attend social meetings, activities, programs or events or to visit friends or relatives?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
Never
2
1/2x per yr
3
1/2x per mo
4
1/2x per wk
5
Daily
8
Don't know
9
Not applicable
Q6010: Want to get out more?
Q6010: Want to get out more?
Q6010: Want to get out more?
Q6010: Want to get out more?
Q6010: Want to get out more?
Would you like to go out more often or are you satisfied with how much you get out of the house?
1Would like to go out more often
2Satisfied with frequency of going out ..........Q6012
Would NOT like to go out more often .........Q6012
1
Go out more
2
Satisfied
3
Go out less
8
Don't know
9
Not applicable
Q6011: Why not?
Q6011: Why not?
Q6011: Why not?
Q6011: Why not?
Q6011: Why not?
What is the main reason that you don't get out more?
1Health problems
2Safety or security concerns
3Other non-health related reasons
87 Other, specify
1
Health
2
Non-health reason
3
Safety/security concerns
7
Other, specify
8
Don't know
9
Not applicable
Q6012: General trust
Q6012: General trust
Q6012: General trust
Q6012: General trust
Q6012: General trust
Generally speaking, would you say that most people can be trusted or that you can't be too careful in dealing with people?
1Can be trusted
Can't be too careful
1
Can be trusted
2
Can't be trusted
8
Don't know
9
Not applicable
Q6013: Have someone to trust
Q6013: Have someone to trust
Q6013: Have someone to trust
Q6013: Have someone to trust
Q6013: Have someone to trust
Do you have someone you can trust and confide in?
1Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q6014: Neighbors
Q6014: Neighbors
Q6014: Neighbors
Q6014: Neighbors
Q6014: Neighbors
First, think about people in your neighbourhood. Generally speaking, would you say that you can trust them…?
1 To a very great extent
2 To a great extent
3 Neither great nor small extent
4 To a small extent
5 To a very small extent
1
A lot
2
Some
3
Neither
4
A little
5
Not at all
8
Don't know
9
Not applicable
Q6015: Coworkers
Q6015: Coworkers
Q6015: Coworkers
Q6015: Coworkers
Q6015: Coworkers
Now, think about people whom you work with. Generally speaking, would you say that you can trust them …?
1 To a very great extent
2 To a great extent
3 Neither great nor small extent
4 To a small extent
5 To a very small extent
1
A lot
2
Some
3
Neither
4
A little
5
Not at all
8
Don't know
9
Not applicable
Q6016: Strangers
Q6016: Strangers
Q6016: Strangers
Q6016: Strangers
Q6016: Strangers
And how about strangers? Generally speaking, would you say that you can trust them …?
1 To a very great extent
2 To a great extent
3 Neither great nor small extent
4 To a small extent
5 To a very small extent
1
A lot
2
Some
3
Neither
4
A little
5
Not at all
8
Don't know
9
Not applicable
Q6017: Safe at home
Q6017: Safe at home
Q6017: Safe at home
Q6017: Safe at home
Q6017: Safe at home
In general, how safe from crime and violence do you feel when you are alone at home?
1Completely safe
2Very safe
3Moderately safe
4Slightly safe
5 Not safe at all
1
Completely safe
2
Very safe
3
Moderately safe
4
Slightly safe
5
Not safe at all
8
Don't know
9
Not applicable
Q6018: Safe on street
Q6018: Safe on street
Q6018: Safe on street
Q6018: Safe on street
Q6018: Safe on street
How safe do you feel when walking down your street alone after dark?
1Completely safe
2Very safe
3Moderately safe
4Slightly safe
5 Not safe at all
1
Completely safe
2
Very safe
3
Moderately safe
4
Slightly safe
5
Not safe at all
8
Don't know
9
Not applicable
Q6019: Victim
Q6019: Victim
Q6019: Victim
Q6019: Victim
Q6019: Victim
In the last 12 months, have you or anyone in your household been the victim of a violent crime, such as assault or mugging?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q6020: Interest
Q6020: Interest
Q6020: Interest
Q6020: Interest
Q6020: Interest
Last, we would like to know about your level of interest in local or national politics and your opinions about how the government responds to issues that interest you. Remember, all responses are confidential.
How interested would you say you are in politics and national affairs? Would you say you are …..?
Read responses
1Very interested
2Interested
3Neither interested nor uninterested
4Uninterested
5 Very uninterested
1
Very interested
2
Somewhat interested
3
neither
4
Only slightly interested
5
Not at all
8
Don't know
9
Not applicable
Q6021: Voted
Q6021: Voted
Q6021: Voted
Q6021: Voted
Q6021: Voted
Lots of people find it difficult to get out and vote. Did you vote in the last state/national/presidential election?
1Yes
2No
9 Refusal
1
Yes
2
No
8
Don't know
9
Refusal
Q6022: Say in govt
Q6022: Say in govt
Q6022: Say in govt
Q6022: Say in govt
Q6022: Say in govt
How much say do you have in getting the government to address issues that interest you?
1Unlimited say
2A lot of say
3Some say
4Little say
5 No say at all
1
Unlimited say
2
A lot of say
3
Some say
4
Little say
5
No say at all
8
Don't know
9
Not applicable
Q6023: Express yrself freely
Q6023: Express yrself freely
Q6023: Express yrself freely
Q6023: Express yrself freely
Q6023: Express yrself freely
How free do you think you are to express yourself without fear of government reprisal?
1Completely free
2Very free
3Moderately free
4Slightly free
5 Not free at all
1
Completely free
2
Very free
3
Moderately free
4
Slightly free
5
Not free at all
8
Don't know
9
Not applicable
S7000: HH begin
S7000: HH begin
S7000: HH begin
S7000: HH begin
S7000: HH begin
S7000: MM begin
S7000: MM begin
S7000: MM begin
S7000: MM begin
S7000: MM begin
S7000: HH end
S7000: HH end
S7000: HH end
S7000: HH end
S7000: HH end
S7000: MM end
S7000: MM end
S7000: MM end
S7000: MM end
S7000: MM end
Q7001: Enough energy
Q7001: Enough energy
Q7001: Enough energy
Q7001: Enough energy
Q7001: Enough energy
Now, we'd like to ask for your thoughts about your life and life situation. We want to know how you feel about your health and quality of life.
Do you have enough energy for everyday life?
1Completely
2Mostly
3Moderately
4A little
5 None at all
1
Completely
2
Mostly
3
Moderately
4
A little
5
Not at all
8
Don't know
9
Not applicable
Q7002: Enough money
Q7002: Enough money
Q7002: Enough money
Q7002: Enough money
Q7002: Enough money
Now, we'd like to ask for your thoughts about your life and life situation. We want to know how you feel about your health and quality of life.
Do you have enough money to meet your needs?
1Completely
2Mostly
3Moderately
4A little
5 None at all
1
Completely
2
Mostly
3
Moderately
4
A little
5
Not at all
8
Don't know
9
Not applicable
Q7003: Health
Q7003: Health
Q7003: Health
Q7003: Health
Q7003: Health
Please tell us how satisfied you are with the following issues.
How satisfied are you with your health?
1 VERY SATISFIED
2 SATISFIED
3 NEITHER SATISFIED NOR DISSATISFIED
4 DISSATISFIED
5 VERY DISSATISFIED
1
Very satisfied
2
Satisfied
3
Neutral
4
Dissatisfied
5
Very dissatisfied
8
Don't know
9
Not applicable
Q7004: Yourself
Q7004: Yourself
Q7004: Yourself
Q7004: Yourself
Q7004: Yourself
Please tell us how satisfied you are with the following issues.
How satisfied are you with yourself?
1 VERY SATISFIED
2 SATISFIED
3 NEITHER SATISFIED NOR DISSATISFIED
4 DISSATISFIED
5 VERY DISSATISFIED
1
Very satisfied
2
Satisfied
3
Neutral
4
Dissatisfied
5
Very dissatisfied
8
Don't know
9
Not applicable
Q7005: DD-to-DD
Q7005: DD-to-DD
Q7005: DD-to-DD
Q7005: DD-to-DD
Q7005: DD-to-DD
Please tell us how satisfied you are with the following issues.
How satisfied are you with your ability to perform your daily living activities?
1 VERY SATISFIED
2 SATISFIED
3 NEITHER SATISFIED NOR DISSATISFIED
4 DISSATISFIED
5 VERY DISSATISFIED
1
Very satisfied
2
Satisfied
3
Neutral
4
Dissatisfied
5
Very dissatisfied
8
Don't know
9
Not applicable
Q7006: Personal
Q7006: Personal
Q7006: Personal
Q7006: Personal
Q7006: Personal
Please tell us how satisfied you are with the following issues.
How satisfied are you with your personal relationships?
1 VERY SATISFIED
2 SATISFIED
3 NEITHER SATISFIED NOR DISSATISFIED
4 DISSATISFIED
5 VERY DISSATISFIED
1
Very satisfied
2
Satisfied
3
Neutral
4
Dissatisfied
5
Very dissatisfied
8
Don't know
9
Not applicable
Q7007: Living conditions
Q7007: Living conditions
Q7007: Living conditions
Q7007: Living conditions
Q7007: Living conditions
Please tell us how satisfied you are with the following issues.
How satisfied are you with the conditions of your living place?
1 VERY SATISFIED
2 SATISFIED
3 NEITHER SATISFIED NOR DISSATISFIED
4 DISSATISFIED
5 VERY DISSATISFIED
1
Very satisfied
2
Satisfied
3
Neutral
4
Dissatisfied
5
Very dissatisfied
8
Don't know
9
Not applicable
Q7008: How satisfied with life
Q7008: How satisfied with life
Q7008: How satisfied with life
Q7008: How satisfied with life
Q7008: How satisfied with life
Please tell us how satisfied you are with the following issues.
How satisfied are you with Taking all things together, how satisfied are you with your life as a whole these days?
1 VERY SATISFIED
2 SATISFIED
3 NEITHER SATISFIED NOR DISSATISFIED
4 DISSATISFIED
5 VERY DISSATISFIED
1
Very satisfied
2
Satisfied
3
Neutral
4
Dissatisfied
5
Very dissatisfied
8
Don't know
9
Not applicable
Q7008a: Control
Q7008a: Control
Q7008a: Control
Q7008a: Control
Q7008a: Control
How often have you felt that you were unable to control the important things in your life?
Read responses
1Never
2Almost never
3Sometimes
4Fairly often
5 Very often
1
Never
2
Almost never
3
Sometimes
4
Fairly often
5
Very often
8
Don't know
9
Not applicable
Q7008b: Coping
Q7008b: Coping
Q7008b: Coping
Q7008b: Coping
Q7008b: Coping
How often have you found that you could not cope with all the things that you had to do?
Read responses
1Never
2Almost never
3Sometimes
4Fairly often
5 Very often
1
Never
2
Almost never
3
Sometimes
4
Fairly often
5
Very often
8
Don't know
9
Not applicable
Q7009: Overall QoL
Q7009: Overall QoL
Q7009: Overall QoL
Q7009: Overall QoL
Q7009: Overall QoL
How would you rate your overall quality of life?
Read responses
1Very Good
2Good
3Moderate
4Bad
5Very Bad
8 Don't Know
1
Very good`
2
good
3
moderate
4
bad
5
Very bad
8
Don't know
9
Not applicable
Q7010: Happiness level
Q7010: Happiness level
Q7010: Happiness level
Q7010: Happiness level
Q7010: Happiness level
Taking all things together, how would you say you are these days? Are you…?
Read responses
1Very Good
2Good
3Moderate
4Bad
5Very Bad
8 Don't Know
1
Very happy
2
Happy
3
Neither
4
Unhappy
5
Very unhappy
8
Don't know
9
Not applicable
Q7500: Time activity ended (HH)
Q7500: Time activity ended (HH)
Q7500: Time activity ended (HH)
Q7500: Time activity ended (HH)
Q7500: Time activity ended (HH)
Q7500: Time activity ended (mm)
Q7500: Time activity ended (mm)
Q7500: Time activity ended (mm)
Q7500: Time activity ended (mm)
Q7500: Time activity ended (mm)
Q7501: Worried
Q7501: Worried
Q7501: Worried
Q7501: Worried
Q7501: Worried
I will now ask you some questions about how you felt yesterday overall.
Looking at the whole day (morning, afternoon, AND evening), please tell me whether you had these feelings for much of the day. Please just answer “yes” or “no”.
Did you feel …worried… for much of the day yesterday? Yes or no
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q7502: Rushed
Q7502: Rushed
Q7502: Rushed
Q7502: Rushed
Q7502: Rushed
I will now ask you some questions about how you felt yesterday overall.
Looking at the whole day (morning, afternoon, AND evening), please tell me whether you had these feelings for much of the day. Please just answer “yes” or “no”.
Did you feel …rushed… for much of the day yesterday? Yes or no.
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q7503: Irritated/angry
Q7503: Irritated/angry
Q7503: Irritated/angry
Q7503: Irritated/angry
Q7503: Irritated/angry
I will now ask you some questions about how you felt yesterday overall.
Looking at the whole day (morning, afternoon, AND evening), please tell me whether you had these feelings for much of the day. Please just answer “yes” or “no”.
Did you feel …irritated or angry…for much of the day yesterday?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q7504: Depressed
Q7504: Depressed
Q7504: Depressed
Q7504: Depressed
Q7504: Depressed
I will now ask you some questions about how you felt yesterday overall.
Looking at the whole day (morning, afternoon, AND evening), please tell me whether you had these feelings for much of the day. Please just answer “yes” or “no”.
Did you feel …depressed…?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q7505: Tense/stressed
Q7505: Tense/stressed
Q7505: Tense/stressed
Q7505: Tense/stressed
Q7505: Tense/stressed
I will now ask you some questions about how you felt yesterday overall.
Looking at the whole day (morning, afternoon, AND evening), please tell me whether you had these feelings for much of the day. Please just answer “yes” or “no”.
Did you feel …tense or stressed……for much of the day yesterday?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q7506: Calm/relaxed
Q7506: Calm/relaxed
Q7506: Calm/relaxed
Q7506: Calm/relaxed
Q7506: Calm/relaxed
I will now ask you some questions about how you felt yesterday overall.
Looking at the whole day (morning, afternoon, AND evening), please tell me whether you had these feelings for much of the day. Please just answer “yes” or “no”.
Did you feel …calm or relaxed…?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q7507: Enjoyment
Q7507: Enjoyment
Q7507: Enjoyment
Q7507: Enjoyment
Q7507: Enjoyment
I will now ask you some questions about how you felt yesterday overall.
Looking at the whole day (morning, afternoon, AND evening), please tell me whether you had these feelings for much of the day. Please just answer “yes” or “no”.
Were you enjoying what you were doing for much of the day yesterday?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q7508: Lonely
Q7508: Lonely
Q7508: Lonely
Q7508: Lonely
Q7508: Lonely
I will now ask you some questions about how you felt yesterday overall.
Looking at the whole day (morning, afternoon, AND evening), please tell me whether you had these feelings for much of the day. Please just answer “yes” or “no”.
Did you feel …lonely … for much of the day yesterday?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q7509: Bored
Q7509: Bored
Q7509: Bored
Q7509: Bored
Q7509: Bored
I will now ask you some questions about how you felt yesterday overall.
Looking at the whole day (morning, afternoon, AND evening), please tell me whether you had these feelings for much of the day. Please just answer “yes” or “no”.
Did you feel … bored …?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q7510: Physical pain
Q7510: Physical pain
Q7510: Physical pain
Q7510: Physical pain
Q7510: Physical pain
I will now ask you some questions about how you felt yesterday overall.
Looking at the whole day (morning, afternoon, AND evening), please tell me whether you had these feelings for much of the day. Please just answer “yes” or “no”.
Did you feel …physical pain… for much of the day yesterday?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q7511: Sleepiness
Q7511: Sleepiness
Q7511: Sleepiness
Q7511: Sleepiness
Q7511: Sleepiness
I will now ask you some questions about how you felt yesterday overall.
Looking at the whole day (morning, afternoon, AND evening), please tell me whether you had these feelings for much of the day. Please just answer “yes” or “no”.
Did you feel …sleepiness…?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q7512: Stomach-ache
Q7512: Stomach-ache
Q7512: Stomach-ache
Q7512: Stomach-ache
Q7512: Stomach-ache
I will now ask you some questions about how you felt yesterday overall.
Looking at the whole day (morning, afternoon, AND evening), please tell me whether you had these feelings for much of the day. Please just answer “yes” or “no”.
Did you have a stomach ache at any time yesterday?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q7513: Headache
Q7513: Headache
Q7513: Headache
Q7513: Headache
Q7513: Headache
I will now ask you some questions about how you felt yesterday overall.
Looking at the whole day (morning, afternoon, AND evening), please tell me whether you had these feelings for much of the day. Please just answer “yes” or “no”.
Did you have a headache at any time yesterday?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q7514: Smile or laugh
Q7514: Smile or laugh
Q7514: Smile or laugh
Q7514: Smile or laugh
Q7514: Smile or laugh
I will now ask you some questions about how you felt yesterday overall.
Looking at the whole day (morning, afternoon, AND evening), please tell me whether you had these feelings for much of the day. Please just answer “yes” or “no”.
Did you smile or laugh a lot yesterday?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q7515: Part of day enjoyed most
Q7515: Part of day enjoyed most
Q7515: Part of day enjoyed most
Q7515: Part of day enjoyed most
Q7515: Part of day enjoyed most
What part of the day did you enjoy most yesterday? Was it the morning, the afternoon, or the evening?
1Morning
2Afternoon
3 Evening
1
Morning
2
Afternoon
3
Evening
8
Don't know
9
Not applicable
Q7516: Free time
Q7516: Free time
Q7516: Free time
Q7516: Free time
Q7516: Free time
Compared to a typical morning, how much free time did you have yesterday morning? Was yesterday typical, or did you have more free time yesterday morning, or did you have less free time yesterday morning?
1More Free Time
2Typical
3 Less Free Time
1
More
2
Typical
3
Less
8
Don't know
9
Not applicable
Q7517: Mood
Q7517: Mood
Q7517: Mood
Q7517: Mood
Q7517: Mood
Compared to a typical morning, how was your mood yesterday morning? Was it typical, or were you in a better mood yesterday morning, or were you in a worse mood yesterday morning?
1Better Mood
2Typical
3Worse Mood
1
Better
2
Typical
3
Worse
8
Don't know
9
Not applicable
Q7518: Sleep (HH)
Q7518: Sleep (HH)
Q7518: Sleep (HH)
Q7518: Sleep (HH)
Q7518: Sleep (HH)
How many hours did you sleep last night?
Hours : Minutes
8888 Don't remember
-9
Not applicable
-8
Don't know
88
Don't know
Q7518: Sleep (MM)
Q7518: Sleep (MM)
Q7518: Sleep (MM)
Q7518: Sleep (MM)
Q7518: Sleep (MM)
How many hours did you sleep last night?
Hours : Minutes
8888 Don't remember
-9
Not applicable
-8
Don't know
88
Don't know
Q7519: Quality of sleep last night
Q7519: Quality of sleep last night
Q7519: Quality of sleep last night
Q7519: Quality of sleep last night
Q7519: Quality of sleep last night
Please rate the quality of your sleep last night. Was it very good, good, moderate, poor or very poor?
Very good
2 Good
3 Moderate
4 Poor
5 Very poor
1
Very good
2
Good
3
Moderate
4
Poor
5
Very poor
8
Don't know
9
Not applicable
Q7520: Sleep (HH)
Q7520: Sleep (HH)
Q7520: Sleep (HH)
Q7520: Sleep (HH)
Q7520: Sleep (HH)
How many hours did you sleep the night before last?
Hours : Minutes
8888 Don't remember
-9
Not applicable
-8
Don't know
88
Don't know
Q7520: Sleep (MM)
Q7520: Sleep (MM)
Q7520: Sleep (MM)
Q7520: Sleep (MM)
Q7520: Sleep (MM)
How many hours did you sleep the night before last?
Hours : Minutes
8888 Don't remember
-9
Not applicable
-8
Don't know
88
Don't know
Q7521: Quality of sleep nite b4 last
Q7521: Quality of sleep nite b4 last
Q7521: Quality of sleep nite b4 last
Q7521: Quality of sleep nite b4 last
Q7521: Quality of sleep nite b4 last
Please rate the quality of your sleep the night before last. Was it very good, good, moderate, poor or very poor?
Very good
2 Good
3 Moderate
4 Poor
5 Very poor
1
Very good
2
Good
3
Moderate
4
Poor
5
Very poor
8
Don't know
9
Not applicable
Q7522: Who is happier?
Q7522: Who is happier?
Q7522: Who is happier?
Q7522: Who is happier?
Q7522: Who is happier?
Who do you think are happier, men or women? Or are they equally happy?
1Men
2Women
3Equally Happy
1
Men
2
Women
3
Equally happy
8
Don't know
9
Not applicable
Q7523: Who has more free time?
Q7523: Who has more free time?
Q7523: Who has more free time?
Q7523: Who has more free time?
Q7523: Who has more free time?
Who do you think has more free time, men or women? Or do they have equal amounts of free time?
1Men
2Women
3Equal Amounts of free time
1
Men
2
Women
3
Equal time
8
Don't know
9
Not applicable
Q7524: Mood better/worse
Q7524: Mood better/worse
Q7524: Mood better/worse
Q7524: Mood better/worse
Q7524: Mood better/worse
Now I will ask you to compare yourself to other people your age who live in this area
Are you usually in a better mood or a worse mood than most others? Or are you about the same?
1Better Mood
2Same Mood
3 Worse Mood
1
Better
2
Same
3
Worse
8
Don't know
9
Not applicable
Q7525: More/less free time
Q7525: More/less free time
Q7525: More/less free time
Q7525: More/less free time
Q7525: More/less free time
Now I will ask you to compare yourself to other people your age who live in this area
Do you have more free time or less free time than most others? Or do you have about the same?
1More Free Time
2Same Amount of Free Time
3 Less Free Time
1
More
2
Same
3
Less
8
Don't know
9
Not applicable
Q7526: More/less anxious
Q7526: More/less anxious
Q7526: More/less anxious
Q7526: More/less anxious
Q7526: More/less anxious
Now I will ask you to compare yourself to other people your age who live in this area
Are you more anxious or less anxious than most others? Or are you about the same?
More Anxious
2 Same level
3 Less Anxious
1
More anxious
2
Same anxiety
3
Less anxious
8
Don't know
9
Not applicable
Q7527: More/less healthy
Q7527: More/less healthy
Q7527: More/less healthy
Q7527: More/less healthy
Q7527: More/less healthy
Now I will ask you to compare yourself to other people your age who live in this area
Are you more healthy or less healthy than most others? Or are you about the same?
1 More Healthy
2 Same level of health
3 Less Healthy
1
Healthier
2
Same health
3
Less healthy
8
Don't know
9
Not applicable
Q7528: Admit sadness
Q7528: Admit sadness
Q7528: Admit sadness
Q7528: Admit sadness
Q7528: Admit sadness
We will be interviewing many people in this area. We will ask them all about how happy they are. Some people will be sad but they may not tell us they are sad because they are shy or embarrassed.
Do you think that most people who are sad will tell us they are sad?
1Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
Q7529: Most people sad/not sad
Q7529: Most people sad/not sad
Q7529: Most people sad/not sad
Q7529: Most people sad/not sad
Q7529: Most people sad/not sad
We will be interviewing many people in this area. We will ask them all about how happy they are. Some people will be sad but they may not tell us they are sad because they are shy or embarrassed.
Overall, are most people in this area who are about your age happy or sad?
1Most are Happy
2 Most are Sad
1
Most happy
2
Most sad
8
Don't know
9
Not applicable
Q7530: Intelligence/happiness
Q7530: Intelligence/happiness
Q7530: Intelligence/happiness
Q7530: Intelligence/happiness
Q7530: Intelligence/happiness
We will be interviewing many people in this area. We will ask them all about how happy they are. Some people will be sad but they may not tell us they are sad because they are shy or embarrassed.
Now, imagine that you had a newly born grandson, what would you hope for that boy? Would it be more important that he be more intelligent than other boys, or happier than other boys?
1More Intelligent
2Happier
1
More intelligent
2
Happier
8
Don't know
9
Not applicable
Q7531: Time awareness (1)
Q7531: Time awareness (1)
Q7531: Time awareness (1)
Q7531: Time awareness (1)
Q7531: Time awareness (1)
Finally, I will ask you a few questions about how you keep track of time during the day.
During a typical day, do you usually know what time it is? How often do you know what time it is: never, sometimes, mostly, or always?
1Never
2Sometimes
3Mostly
4 Always
1
Never
2
Sometimes
3
Mostly
4
Always
8
Don't know
9
Not applicable
Q7532: Wear watch
Q7532: Wear watch
Q7532: Wear watch
Q7532: Wear watch
Q7532: Wear watch
Finally, I will ask you a few questions about how you keep track of time during the day.
Do you usually wear a watch or something else that tells you the time?
1Yes
2No
1
Yes
2
No
8
Don't know
9
Not applicable
Q7533: Time awareness (2)
Q7533: Time awareness (2)
Q7533: Time awareness (2)
Q7533: Time awareness (2)
Q7533: Time awareness (2)
Finally, I will ask you a few questions about how you keep track of time during the day.
How do you usually know the time? Do you look at a watch or clock, or do you do certain activities at the same time every day, or do you know from the position of the sun, or do you just guess, or is there something else?
1Look at a Watch or Clock
2Do Things at Same Time Every Day
3The Position of the Sun
4Guess
7 Other, specify:
8 Don't Know
1
Look at watch/clock
2
Daily routine
3
Position of sun
4
Guess
7
Other
8
Don't know
9
Not applicable
Q7011: Current time (HH)
Q7011: Current time (HH)
Q7011: Current time (HH)
Q7011: Current time (HH)
Q7011: Current time (HH)
Record current time.
Q7011: Current time (MM)
Q7011: Current time (MM)
Q7011: Current time (MM)
Q7011: Current time (MM)
Q7011: Current time (MM)
Record current time.
Q7012: End time (HH)
Q7012: End time (HH)
Q7012: End time (HH)
Q7012: End time (HH)
Q7012: End time (HH)
Add 15 minutes to compute the end time of this part of the interview.
Q7012: End time (MM)
Q7012: End time (MM)
Q7012: End time (MM)
Q7012: End time (MM)
Q7012: End time (MM)
Add 15 minutes to compute the end time of this part of the interview.
Q7013: Awoke (HH)
Q7013: Awoke (HH)
Q7013: Awoke (HH)
Q7013: Awoke (HH)
Q7013: Awoke (HH)
Now I would like to ask you questions about what you did yesterday. I want you to try to remember the sequence of activities that you did from when you woke up until later in the day. We'll go through this one activity at a time.
People do different activities throughout the day. Here is a list of examples: working, preparing food, doing housework, watching children, traveling to work or the market, grooming, bathing, eating, exercising, praying, resting, chatting with friends, playing cards, watching TV, listening to the radio, reading the newspaper or taking care of someone.
I would like for you to tell me about all the different things that you did yesterday. You may have done some of the things that I just mentioned. You may have done other things too.
Please keep all of your responses to just a word or two. And you don't have to mention very short activities, like washing hands, which only take one or two minutes. We'll start at the beginning.
When did you wake up yesterday?
TIME
8888 DON'T KNOW TIME
INTERVIEWER: If respondent can't remember, get his or her best guess.
88
DK
Q7013: Awoke (MM)
Q7013: Awoke (MM)
Q7013: Awoke (MM)
Q7013: Awoke (MM)
Q7013: Awoke (MM)
Now I would like to ask you questions about what you did yesterday. I want you to try to remember the sequence of activities that you did from when you woke up until later in the day. We'll go through this one activity at a time.
People do different activities throughout the day. Here is a list of examples: working, preparing food, doing housework, watching children, traveling to work or the market, grooming, bathing, eating, exercising, praying, resting, chatting with friends, playing cards, watching TV, listening to the radio, reading the newspaper or taking care of someone.
I would like for you to tell me about all the different things that you did yesterday. You may have done some of the things that I just mentioned. You may have done other things too.
Please keep all of your responses to just a word or two. And you don't have to mention very short activities, like washing hands, which only take one or two minutes. We'll start at the beginning.
When did you wake up yesterday?
TIME
8888 DON'T KNOW TIME
INTERVIEWER: If respondent can't remember, get his or her best guess.
88
DK
Q7015: Activity (1)
Q7015: Activity (1)
Q7015: Activity (1)
Q7015: Activity (1)
Q7015: Activity (1)
What was the first thing you did after waking up yesterday morning?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
NTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity.
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
88
Don't know
98
Not applicable
Q7016: Duration (HH)
Q7016: Duration (HH)
Q7016: Duration (HH)
Q7016: Duration (HH)
Q7016: Duration (HH)
How long did this activity last?
88
Don't know
98
Not applicable
Q7016: Duration (MM)
Q7016: Duration (MM)
Q7016: Duration (MM)
Q7016: Duration (MM)
Q7016: Duration (MM)
How long did this activity last?
88
Don't know
98
Not applicable
Q7017: Start (1) (HH)
Q7017: Start (1) (HH)
Q7017: Start (1) (HH)
Q7017: Start (1) (HH)
Q7017: Start (1) (HH)
At what time did this activity begin?
INTERVIEWER: If respondent has trouble with exact time, get estimate or approximate.
88
Don't know
98
Not applicable
Q7017: Start (1) (MM)
Q7017: Start (1) (MM)
Q7017: Start (1) (MM)
Q7017: Start (1) (MM)
Q7017: Start (1) (MM)
At what time did this activity begin?
INTERVIEWER: If respondent has trouble with exact time, get estimate or approximate.
88
Don't know
98
Not applicable
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
1Alone ……..…… Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
1Alone ……..…… Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
1Alone ……..…… Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
1Alone ……..…… Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
1Alone ……..…… Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
1Alone ……..…… Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
1Alone ……..…… Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
1Alone ……..…… Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018a: Friendly?
Q7018a: Friendly?
Q7018a: Friendly?
Q7018a: Friendly?
Q7018a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1Very friendly
2A little friendly
3A little irritated
Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7019: Worried
Q7019: Worried
Q7019: Worried
Q7019: Worried
Q7019: Worried
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much" to the following questions
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7020: Rushed
Q7020: Rushed
Q7020: Rushed
Q7020: Rushed
Q7020: Rushed
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much" to the following questions
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7021: Irritated/angry
Q7021: Irritated/angry
Q7021: Irritated/angry
Q7021: Irritated/angry
Q7021: Irritated/angry
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much" to the following questions
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7022: Depressed
Q7022: Depressed
Q7022: Depressed
Q7022: Depressed
Q7022: Depressed
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much" to the following questions
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7023: Tense/stressed
Q7023: Tense/stressed
Q7023: Tense/stressed
Q7023: Tense/stressed
Q7023: Tense/stressed
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much" to the following questions
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7024: Calm/relaxed
Q7024: Calm/relaxed
Q7024: Calm/relaxed
Q7024: Calm/relaxed
Q7024: Calm/relaxed
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much" to the following questions
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7025: Enjoying
Q7025: Enjoying
Q7025: Enjoying
Q7025: Enjoying
Q7025: Enjoying
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much" to the following questions
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7050: Activity (2)
Q7050: Activity (2)
Q7050: Activity (2)
Q7050: Activity (2)
Q7050: Activity (2)
What was the next thing you did yesterday morning?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity
-9
Not applicable
-8
Don't know
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7051: Duration (HH)
Q7051: Duration (HH)
Q7051: Duration (HH)
Q7051: Duration (HH)
Q7051: Duration (HH)
How long did this activity last?
Hours : Minutes
NTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
-9
Not applicable
-8
Don't know
Q7051: Duration (MM)
Q7051: Duration (MM)
Q7051: Duration (MM)
Q7051: Duration (MM)
Q7051: Duration (MM)
How long did this activity last?
Hours : Minutes
NTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
-9
Not applicable
-8
Don't know
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052a: Friendly?
Q7052a: Friendly?
Q7052a: Friendly?
Q7052a: Friendly?
Q7052a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1Very friendly
2A little friendly
3A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7053: Worried
Q7053: Worried
Q7053: Worried
Q7053: Worried
Q7053: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7054: Rushed
Q7054: Rushed
Q7054: Rushed
Q7054: Rushed
Q7054: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7055: Irritated/angry
Q7055: Irritated/angry
Q7055: Irritated/angry
Q7055: Irritated/angry
Q7055: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7056: Depressed
Q7056: Depressed
Q7056: Depressed
Q7056: Depressed
Q7056: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7057: Tense/stressed
Q7057: Tense/stressed
Q7057: Tense/stressed
Q7057: Tense/stressed
Q7057: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7058: Calm/relaxed
Q7058: Calm/relaxed
Q7058: Calm/relaxed
Q7058: Calm/relaxed
Q7058: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7059: Enjoyed
Q7059: Enjoyed
Q7059: Enjoyed
Q7059: Enjoyed
Q7059: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7100: Activity (3)
Q7100: Activity (3)
Q7100: Activity (3)
Q7100: Activity (3)
Q7100: Activity (3)
What was the next thing you did yesterday?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity.
-9
Not applicable
-8
Don't know
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7101: Duration (HH)
Q7101: Duration (HH)
Q7101: Duration (HH)
Q7101: Duration (HH)
Q7101: Duration (HH)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate
Q7101: Duration (MM)
Q7101: Duration (MM)
Q7101: Duration (MM)
Q7101: Duration (MM)
Q7101: Duration (MM)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102a: Friendly?
Q7102a: Friendly?
Q7102a: Friendly?
Q7102a: Friendly?
Q7102a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1Very friendly
2A little friendly
3A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7103: Worried
Q7103: Worried
Q7103: Worried
Q7103: Worried
Q7103: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7104: Rushed
Q7104: Rushed
Q7104: Rushed
Q7104: Rushed
Q7104: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7105: Irritated/angry
Q7105: Irritated/angry
Q7105: Irritated/angry
Q7105: Irritated/angry
Q7105: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7106: Depressed
Q7106: Depressed
Q7106: Depressed
Q7106: Depressed
Q7106: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7107: Tense/stressed
Q7107: Tense/stressed
Q7107: Tense/stressed
Q7107: Tense/stressed
Q7107: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7108: Calm/relaxed
Q7108: Calm/relaxed
Q7108: Calm/relaxed
Q7108: Calm/relaxed
Q7108: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7109: Enjoyed
Q7109: Enjoyed
Q7109: Enjoyed
Q7109: Enjoyed
Q7109: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7150: Activity (4)
Q7150: Activity (4)
Q7150: Activity (4)
Q7150: Activity (4)
Q7150: Activity (4)
What was the next thing you did yesterday?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity.
-9
Not applicable
-8
Don't know
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7151: Duration (HH)
Q7151: Duration (HH)
Q7151: Duration (HH)
Q7151: Duration (HH)
Q7151: Duration (HH)
How long did this activity last?
INTERVIEWER: If respondent has trouble with exact time, get estimate or approximate
Q7151: Duration (MM)
Q7151: Duration (MM)
Q7151: Duration (MM)
Q7151: Duration (MM)
Q7151: Duration (MM)
How long did this activity last?
INTERVIEWER: If respondent has trouble with exact time, get estimate or approximate
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152a: Friendly?
Q7152a: Friendly?
Q7152a: Friendly?
Q7152a: Friendly?
Q7152a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1Very friendly
2A little friendly
3A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7153: Worried
Q7153: Worried
Q7153: Worried
Q7153: Worried
Q7153: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7154: Rushed
Q7154: Rushed
Q7154: Rushed
Q7154: Rushed
Q7154: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7155: Irritated/angry
Q7155: Irritated/angry
Q7155: Irritated/angry
Q7155: Irritated/angry
Q7155: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7156: Depressed
Q7156: Depressed
Q7156: Depressed
Q7156: Depressed
Q7156: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7157: Tense/stressed
Q7157: Tense/stressed
Q7157: Tense/stressed
Q7157: Tense/stressed
Q7157: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7158: Calm/relaxed
Q7158: Calm/relaxed
Q7158: Calm/relaxed
Q7158: Calm/relaxed
Q7158: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7159: Enjoyed
Q7159: Enjoyed
Q7159: Enjoyed
Q7159: Enjoyed
Q7159: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7200: Activity (5)
Q7200: Activity (5)
Q7200: Activity (5)
Q7200: Activity (5)
Q7200: Activity (5)
What was the next thing you did yesterday?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity.
-9
Not applicable
-8
Don't know
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7201: Duration (5) (HH)
Q7201: Duration (5) (HH)
Q7201: Duration (5) (HH)
Q7201: Duration (5) (HH)
Q7201: Duration (5) (HH)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7201: Duration (5) (MM)
Q7201: Duration (5) (MM)
Q7201: Duration (5) (MM)
Q7201: Duration (5) (MM)
Q7201: Duration (5) (MM)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7202a: Friendly?
Q7202a: Friendly?
Q7202a: Friendly?
Q7202a: Friendly?
Q7202a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1Very friendly
2A little friendly
3A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7203: Worried
Q7203: Worried
Q7203: Worried
Q7203: Worried
Q7203: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7204: Rushed
Q7204: Rushed
Q7204: Rushed
Q7204: Rushed
Q7204: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7205: Irritated/angry
Q7205: Irritated/angry
Q7205: Irritated/angry
Q7205: Irritated/angry
Q7205: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7206: Depressed
Q7206: Depressed
Q7206: Depressed
Q7206: Depressed
Q7206: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7207: Tense/stressed
Q7207: Tense/stressed
Q7207: Tense/stressed
Q7207: Tense/stressed
Q7207: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7208: Calm/relaxed
Q7208: Calm/relaxed
Q7208: Calm/relaxed
Q7208: Calm/relaxed
Q7208: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7209: Enjoyed
Q7209: Enjoyed
Q7209: Enjoyed
Q7209: Enjoyed
Q7209: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7210: Current time (HH)
Q7210: Current time (HH)
Q7210: Current time (HH)
Q7210: Current time (HH)
Q7210: Current time (HH)
Record current time.
Q7210: Current time (MM)
Q7210: Current time (MM)
Q7210: Current time (MM)
Q7210: Current time (MM)
Q7210: Current time (MM)
Record current time.
Q7250: Activity (6)
Q7250: Activity (6)
Q7250: Activity (6)
Q7250: Activity (6)
Q7250: Activity (6)
What was the next thing you did yesterday?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity.
-9
Not applicable
-8
Don't know
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7251: Duration (6) (HH)
Q7251: Duration (6) (HH)
Q7251: Duration (6) (HH)
Q7251: Duration (6) (HH)
Q7251: Duration (6) (HH)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate
Q7251: Duration (6) (MM)
Q7251: Duration (6) (MM)
Q7251: Duration (6) (MM)
Q7251: Duration (6) (MM)
Q7251: Duration (6) (MM)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252a: Friendly?
Q7252a: Friendly?
Q7252a: Friendly?
Q7252a: Friendly?
Q7252a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1Very friendly
2A little friendly
3A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7253: Worried
Q7253: Worried
Q7253: Worried
Q7253: Worried
Q7253: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7254: Rushed
Q7254: Rushed
Q7254: Rushed
Q7254: Rushed
Q7254: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7255: Irritated/angry
Q7255: Irritated/angry
Q7255: Irritated/angry
Q7255: Irritated/angry
Q7255: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7256: Depressed
Q7256: Depressed
Q7256: Depressed
Q7256: Depressed
Q7256: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7257: Tense/stressed
Q7257: Tense/stressed
Q7257: Tense/stressed
Q7257: Tense/stressed
Q7257: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7258: Calm/relaxed
Q7258: Calm/relaxed
Q7258: Calm/relaxed
Q7258: Calm/relaxed
Q7258: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7259: Enjoyed
Q7259: Enjoyed
Q7259: Enjoyed
Q7259: Enjoyed
Q7259: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7260: Current time (HH)
Q7260: Current time (HH)
Q7260: Current time (HH)
Q7260: Current time (HH)
Q7260: Current time (HH)
Record current time
Q7260: Current time (MM)
Q7260: Current time (MM)
Q7260: Current time (MM)
Q7260: Current time (MM)
Q7260: Current time (MM)
Record current time
Q7300: Activity (7)
Q7300: Activity (7)
Q7300: Activity (7)
Q7300: Activity (7)
Q7300: Activity (7)
What was the next thing you did yesterday?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity.
-9
Not applicable
-8
Don't know
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7301: Duration (7) (HH)
Q7301: Duration (7) (HH)
Q7301: Duration (7) (HH)
Q7301: Duration (7) (HH)
Q7301: Duration (7) (HH)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7301: Duration (7) (MM)
Q7301: Duration (7) (MM)
Q7301: Duration (7) (MM)
Q7301: Duration (7) (MM)
Q7301: Duration (7) (MM)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302a: Friendly?
Q7302a: Friendly?
Q7302a: Friendly?
Q7302a: Friendly?
Q7302a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1Very friendly
2A little friendly
3A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7303: Worried
Q7303: Worried
Q7303: Worried
Q7303: Worried
Q7303: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7304: Rushed
Q7304: Rushed
Q7304: Rushed
Q7304: Rushed
Q7304: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7305: Irritated/angry
Q7305: Irritated/angry
Q7305: Irritated/angry
Q7305: Irritated/angry
Q7305: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7306: Depressed
Q7306: Depressed
Q7306: Depressed
Q7306: Depressed
Q7306: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7307: Tense/stressed
Q7307: Tense/stressed
Q7307: Tense/stressed
Q7307: Tense/stressed
Q7307: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7308: Calm/relaxed
Q7308: Calm/relaxed
Q7308: Calm/relaxed
Q7308: Calm/relaxed
Q7308: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7309: Enjoyed
Q7309: Enjoyed
Q7309: Enjoyed
Q7309: Enjoyed
Q7309: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7310: Current time (HH)
Q7310: Current time (HH)
Q7310: Current time (HH)
Q7310: Current time (HH)
Q7310: Current time (HH)
Record current time.
Q7310: Current time (MM)
Q7310: Current time (MM)
Q7310: Current time (MM)
Q7310: Current time (MM)
Q7310: Current time (MM)
Record current time.
Q7350: Activity (8)
Q7350: Activity (8)
Q7350: Activity (8)
Q7350: Activity (8)
Q7350: Activity (8)
What was the next thing you did yesterday?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity
-9
Not applicable
-8
Don't know
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7351: Duration (8) (HH)
Q7351: Duration (8) (HH)
Q7351: Duration (8) (HH)
Q7351: Duration (8) (HH)
Q7351: Duration (8) (HH)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7351: Duration (8) (MM)
Q7351: Duration (8) (MM)
Q7351: Duration (8) (MM)
Q7351: Duration (8) (MM)
Q7351: Duration (8) (MM)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352a: Friendly?
Q7352a: Friendly?
Q7352a: Friendly?
Q7352a: Friendly?
Q7352a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1Very friendly
2A little friendly
3A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7353: Worried
Q7353: Worried
Q7353: Worried
Q7353: Worried
Q7353: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7354: Rushed
Q7354: Rushed
Q7354: Rushed
Q7354: Rushed
Q7354: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7355: Irritated/angry
Q7355: Irritated/angry
Q7355: Irritated/angry
Q7355: Irritated/angry
Q7355: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7356: Depressed
Q7356: Depressed
Q7356: Depressed
Q7356: Depressed
Q7356: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7357: Tense/stressed
Q7357: Tense/stressed
Q7357: Tense/stressed
Q7357: Tense/stressed
Q7357: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7358: Calm/relaxed
Q7358: Calm/relaxed
Q7358: Calm/relaxed
Q7358: Calm/relaxed
Q7358: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7359: Enjoyed
Q7359: Enjoyed
Q7359: Enjoyed
Q7359: Enjoyed
Q7359: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7360: Current time (HH)
Q7360: Current time (HH)
Q7360: Current time (HH)
Q7360: Current time (HH)
Q7360: Current time (HH)
Record current time
Q7360: Current time (MM)
Q7360: Current time (MM)
Q7360: Current time (MM)
Q7360: Current time (MM)
Q7360: Current time (MM)
Record current time
Q7400: Activity (9)
Q7400: Activity (9)
Q7400: Activity (9)
Q7400: Activity (9)
Q7400: Activity (9)
What was the next thing you did yesterday?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity.
-9
Not applicable
-8
Don't know
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7401: Duration (9) (HH)
Q7401: Duration (9) (HH)
Q7401: Duration (9) (HH)
Q7401: Duration (9) (HH)
Q7401: Duration (9) (HH)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7401: Duration (9) (MM)
Q7401: Duration (9) (MM)
Q7401: Duration (9) (MM)
Q7401: Duration (9) (MM)
Q7401: Duration (9) (MM)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7402a: Friendly?
Q7402a: Friendly?
Q7402a: Friendly?
Q7402a: Friendly?
Q7402a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1Very friendly
2A little friendly
3A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7403: Worried
Q7403: Worried
Q7403: Worried
Q7403: Worried
Q7403: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7404: Rushed
Q7404: Rushed
Q7404: Rushed
Q7404: Rushed
Q7404: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7405: Irritated/angry
Q7405: Irritated/angry
Q7405: Irritated/angry
Q7405: Irritated/angry
Q7405: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7406: Depressed
Q7406: Depressed
Q7406: Depressed
Q7406: Depressed
Q7406: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7407: Tense/stressed
Q7407: Tense/stressed
Q7407: Tense/stressed
Q7407: Tense/stressed
Q7407: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7408: Calm/relaxed
Q7408: Calm/relaxed
Q7408: Calm/relaxed
Q7408: Calm/relaxed
Q7408: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7409: Enjoyed
Q7409: Enjoyed
Q7409: Enjoyed
Q7409: Enjoyed
Q7409: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7410: Current time (HH)
Q7410: Current time (HH)
Q7410: Current time (HH)
Q7410: Current time (HH)
Q7410: Current time (HH)
Record current time.
Q7410: Current time (MM)
Q7410: Current time (MM)
Q7410: Current time (MM)
Q7410: Current time (MM)
Q7410: Current time (MM)
Record current time.
Q7450: Activity (10)
Q7450: Activity (10)
Q7450: Activity (10)
Q7450: Activity (10)
Q7450: Activity (10)
What was the next thing you did yesterday?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity.
-9
Not applicable
-8
Don't know
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7451: Duration (10) (HH)
Q7451: Duration (10) (HH)
Q7451: Duration (10) (HH)
Q7451: Duration (10) (HH)
Q7451: Duration (10) (HH)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7451: Duration (10) (MM)
Q7451: Duration (10) (MM)
Q7451: Duration (10) (MM)
Q7451: Duration (10) (MM)
Q7451: Duration (10) (MM)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452a: Friendly?
Q7452a: Friendly?
Q7452a: Friendly?
Q7452a: Friendly?
Q7452a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1Very friendly
2A little friendly
3A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7453: Worried
Q7453: Worried
Q7453: Worried
Q7453: Worried
Q7453: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7454: Rushed
Q7454: Rushed
Q7454: Rushed
Q7454: Rushed
Q7454: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7455: Irritated/angry
Q7455: Irritated/angry
Q7455: Irritated/angry
Q7455: Irritated/angry
Q7455: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7456: Depressed
Q7456: Depressed
Q7456: Depressed
Q7456: Depressed
Q7456: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7457: Tense/stressed
Q7457: Tense/stressed
Q7457: Tense/stressed
Q7457: Tense/stressed
Q7457: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7458: Calm/relaxed
Q7458: Calm/relaxed
Q7458: Calm/relaxed
Q7458: Calm/relaxed
Q7458: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7459: Enjoyed
Q7459: Enjoyed
Q7459: Enjoyed
Q7459: Enjoyed
Q7459: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7500: End time (HH)
Q7500: End time (HH)
Q7500: End time (HH)
Q7500: End time (HH)
Q7500: End time (HH)
You have now described your activities from this part of your day yesterday, can you tell me what time this last activity ended.
8888 Don't know
INTERVIEWER: If respondent has trouble with exact time, get estimate or approximate.
Q7500: End time (MM)
Q7500: End time (MM)
Q7500: End time (MM)
Q7500: End time (MM)
Q7500: End time (MM)
You have now described your activities from this part of your day yesterday, can you tell me what time this last activity ended.
8888 Don't know
INTERVIEWER: If respondent has trouble with exact time, get estimate or approximate.
Q7011: Current time (HH)
Q7011: Current time (HH)
Q7011: Current time (HH)
Q7011: Current time (HH)
Q7011: Current time (HH)
Record current time.
Q7011: Current time (MM)
Q7011: Current time (MM)
Q7011: Current time (MM)
Q7011: Current time (MM)
Q7011: Current time (MM)
Record current time.
Q7012: End time (HH)
Q7012: End time (HH)
Q7012: End time (HH)
Q7012: End time (HH)
Q7012: End time (HH)
Add 15 minutes to compute the end time of this part of the interview.
Q7012: End time (MM)
Q7012: End time (MM)
Q7012: End time (MM)
Q7012: End time (MM)
Q7012: End time (MM)
Add 15 minutes to compute the end time of this part of the interview.
Q7013: Awoke (HH)
Q7013: Awoke (HH)
Q7013: Awoke (HH)
Q7013: Awoke (HH)
Q7013: Awoke (HH)
Now I would like to ask you questions about what you did yesterday. I want you to try to remember the sequence of activities that you did from about noon or mid-day until later in the day. We'll go through this one activity at a time.
People do different activities throughout the day. Here is a list of examples: working, preparing food, doing housework, watching children, traveling to work or the market, grooming, bathing, eating, exercising, praying, resting, chatting with friends, playing cards, watching TV, listening to the radio, reading the newspaper or taking care of someone.
I would like for you to tell me about all the different things that you did yesterday. You may have done some of the things that I just mentioned. You may have done other things too.
Please keep all of your responses to just a word or two. And you don't have to mention very short activities, like washing hands, which only take one or two minutes. We'll start at the beginning.
When did you wake up yesterday?
8888 DON'T KNOW TIME
INTERVIEWER: If respondent can't remember, get his or her best guess.
88
DK
Q7013: Awoke (MM)
Q7013: Awoke (MM)
Q7013: Awoke (MM)
Q7013: Awoke (MM)
Q7013: Awoke (MM)
Now I would like to ask you questions about what you did yesterday. I want you to try to remember the sequence of activities that you did from about noon or mid-day until later in the day. We'll go through this one activity at a time.
People do different activities throughout the day. Here is a list of examples: working, preparing food, doing housework, watching children, traveling to work or the market, grooming, bathing, eating, exercising, praying, resting, chatting with friends, playing cards, watching TV, listening to the radio, reading the newspaper or taking care of someone.
I would like for you to tell me about all the different things that you did yesterday. You may have done some of the things that I just mentioned. You may have done other things too.
Please keep all of your responses to just a word or two. And you don't have to mention very short activities, like washing hands, which only take one or two minutes. We'll start at the beginning.
When did you wake up yesterday?
8888 DON'T KNOW TIME
INTERVIEWER: If respondent can't remember, get his or her best guess.
88
DK
Q7015: Activity (1)
Q7015: Activity (1)
Q7015: Activity (1)
Q7015: Activity (1)
Q7015: Activity (1)
What were you doing at around noon or mid-day yesterday?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity.
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7016: Duration (HH)
Q7016: Duration (HH)
Q7016: Duration (HH)
Q7016: Duration (HH)
Q7016: Duration (HH)
How long did this activity last?
Hours : Minutes
Q7016: Duration (MM)
Q7016: Duration (MM)
Q7016: Duration (MM)
Q7016: Duration (MM)
Q7016: Duration (MM)
How long did this activity last?
Hours : Minutes
Q7017: Start (1) (HH)
Q7017: Start (1) (HH)
Q7017: Start (1) (HH)
Q7017: Start (1) (HH)
Q7017: Start (1) (HH)
At what time did this activity begin?
TIME
INTERVIEWER: If respondent has trouble with exact time, get estimate or approximate.
Q7017: Start (1) (MM)
Q7017: Start (1) (MM)
Q7017: Start (1) (MM)
Q7017: Start (1) (MM)
Q7017: Start (1) (MM)
At what time did this activity begin?
TIME
INTERVIEWER: If respondent has trouble with exact time, get estimate or approximate.
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
1Alone ……..…… Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
1Alone ……..…… Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
1Alone ……..…… Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
1Alone ……..…… Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
1Alone ……..…… Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
1Alone ……..…… Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
1Alone ……..…… Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
1Alone ……..…… Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018a: Friendly?
Q7018a: Friendly?
Q7018a: Friendly?
Q7018a: Friendly?
Q7018a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1Very friendly
2A little friendly
3A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7019: Worried
Q7019: Worried
Q7019: Worried
Q7019: Worried
Q7019: Worried
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much" to the following questions
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7020: Rushed
Q7020: Rushed
Q7020: Rushed
Q7020: Rushed
Q7020: Rushed
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much" to the following questions
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7021: Irritated/angry
Q7021: Irritated/angry
Q7021: Irritated/angry
Q7021: Irritated/angry
Q7021: Irritated/angry
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much" to the following questions
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7022: Depressed
Q7022: Depressed
Q7022: Depressed
Q7022: Depressed
Q7022: Depressed
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much" to the following questions
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7023: Tense/stressed
Q7023: Tense/stressed
Q7023: Tense/stressed
Q7023: Tense/stressed
Q7023: Tense/stressed
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much" to the following questions
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7024: Calm/relaxed
Q7024: Calm/relaxed
Q7024: Calm/relaxed
Q7024: Calm/relaxed
Q7024: Calm/relaxed
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much" to the following questions
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7025: Enjoying
Q7025: Enjoying
Q7025: Enjoying
Q7025: Enjoying
Q7025: Enjoying
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much" to the following questions
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7050: Activity (2)
Q7050: Activity (2)
Q7050: Activity (2)
Q7050: Activity (2)
Q7050: Activity (2)
What was the next thing you did yesterday afternoon?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity.
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7051: Duration (HH)
Q7051: Duration (HH)
Q7051: Duration (HH)
Q7051: Duration (HH)
Q7051: Duration (HH)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7051: Duration (MM)
Q7051: Duration (MM)
Q7051: Duration (MM)
Q7051: Duration (MM)
Q7051: Duration (MM)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052a: Friendly?
Q7052a: Friendly?
Q7052a: Friendly?
Q7052a: Friendly?
Q7052a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1Very friendly
2A little friendly
3A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7053: Worried
Q7053: Worried
Q7053: Worried
Q7053: Worried
Q7053: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7054: Rushed
Q7054: Rushed
Q7054: Rushed
Q7054: Rushed
Q7054: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7055: Irritated/angry
Q7055: Irritated/angry
Q7055: Irritated/angry
Q7055: Irritated/angry
Q7055: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7056: Depressed
Q7056: Depressed
Q7056: Depressed
Q7056: Depressed
Q7056: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7057: Tense/stressed
Q7057: Tense/stressed
Q7057: Tense/stressed
Q7057: Tense/stressed
Q7057: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7058: Calm/relaxed
Q7058: Calm/relaxed
Q7058: Calm/relaxed
Q7058: Calm/relaxed
Q7058: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7059: Enjoyed
Q7059: Enjoyed
Q7059: Enjoyed
Q7059: Enjoyed
Q7059: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7100: Activity (3)
Q7100: Activity (3)
Q7100: Activity (3)
Q7100: Activity (3)
Q7100: Activity (3)
What was the next thing you did yesterday?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7101: Duration (HH)
Q7101: Duration (HH)
Q7101: Duration (HH)
Q7101: Duration (HH)
Q7101: Duration (HH)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7101: Duration (MM)
Q7101: Duration (MM)
Q7101: Duration (MM)
Q7101: Duration (MM)
Q7101: Duration (MM)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102a: Friendly?
Q7102a: Friendly?
Q7102a: Friendly?
Q7102a: Friendly?
Q7102a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1Very friendly
2A little friendly
3A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7103: Worried
Q7103: Worried
Q7103: Worried
Q7103: Worried
Q7103: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7104: Rushed
Q7104: Rushed
Q7104: Rushed
Q7104: Rushed
Q7104: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7105: Irritated/angry
Q7105: Irritated/angry
Q7105: Irritated/angry
Q7105: Irritated/angry
Q7105: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7106: Depressed
Q7106: Depressed
Q7106: Depressed
Q7106: Depressed
Q7106: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7107: Tense/stressed
Q7107: Tense/stressed
Q7107: Tense/stressed
Q7107: Tense/stressed
Q7107: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7108: Calm/relaxed
Q7108: Calm/relaxed
Q7108: Calm/relaxed
Q7108: Calm/relaxed
Q7108: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7109: Enjoyed
Q7109: Enjoyed
Q7109: Enjoyed
Q7109: Enjoyed
Q7109: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7150: Activity (4)
Q7150: Activity (4)
Q7150: Activity (4)
Q7150: Activity (4)
Q7150: Activity (4)
What was the next thing you did yesterday?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity.
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7151: Duration (HH)
Q7151: Duration (HH)
Q7151: Duration (HH)
Q7151: Duration (HH)
Q7151: Duration (HH)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact time, get estimate or approximate.
Q7151: Duration (MM)
Q7151: Duration (MM)
Q7151: Duration (MM)
Q7151: Duration (MM)
Q7151: Duration (MM)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact time, get estimate or approximate.
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152a: Friendly?
Q7152a: Friendly?
Q7152a: Friendly?
Q7152a: Friendly?
Q7152a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1Very friendly
2A little friendly
3A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7153: Worried
Q7153: Worried
Q7153: Worried
Q7153: Worried
Q7153: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7154: Rushed
Q7154: Rushed
Q7154: Rushed
Q7154: Rushed
Q7154: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7155: Irritated/angry
Q7155: Irritated/angry
Q7155: Irritated/angry
Q7155: Irritated/angry
Q7155: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7156: Depressed
Q7156: Depressed
Q7156: Depressed
Q7156: Depressed
Q7156: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7157: Tense/stressed
Q7157: Tense/stressed
Q7157: Tense/stressed
Q7157: Tense/stressed
Q7157: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7158: Calm/relaxed
Q7158: Calm/relaxed
Q7158: Calm/relaxed
Q7158: Calm/relaxed
Q7158: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7159: Enjoyed
Q7159: Enjoyed
Q7159: Enjoyed
Q7159: Enjoyed
Q7159: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7200: Activity (5)
Q7200: Activity (5)
Q7200: Activity (5)
Q7200: Activity (5)
Q7200: Activity (5)
What was the next thing you did yesterday?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity.
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7201: Duration (5) (HH)
Q7201: Duration (5) (HH)
Q7201: Duration (5) (HH)
Q7201: Duration (5) (HH)
Q7201: Duration (5) (HH)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7201: Duration (5) (MM)
Q7201: Duration (5) (MM)
Q7201: Duration (5) (MM)
Q7201: Duration (5) (MM)
Q7201: Duration (5) (MM)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7202a: Friendly?
Q7202a: Friendly?
Q7202a: Friendly?
Q7202a: Friendly?
Q7202a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1Very friendly
2A little friendly
3A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7203: Worried
Q7203: Worried
Q7203: Worried
Q7203: Worried
Q7203: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7204: Rushed
Q7204: Rushed
Q7204: Rushed
Q7204: Rushed
Q7204: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7205: Irritated/angry
Q7205: Irritated/angry
Q7205: Irritated/angry
Q7205: Irritated/angry
Q7205: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7206: Depressed
Q7206: Depressed
Q7206: Depressed
Q7206: Depressed
Q7206: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7207: Tense/stressed
Q7207: Tense/stressed
Q7207: Tense/stressed
Q7207: Tense/stressed
Q7207: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7208: Calm/relaxed
Q7208: Calm/relaxed
Q7208: Calm/relaxed
Q7208: Calm/relaxed
Q7208: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7209: Enjoyed
Q7209: Enjoyed
Q7209: Enjoyed
Q7209: Enjoyed
Q7209: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7210: Current time (HH)
Q7210: Current time (HH)
Q7210: Current time (HH)
Q7210: Current time (HH)
Q7210: Current time (HH)
Record current time.
Q7210: Current time (MM)
Q7210: Current time (MM)
Q7210: Current time (MM)
Q7210: Current time (MM)
Q7210: Current time (MM)
Record current time.
Q7250: Activity (6)
Q7250: Activity (6)
Q7250: Activity (6)
Q7250: Activity (6)
Q7250: Activity (6)
What was the next thing you did yesterday?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity.
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7251: Duration (6) (HH)
Q7251: Duration (6) (HH)
Q7251: Duration (6) (HH)
Q7251: Duration (6) (HH)
Q7251: Duration (6) (HH)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7251: Duration (6) (MM)
Q7251: Duration (6) (MM)
Q7251: Duration (6) (MM)
Q7251: Duration (6) (MM)
Q7251: Duration (6) (MM)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252a: Friendly?
Q7252a: Friendly?
Q7252a: Friendly?
Q7252a: Friendly?
Q7252a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1Very friendly
2A little friendly
3A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7253: Worried
Q7253: Worried
Q7253: Worried
Q7253: Worried
Q7253: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7254: Rushed
Q7254: Rushed
Q7254: Rushed
Q7254: Rushed
Q7254: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7255: Irritated/angry
Q7255: Irritated/angry
Q7255: Irritated/angry
Q7255: Irritated/angry
Q7255: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7256: Depressed
Q7256: Depressed
Q7256: Depressed
Q7256: Depressed
Q7256: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7257: Tense/stressed
Q7257: Tense/stressed
Q7257: Tense/stressed
Q7257: Tense/stressed
Q7257: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7258: Calm/relaxed
Q7258: Calm/relaxed
Q7258: Calm/relaxed
Q7258: Calm/relaxed
Q7258: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7259: Enjoyed
Q7259: Enjoyed
Q7259: Enjoyed
Q7259: Enjoyed
Q7259: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much"
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7260: Current time (HH)
Q7260: Current time (HH)
Q7260: Current time (HH)
Q7260: Current time (HH)
Q7260: Current time (HH)
Record current time.
Q7260: Current time (MM)
Q7260: Current time (MM)
Q7260: Current time (MM)
Q7260: Current time (MM)
Q7260: Current time (MM)
Record current time.
Q7300: Activity (7)
Q7300: Activity (7)
Q7300: Activity (7)
Q7300: Activity (7)
Q7300: Activity (7)
What was the next thing you did yesterday?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity.
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7301: Duration (7) (HH)
Q7301: Duration (7) (HH)
Q7301: Duration (7) (HH)
Q7301: Duration (7) (HH)
Q7301: Duration (7) (HH)
How long did this activity last?
Hours : Minutes
NTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7301: Duration (7) (MM)
Q7301: Duration (7) (MM)
Q7301: Duration (7) (MM)
Q7301: Duration (7) (MM)
Q7301: Duration (7) (MM)
How long did this activity last?
Hours : Minutes
NTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302a: Friendly?
Q7302a: Friendly?
Q7302a: Friendly?
Q7302a: Friendly?
Q7302a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1Very friendly
2A little friendly
3A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7303: Worried
Q7303: Worried
Q7303: Worried
Q7303: Worried
Q7303: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7304: Rushed
Q7304: Rushed
Q7304: Rushed
Q7304: Rushed
Q7304: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7305: Irritated/angry
Q7305: Irritated/angry
Q7305: Irritated/angry
Q7305: Irritated/angry
Q7305: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7306: Depressed
Q7306: Depressed
Q7306: Depressed
Q7306: Depressed
Q7306: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7307: Tense/stressed
Q7307: Tense/stressed
Q7307: Tense/stressed
Q7307: Tense/stressed
Q7307: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7308: Calm/relaxed
Q7308: Calm/relaxed
Q7308: Calm/relaxed
Q7308: Calm/relaxed
Q7308: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7309: Enjoyed
Q7309: Enjoyed
Q7309: Enjoyed
Q7309: Enjoyed
Q7309: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7310: Current time (HH)
Q7310: Current time (HH)
Q7310: Current time (HH)
Q7310: Current time (HH)
Q7310: Current time (HH)
Record current time
TIME
Q7310: Current time (MM)
Q7310: Current time (MM)
Q7310: Current time (MM)
Q7310: Current time (MM)
Q7310: Current time (MM)
Record current time
TIME
Q7350: Activity (8)
Q7350: Activity (8)
Q7350: Activity (8)
Q7350: Activity (8)
Q7350: Activity (8)
What was the next thing you did yesterday?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity.
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7351: Duration (8) (HH)
Q7351: Duration (8) (HH)
Q7351: Duration (8) (HH)
Q7351: Duration (8) (HH)
Q7351: Duration (8) (HH)
How long did this activity last?
Hours : Minutes
NTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7351: Duration (8) (MM)
Q7351: Duration (8) (MM)
Q7351: Duration (8) (MM)
Q7351: Duration (8) (MM)
Q7351: Duration (8) (MM)
How long did this activity last?
Hours : Minutes
NTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
NTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
NTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
NTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
NTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
NTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
NTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
NTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
NTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352a: Friendly?
Q7352a: Friendly?
Q7352a: Friendly?
Q7352a: Friendly?
Q7352a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1Very friendly
2A little friendly
3A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7353: Worried
Q7353: Worried
Q7353: Worried
Q7353: Worried
Q7353: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7354: Rushed
Q7354: Rushed
Q7354: Rushed
Q7354: Rushed
Q7354: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7355: Irritated/angry
Q7355: Irritated/angry
Q7355: Irritated/angry
Q7355: Irritated/angry
Q7355: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7356: Depressed
Q7356: Depressed
Q7356: Depressed
Q7356: Depressed
Q7356: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7357: Tense/stressed
Q7357: Tense/stressed
Q7357: Tense/stressed
Q7357: Tense/stressed
Q7357: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7358: Calm/relaxed
Q7358: Calm/relaxed
Q7358: Calm/relaxed
Q7358: Calm/relaxed
Q7358: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7359: Enjoyed
Q7359: Enjoyed
Q7359: Enjoyed
Q7359: Enjoyed
Q7359: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7360: Current time (HH)
Q7360: Current time (HH)
Q7360: Current time (HH)
Q7360: Current time (HH)
Q7360: Current time (HH)
Record current time.
TIME
Q7360: Current time (MM)
Q7360: Current time (MM)
Q7360: Current time (MM)
Q7360: Current time (MM)
Q7360: Current time (MM)
Record current time.
TIME
Q7400: Activity (9)
Q7400: Activity (9)
Q7400: Activity (9)
Q7400: Activity (9)
Q7400: Activity (9)
What was the next thing you did yesterday?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity.
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7401: Duration (9) (HH)
Q7401: Duration (9) (HH)
Q7401: Duration (9) (HH)
Q7401: Duration (9) (HH)
Q7401: Duration (9) (HH)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7401: Duration (9) (MM)
Q7401: Duration (9) (MM)
Q7401: Duration (9) (MM)
Q7401: Duration (9) (MM)
Q7401: Duration (9) (MM)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
1Alone ……..…… Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
1Alone ……..…… Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
1Alone ……..…… Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
1Alone ……..…… Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
1Alone ……..…… Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
1Alone ……..…… Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
1Alone ……..…… Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
1Alone ……..…… Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
Q7402a: Friendly?
Q7402a: Friendly?
Q7402a: Friendly?
Q7402a: Friendly?
Q7402a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1Very friendly
2A little friendly
3A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7403: Worried
Q7403: Worried
Q7403: Worried
Q7403: Worried
Q7403: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7404: Rushed
Q7404: Rushed
Q7404: Rushed
Q7404: Rushed
Q7404: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7405: Irritated/angry
Q7405: Irritated/angry
Q7405: Irritated/angry
Q7405: Irritated/angry
Q7405: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7406: Depressed
Q7406: Depressed
Q7406: Depressed
Q7406: Depressed
Q7406: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7407: Tense/stressed
Q7407: Tense/stressed
Q7407: Tense/stressed
Q7407: Tense/stressed
Q7407: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7408: Calm/relaxed
Q7408: Calm/relaxed
Q7408: Calm/relaxed
Q7408: Calm/relaxed
Q7408: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7409: Enjoyed
Q7409: Enjoyed
Q7409: Enjoyed
Q7409: Enjoyed
Q7409: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7410: Current time (HH)
Q7410: Current time (HH)
Q7410: Current time (HH)
Q7410: Current time (HH)
Q7410: Current time (HH)
Record current time.
Time
Q7410: Current time (MM)
Q7410: Current time (MM)
Q7410: Current time (MM)
Q7410: Current time (MM)
Q7410: Current time (MM)
Record current time.
Time
Q7450: Activity (10)
Q7450: Activity (10)
Q7450: Activity (10)
Q7450: Activity (10)
Q7450: Activity (10)
What was the next thing you did yesterday?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity.
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7451: Duration (10) (HH)
Q7451: Duration (10) (HH)
Q7451: Duration (10) (HH)
Q7451: Duration (10) (HH)
Q7451: Duration (10) (HH)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate
Q7451: Duration (10) (MM)
Q7451: Duration (10) (MM)
Q7451: Duration (10) (MM)
Q7451: Duration (10) (MM)
Q7451: Duration (10) (MM)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452a: Friendly?
Q7452a: Friendly?
Q7452a: Friendly?
Q7452a: Friendly?
Q7452a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1Very friendly
2A little friendly
3A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7453: Worried
Q7453: Worried
Q7453: Worried
Q7453: Worried
Q7453: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7454: Rushed
Q7454: Rushed
Q7454: Rushed
Q7454: Rushed
Q7454: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7455: Irritated/angry
Q7455: Irritated/angry
Q7455: Irritated/angry
Q7455: Irritated/angry
Q7455: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7456: Depressed
Q7456: Depressed
Q7456: Depressed
Q7456: Depressed
Q7456: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7457: Tense/stressed
Q7457: Tense/stressed
Q7457: Tense/stressed
Q7457: Tense/stressed
Q7457: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7458: Calm/relaxed
Q7458: Calm/relaxed
Q7458: Calm/relaxed
Q7458: Calm/relaxed
Q7458: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7459: Enjoyed
Q7459: Enjoyed
Q7459: Enjoyed
Q7459: Enjoyed
Q7459: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7500: End time (HH)
Q7500: End time (HH)
Q7500: End time (HH)
Q7500: End time (HH)
Q7500: End time (HH)
You have now described your activities from this part of your day yesterday, can you tell me what time this last activity ended.
8888 Don't know
INTERVIEWER: If respondent has trouble with exact time, get estimate or approximate.
Q7500: End time (MM)
Q7500: End time (MM)
Q7500: End time (MM)
Q7500: End time (MM)
Q7500: End time (MM)
You have now described your activities from this part of your day yesterday, can you tell me what time this last activity ended.
8888 Don't know
INTERVIEWER: If respondent has trouble with exact time, get estimate or approximate.
Q7011: Current time (HH)
Q7011: Current time (HH)
Q7011: Current time (HH)
Q7011: Current time (HH)
Q7011: Current time (HH)
Record current time.
TIME
INTERVIEWER: For this module, you will ask the respondent to reconstruct his or her previous day beginning from evening (about 18.00 or 6pm) until the respondent goes to bed for the night. You will not be able to reconstruct the entire day. You should limit this section to 15 minutes of interview time, so keep track of time elapsed, using the spaces provided in this section - and stop asking about activities to leave enough time to ask Q7501-7534 in the allotted time.
Q7011: Current time (MM)
Q7011: Current time (MM)
Q7011: Current time (MM)
Q7011: Current time (MM)
Q7011: Current time (MM)
Record current time.
TIME
INTERVIEWER: For this module, you will ask the respondent to reconstruct his or her previous day beginning from evening (about 18.00 or 6pm) until the respondent goes to bed for the night. You will not be able to reconstruct the entire day. You should limit this section to 15 minutes of interview time, so keep track of time elapsed, using the spaces provided in this section - and stop asking about activities to leave enough time to ask Q7501-7534 in the allotted time.
Q7012: End time (HH)
Q7012: End time (HH)
Q7012: End time (HH)
Q7012: End time (HH)
Q7012: End time (HH)
Add 15 minutes to compute the end time of this part of the interview.
TIME
Q7012: End time (MM)
Q7012: End time (MM)
Q7012: End time (MM)
Q7012: End time (MM)
Q7012: End time (MM)
Add 15 minutes to compute the end time of this part of the interview.
TIME
Q7013: Awoke (HH)
Q7013: Awoke (HH)
Q7013: Awoke (HH)
Q7013: Awoke (HH)
Q7013: Awoke (HH)
Now I would like to ask you questions about what you did yesterday. I want you to try to remember the sequence of activities that you did in the evening, from about 6pm (18.00 or early evening), until you went to bed. We'll go through this one activity at a time.
People do different activities throughout the day. Here is a list of examples: working, preparing food, doing housework, watching children, traveling to work or the market, grooming, bathing, eating, exercising, praying, resting, chatting with friends, playing cards, watching TV, listening to the radio, reading the newspaper or taking care of someone.
I would like for you to tell me about all the different things that you did yesterday. You may have done some of the things that I just mentioned. You may have done other things too.
Please keep all of your responses to just a word or two. And you don't have to mention very short activities, like washing hands, which only take one or two minutes.
At what time did you wake up yesterday?
8888 DON'T KNOW TIME
INTERVIEWER: If respondent can't remember, get his or her best guess.
88
DK
Q7013: Awoke (MM)
Q7013: Awoke (MM)
Q7013: Awoke (MM)
Q7013: Awoke (MM)
Q7013: Awoke (MM)
Now I would like to ask you questions about what you did yesterday. I want you to try to remember the sequence of activities that you did in the evening, from about 6pm (18.00 or early evening), until you went to bed. We'll go through this one activity at a time.
People do different activities throughout the day. Here is a list of examples: working, preparing food, doing housework, watching children, traveling to work or the market, grooming, bathing, eating, exercising, praying, resting, chatting with friends, playing cards, watching TV, listening to the radio, reading the newspaper or taking care of someone.
I would like for you to tell me about all the different things that you did yesterday. You may have done some of the things that I just mentioned. You may have done other things too.
Please keep all of your responses to just a word or two. And you don't have to mention very short activities, like washing hands, which only take one or two minutes.
At what time did you wake up yesterday?
8888 DON'T KNOW TIME
INTERVIEWER: If respondent can't remember, get his or her best guess.
88
DK
Q7015: Activity (1)
Q7015: Activity (1)
Q7015: Activity (1)
Q7015: Activity (1)
Q7015: Activity (1)
What was the next thing you did yesterday evening or night?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7016: Duration (HH)
Q7016: Duration (HH)
Q7016: Duration (HH)
Q7016: Duration (HH)
Q7016: Duration (HH)
How long did this activity last?
Hours : Minutes
Q7016: Duration (MM)
Q7016: Duration (MM)
Q7016: Duration (MM)
Q7016: Duration (MM)
Q7016: Duration (MM)
How long did this activity last?
Hours : Minutes
Q7017: Start (1) (HH)
Q7017: Start (1) (HH)
Q7017: Start (1) (HH)
Q7017: Start (1) (HH)
Q7017: Start (1) (HH)
At what time did this activity begin?
TIME
INTERVIEWER: If respondent has trouble with exact time, get estimate or approximate.
Q7017: Start (1) (MM)
Q7017: Start (1) (MM)
Q7017: Start (1) (MM)
Q7017: Start (1) (MM)
Q7017: Start (1) (MM)
At what time did this activity begin?
TIME
INTERVIEWER: If respondent has trouble with exact time, get estimate or approximate.
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting
1Alone ……..…Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting
1Alone ……..…Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting
1Alone ……..…Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting
1Alone ……..…Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting
1Alone ……..…Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting
1Alone ……..…Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting
1Alone ……..…Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Q7018: Talking with (single)
Were you talking or interacting with anyone when you did this? By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting
1Alone ……..…Q7019
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses
Q7018a: Friendly?
Q7018a: Friendly?
Q7018a: Friendly?
Q7018a: Friendly?
Q7018a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1Very friendly
2A little friendly
3A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7019: Worried
Q7019: Worried
Q7019: Worried
Q7019: Worried
Q7019: Worried
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much" to the following questions.
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7020: Rushed
Q7020: Rushed
Q7020: Rushed
Q7020: Rushed
Q7020: Rushed
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much" to the following questions.
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7021: Irritated/angry
Q7021: Irritated/angry
Q7021: Irritated/angry
Q7021: Irritated/angry
Q7021: Irritated/angry
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much" to the following questions.
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7022: Depressed
Q7022: Depressed
Q7022: Depressed
Q7022: Depressed
Q7022: Depressed
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much" to the following questions.
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7023: Tense/stressed
Q7023: Tense/stressed
Q7023: Tense/stressed
Q7023: Tense/stressed
Q7023: Tense/stressed
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much" to the following questions.
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7024: Calm/relaxed
Q7024: Calm/relaxed
Q7024: Calm/relaxed
Q7024: Calm/relaxed
Q7024: Calm/relaxed
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much" to the following questions.
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7025: Enjoying
Q7025: Enjoying
Q7025: Enjoying
Q7025: Enjoying
Q7025: Enjoying
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much" to the following questions.
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7050: Activity (2)
Q7050: Activity (2)
Q7050: Activity (2)
Q7050: Activity (2)
Q7050: Activity (2)
What was the next thing you did yesterday evening or night?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7051: Duration (HH)
Q7051: Duration (HH)
Q7051: Duration (HH)
Q7051: Duration (HH)
Q7051: Duration (HH)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7051: Duration (MM)
Q7051: Duration (MM)
Q7051: Duration (MM)
Q7051: Duration (MM)
Q7051: Duration (MM)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Q7052: Talking with (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…… Q7053
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7052a: Friendly?
Q7052a: Friendly?
Q7052a: Friendly?
Q7052a: Friendly?
Q7052a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1Very friendly
2A little friendly
3A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7053: Worried
Q7053: Worried
Q7053: Worried
Q7053: Worried
Q7053: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7054: Rushed
Q7054: Rushed
Q7054: Rushed
Q7054: Rushed
Q7054: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7055: Irritated/angry
Q7055: Irritated/angry
Q7055: Irritated/angry
Q7055: Irritated/angry
Q7055: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7056: Depressed
Q7056: Depressed
Q7056: Depressed
Q7056: Depressed
Q7056: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7057: Tense/stressed
Q7057: Tense/stressed
Q7057: Tense/stressed
Q7057: Tense/stressed
Q7057: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7058: Calm/relaxed
Q7058: Calm/relaxed
Q7058: Calm/relaxed
Q7058: Calm/relaxed
Q7058: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7059: Enjoyed
Q7059: Enjoyed
Q7059: Enjoyed
Q7059: Enjoyed
Q7059: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7100: Activity (3)
Q7100: Activity (3)
Q7100: Activity (3)
Q7100: Activity (3)
Q7100: Activity (3)
What was the next thing you did yesterday evening or night?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7101: Duration (HH)
Q7101: Duration (HH)
Q7101: Duration (HH)
Q7101: Duration (HH)
Q7101: Duration (HH)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7101: Duration (MM)
Q7101: Duration (MM)
Q7101: Duration (MM)
Q7101: Duration (MM)
Q7101: Duration (MM)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Q7102: Talking with (3) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7103
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7102a: Friendly?
Q7102a: Friendly?
Q7102a: Friendly?
Q7102a: Friendly?
Q7102a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1 Very friendly
2 A little friendly
3 A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7103: Worried
Q7103: Worried
Q7103: Worried
Q7103: Worried
Q7103: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7104: Rushed
Q7104: Rushed
Q7104: Rushed
Q7104: Rushed
Q7104: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7105: Irritated/angry
Q7105: Irritated/angry
Q7105: Irritated/angry
Q7105: Irritated/angry
Q7105: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7106: Depressed
Q7106: Depressed
Q7106: Depressed
Q7106: Depressed
Q7106: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7107: Tense/stressed
Q7107: Tense/stressed
Q7107: Tense/stressed
Q7107: Tense/stressed
Q7107: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7108: Calm/relaxed
Q7108: Calm/relaxed
Q7108: Calm/relaxed
Q7108: Calm/relaxed
Q7108: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7109: Enjoyed
Q7109: Enjoyed
Q7109: Enjoyed
Q7109: Enjoyed
Q7109: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7150: Activity (4)
Q7150: Activity (4)
Q7150: Activity (4)
Q7150: Activity (4)
Q7150: Activity (4)
What was the next thing you did yesterday evening or night?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7151: Duration (HH)
Q7151: Duration (HH)
Q7151: Duration (HH)
Q7151: Duration (HH)
Q7151: Duration (HH)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact time, get estimate or approximate.
Q7151: Duration (MM)
Q7151: Duration (MM)
Q7151: Duration (MM)
Q7151: Duration (MM)
Q7151: Duration (MM)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact time, get estimate or approximate.
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Q7152: Talking with (4) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7153
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7152a: Friendly?
Q7152a: Friendly?
Q7152a: Friendly?
Q7152a: Friendly?
Q7152a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1 Very friendly
2 A little friendly
3 A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7153: Worried
Q7153: Worried
Q7153: Worried
Q7153: Worried
Q7153: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7154: Rushed
Q7154: Rushed
Q7154: Rushed
Q7154: Rushed
Q7154: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7155: Irritated/angry
Q7155: Irritated/angry
Q7155: Irritated/angry
Q7155: Irritated/angry
Q7155: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7156: Depressed
Q7156: Depressed
Q7156: Depressed
Q7156: Depressed
Q7156: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7157: Tense/stressed
Q7157: Tense/stressed
Q7157: Tense/stressed
Q7157: Tense/stressed
Q7157: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7158: Calm/relaxed
Q7158: Calm/relaxed
Q7158: Calm/relaxed
Q7158: Calm/relaxed
Q7158: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7159: Enjoyed
Q7159: Enjoyed
Q7159: Enjoyed
Q7159: Enjoyed
Q7159: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7200: Activity (5)
Q7200: Activity (5)
Q7200: Activity (5)
Q7200: Activity (5)
Q7200: Activity (5)
What was the next thing you did yesterday evening or night?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7201: Duration (5) (HH)
Q7201: Duration (5) (HH)
Q7201: Duration (5) (HH)
Q7201: Duration (5) (HH)
Q7201: Duration (5) (HH)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7201: Duration (5) (MM)
Q7201: Duration (5) (MM)
Q7201: Duration (5) (MM)
Q7201: Duration (5) (MM)
Q7201: Duration (5) (MM)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Q7202: Talking with (5) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7203
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7202a: Friendly?
Q7202a: Friendly?
Q7202a: Friendly?
Q7202a: Friendly?
Q7202a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1 Very friendly
2 A little friendly
3 A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7203: Worried
Q7203: Worried
Q7203: Worried
Q7203: Worried
Q7203: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7204: Rushed
Q7204: Rushed
Q7204: Rushed
Q7204: Rushed
Q7204: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7205: Irritated/angry
Q7205: Irritated/angry
Q7205: Irritated/angry
Q7205: Irritated/angry
Q7205: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7206: Depressed
Q7206: Depressed
Q7206: Depressed
Q7206: Depressed
Q7206: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7207: Tense/stressed
Q7207: Tense/stressed
Q7207: Tense/stressed
Q7207: Tense/stressed
Q7207: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7208: Calm/relaxed
Q7208: Calm/relaxed
Q7208: Calm/relaxed
Q7208: Calm/relaxed
Q7208: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7209: Enjoyed
Q7209: Enjoyed
Q7209: Enjoyed
Q7209: Enjoyed
Q7209: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7210: Current time (HH)
Q7210: Current time (HH)
Q7210: Current time (HH)
Q7210: Current time (HH)
Q7210: Current time (HH)
Record current time.
Q7210: Current time (MM)
Q7210: Current time (MM)
Q7210: Current time (MM)
Q7210: Current time (MM)
Q7210: Current time (MM)
Record current time.
Q7250: Activity (6)
Q7250: Activity (6)
Q7250: Activity (6)
Q7250: Activity (6)
Q7250: Activity (6)
What was the next thing you did yesterday evening or night?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7251: Duration (6) (HH)
Q7251: Duration (6) (HH)
Q7251: Duration (6) (HH)
Q7251: Duration (6) (HH)
Q7251: Duration (6) (HH)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7251: Duration (6) (MM)
Q7251: Duration (6) (MM)
Q7251: Duration (6) (MM)
Q7251: Duration (6) (MM)
Q7251: Duration (6) (MM)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Q7252: Talking with (6) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7253
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7252a: Friendly?
Q7252a: Friendly?
Q7252a: Friendly?
Q7252a: Friendly?
Q7252a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1 Very friendly
2 A little friendly
3 A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7253: Worried
Q7253: Worried
Q7253: Worried
Q7253: Worried
Q7253: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7254: Rushed
Q7254: Rushed
Q7254: Rushed
Q7254: Rushed
Q7254: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7255: Irritated/angry
Q7255: Irritated/angry
Q7255: Irritated/angry
Q7255: Irritated/angry
Q7255: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7256: Depressed
Q7256: Depressed
Q7256: Depressed
Q7256: Depressed
Q7256: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7257: Tense/stressed
Q7257: Tense/stressed
Q7257: Tense/stressed
Q7257: Tense/stressed
Q7257: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7258: Calm/relaxed
Q7258: Calm/relaxed
Q7258: Calm/relaxed
Q7258: Calm/relaxed
Q7258: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7259: Enjoyed
Q7259: Enjoyed
Q7259: Enjoyed
Q7259: Enjoyed
Q7259: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7260: Current time (HH)
Q7260: Current time (HH)
Q7260: Current time (HH)
Q7260: Current time (HH)
Q7260: Current time (HH)
Record current time
Q7260: Current time (MM)
Q7260: Current time (MM)
Q7260: Current time (MM)
Q7260: Current time (MM)
Q7260: Current time (MM)
Record current time
Q7300: Activity (7)
Q7300: Activity (7)
Q7300: Activity (7)
Q7300: Activity (7)
Q7300: Activity (7)
What was the next thing you did yesterday evening or night?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7301: Duration (7) (HH)
Q7301: Duration (7) (HH)
Q7301: Duration (7) (HH)
Q7301: Duration (7) (HH)
Q7301: Duration (7) (HH)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate
Q7301: Duration (7) (MM)
Q7301: Duration (7) (MM)
Q7301: Duration (7) (MM)
Q7301: Duration (7) (MM)
Q7301: Duration (7) (MM)
How long did this activity last?
Hours : Minutes
INTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Q7302: Talking with (7) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7303
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7302a: Friendly?
Q7302a: Friendly?
Q7302a: Friendly?
Q7302a: Friendly?
Q7302a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1 Very friendly
2 A little friendly
3 A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7303: Worried
Q7303: Worried
Q7303: Worried
Q7303: Worried
Q7303: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7304: Rushed
Q7304: Rushed
Q7304: Rushed
Q7304: Rushed
Q7304: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7305: Irritated/angry
Q7305: Irritated/angry
Q7305: Irritated/angry
Q7305: Irritated/angry
Q7305: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7306: Depressed
Q7306: Depressed
Q7306: Depressed
Q7306: Depressed
Q7306: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7307: Tense/stressed
Q7307: Tense/stressed
Q7307: Tense/stressed
Q7307: Tense/stressed
Q7307: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7308: Calm/relaxed
Q7308: Calm/relaxed
Q7308: Calm/relaxed
Q7308: Calm/relaxed
Q7308: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7309: Enjoyed
Q7309: Enjoyed
Q7309: Enjoyed
Q7309: Enjoyed
Q7309: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7310: Current time (HH)
Q7310: Current time (HH)
Q7310: Current time (HH)
Q7310: Current time (HH)
Q7310: Current time (HH)
Record current time
Q7310: Current time (MM)
Q7310: Current time (MM)
Q7310: Current time (MM)
Q7310: Current time (MM)
Q7310: Current time (MM)
Record current time
Q7350: Activity (8)
Q7350: Activity (8)
Q7350: Activity (8)
Q7350: Activity (8)
Q7350: Activity (8)
What was the next thing you did yesterday evening or night?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7351: Duration (8) (HH)
Q7351: Duration (8) (HH)
Q7351: Duration (8) (HH)
Q7351: Duration (8) (HH)
Q7351: Duration (8) (HH)
How long did this activity last?
Hours : Minutes
NTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate
Q7351: Duration (8) (MM)
Q7351: Duration (8) (MM)
Q7351: Duration (8) (MM)
Q7351: Duration (8) (MM)
Q7351: Duration (8) (MM)
How long did this activity last?
Hours : Minutes
NTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Q7352: Talking with (8) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7353
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7352a: Friendly?
Q7352a: Friendly?
Q7352a: Friendly?
Q7352a: Friendly?
Q7352a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1 Very friendly
2 A little friendly
3 A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7353: Worried
Q7353: Worried
Q7353: Worried
Q7353: Worried
Q7353: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7354: Rushed
Q7354: Rushed
Q7354: Rushed
Q7354: Rushed
Q7354: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7355: Irritated/angry
Q7355: Irritated/angry
Q7355: Irritated/angry
Q7355: Irritated/angry
Q7355: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7356: Depressed
Q7356: Depressed
Q7356: Depressed
Q7356: Depressed
Q7356: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7357: Tense/stressed
Q7357: Tense/stressed
Q7357: Tense/stressed
Q7357: Tense/stressed
Q7357: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7358: Calm/relaxed
Q7358: Calm/relaxed
Q7358: Calm/relaxed
Q7358: Calm/relaxed
Q7358: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7359: Enjoyed
Q7359: Enjoyed
Q7359: Enjoyed
Q7359: Enjoyed
Q7359: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7360: Current time (HH)
Q7360: Current time (HH)
Q7360: Current time (HH)
Q7360: Current time (HH)
Q7360: Current time (HH)
Record current time.
Q7360: Current time (MM)
Q7360: Current time (MM)
Q7360: Current time (MM)
Q7360: Current time (MM)
Q7360: Current time (MM)
Record current time.
Q7400: Activity (9)
Q7400: Activity (9)
Q7400: Activity (9)
Q7400: Activity (9)
Q7400: Activity (9)
What was the next thing you did yesterday evening or night?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7401: Duration (9) (HH)
Q7401: Duration (9) (HH)
Q7401: Duration (9) (HH)
Q7401: Duration (9) (HH)
Q7401: Duration (9) (HH)
How long did this activity last?
Hours : Minutes
NTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate
Q7401: Duration (9) (MM)
Q7401: Duration (9) (MM)
Q7401: Duration (9) (MM)
Q7401: Duration (9) (MM)
Q7401: Duration (9) (MM)
How long did this activity last?
Hours : Minutes
NTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
NTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
NTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
NTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
NTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
NTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
NTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
NTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Q7402: Talking with (9) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..…Q7403
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify
NTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7402a: Friendly?
Q7402a: Friendly?
Q7402a: Friendly?
Q7402a: Friendly?
Q7402a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1 Very friendly
2 A little friendly
3 A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7403: Worried
Q7403: Worried
Q7403: Worried
Q7403: Worried
Q7403: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7404: Rushed
Q7404: Rushed
Q7404: Rushed
Q7404: Rushed
Q7404: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7405: Irritated/angry
Q7405: Irritated/angry
Q7405: Irritated/angry
Q7405: Irritated/angry
Q7405: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7406: Depressed
Q7406: Depressed
Q7406: Depressed
Q7406: Depressed
Q7406: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7407: Tense/stressed
Q7407: Tense/stressed
Q7407: Tense/stressed
Q7407: Tense/stressed
Q7407: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7408: Calm/relaxed
Q7408: Calm/relaxed
Q7408: Calm/relaxed
Q7408: Calm/relaxed
Q7408: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7409: Enjoyed
Q7409: Enjoyed
Q7409: Enjoyed
Q7409: Enjoyed
Q7409: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7410: Current time (HH)
Q7410: Current time (HH)
Q7410: Current time (HH)
Q7410: Current time (HH)
Q7410: Current time (HH)
Record current time.
Q7410: Current time (MM)
Q7410: Current time (MM)
Q7410: Current time (MM)
Q7410: Current time (MM)
Q7410: Current time (MM)
Record current time.
Q7450: Activity (10)
Q7450: Activity (10)
Q7450: Activity (10)
Q7450: Activity (10)
Q7450: Activity (10)
What was the next thing you did yesterday evening or night?
1 Working
2 Subsistence farming
3 Preparing food
4 Doing housework
5 Watching children
6 Shopping
7 Walking somewhere
8 Traveling by bicycle
9 traveling by car/bus/train
10 Rest (includes tea/coffee break)
11 Chatting with Someone
12 Playing (includes cards/games)
13 Reading
14 Listening to radio
15 Watching TV
16 Exercising or Leisurely Walk
17 Other Leisurely Activity
18 Grooming or Bathing (self)
19 Eating
20 Religious activity
21 Providing care to someone
22 Intimate Relations/Sex
23 Went to sleep for the night
INTERVIEWER: If the respondent mentions more than one activity, probe with "Which of these activity were you paying most attention to or required the most effort." Circle only ONE activity
1
Working
2
Subsistence farming
3
Preparing food
4
Doing housework
5
Watching children
6
Shopping/collecting food
7
Walking
8
Travelling by bike
9
Travelling by car/bus/train
10
Resting
11
Chatting with friends
12
Playing with friends
13
Reading
14
Listening to radio
15
Watching TV
16
Exercising
17
Other leisure activity
18
Grooming/bathing
19
Eating
20
Religious activity
21
Providing care to s.o.
22
Intimate relations
23
Went to sleep for the night
Q7451: Duration (10) (HH)
Q7451: Duration (10) (HH)
Q7451: Duration (10) (HH)
Q7451: Duration (10) (HH)
Q7451: Duration (10) (HH)
How long did this activity last?
Hours : Minutes
NTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7451: Duration (10) (MM)
Q7451: Duration (10) (MM)
Q7451: Duration (10) (MM)
Q7451: Duration (10) (MM)
Q7451: Duration (10) (MM)
How long did this activity last?
Hours : Minutes
NTERVIEWER: If respondent has trouble with exact duration, get estimate or approximate.
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Q7452: Talking with (10) (single)
Were you talking or interacting with anyone when you did this?
1Alone ……..……Q7453
2Spouse
3Adult Children
4Young Children or Grandchildren
5Family (Other than Spouse/Children)
6Friends
7Co-Workers
87 Other, specify:
INTERVIEWER: Respondent may provide more than one answer - circle responses.
Q7452a: Friendly?
Q7452a: Friendly?
Q7452a: Friendly?
Q7452a: Friendly?
Q7452a: Friendly?
At the time, how friendly were you feeling towards this person (these people)?
1 Very friendly
2 A little friendly
3 A little irritated
4 Very irritated
1
Very friendly
2
A little friendly
3
A little irritated
4
Very irritated
8
Don't know
9
Not applicable
Q7453: Worried
Q7453: Worried
Q7453: Worried
Q7453: Worried
Q7453: Worried
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7454: Rushed
Q7454: Rushed
Q7454: Rushed
Q7454: Rushed
Q7454: Rushed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7455: Irritated/angry
Q7455: Irritated/angry
Q7455: Irritated/angry
Q7455: Irritated/angry
Q7455: Irritated/angry
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7456: Depressed
Q7456: Depressed
Q7456: Depressed
Q7456: Depressed
Q7456: Depressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7457: Tense/stressed
Q7457: Tense/stressed
Q7457: Tense/stressed
Q7457: Tense/stressed
Q7457: Tense/stressed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7458: Calm/relaxed
Q7458: Calm/relaxed
Q7458: Calm/relaxed
Q7458: Calm/relaxed
Q7458: Calm/relaxed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7459: Enjoyed
Q7459: Enjoyed
Q7459: Enjoyed
Q7459: Enjoyed
Q7459: Enjoyed
Now, please think about how you felt yesterday during that time of the day. Please respond "not at all", "a little", or "very much".
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7500: End time (HH)
Q7500: End time (HH)
Q7500: End time (HH)
Q7500: End time (HH)
Q7500: End time (HH)
You have now described your activities from this part of your day yesterday, can you tell me what time this last activity ended.
8888 Don't know
INTERVIEWER: If respondent has trouble with exact time, get estimate or approximate.
Q7500: End time (MM)
Q7500: End time (MM)
Q7500: End time (MM)
Q7500: End time (MM)
Q7500: End time (MM)
You have now described your activities from this part of your day yesterday, can you tell me what time this last activity ended.
8888 Don't know
INTERVIEWER: If respondent has trouble with exact time, get estimate or approximate.
Q7011: Current time (HH)
Q7011: Current time (HH)
Q7011: Current time (HH)
Q7011: Current time (HH)
Q7011: Current time (HH)
Record current time.
Q7011: Current time (MM)
Q7011: Current time (MM)
Q7011: Current time (MM)
Q7011: Current time (MM)
Q7011: Current time (MM)
Record current time.
Q7013: Awoke (HH)
Q7013: Awoke (HH)
Q7013: Awoke (HH)
Q7013: Awoke (HH)
Q7013: Awoke (HH)
Now I would like to ask you questions about what you did yesterday. I want you to try to remember the sequence of activities that you did from when you woke up until when you went to sleep last night.
I will start by asking you what you did in the morning yesterday, and you should just give me a short description. Then I will ask about the afternoon and then the evening.
At what time did you wake up yesterday?
TIME
INTERVIEWER: If respondent can't remember, get his or her best guess.
88
DK
Q7013: Awoke (MM)
Q7013: Awoke (MM)
Q7013: Awoke (MM)
Q7013: Awoke (MM)
Q7013: Awoke (MM)
Now I would like to ask you questions about what you did yesterday. I want you to try to remember the sequence of activities that you did from when you woke up until when you went to sleep last night.
I will start by asking you what you did in the morning yesterday, and you should just give me a short description. Then I will ask about the afternoon and then the evening.
At what time did you wake up yesterday?
TIME
INTERVIEWER: If respondent can't remember, get his or her best guess.
88
DK
Q7014: to sleep (HH)
Q7014: to sleep (HH)
Q7014: to sleep (HH)
Q7014: to sleep (HH)
Q7014: to sleep (HH)
Now I would like to ask you questions about what you did yesterday. I want you to try to remember the sequence of activities that you did from when you woke up until when you went to sleep last night.
I will start by asking you what you did in the morning yesterday, and you should just give me a short description. Then I will ask about the afternoon and then the evening.
At what time did you go to sleep yesterday?
TIME
INTERVIEWER: If respondent can't remember, get his or her best guess.
Q7014: to sleep (MM)
Q7014: to sleep (MM)
Q7014: to sleep (MM)
Q7014: to sleep (MM)
Q7014: to sleep (MM)
Now I would like to ask you questions about what you did yesterday. I want you to try to remember the sequence of activities that you did from when you woke up until when you went to sleep last night.
I will start by asking you what you did in the morning yesterday, and you should just give me a short description. Then I will ask about the afternoon and then the evening.
At what time did you go to sleep yesterday?
TIME
INTERVIEWER: If respondent can't remember, get his or her best guess.
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Please tell me the main things that you did yesterday morning from the time you woke up until around noon/mid-day. Please also mention if you were talking or interacting with anyone for any parts of the morning. By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to stop with activities from around noon/mid-day.
1 WORKING
1=Yes
2=No
INTERVIEWER: Please note for Q7015 and Q7016, Q7050 and Q7051, Q7100 and Q7101 :
·Circle all activities that the person spontaneously mentions.
·You do not need to record the order and you do not need to record an item that is repeated.
·This does not have to be comprehensive. It is just meant to be an approximation.
·Please also circle all people that they say they were with.
If the person takes more than two minutes to tell you about their morning, you should ask them to give you less detail.
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Please tell me the main things that you did yesterday morning from the time you woke up until around noon/mid-day. Please also mention if you were talking or interacting with anyone for any parts of the morning. By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to stop with activities from around noon/mid-day.
2 PREPARING FOOD
1=Yes
2=No
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Please tell me the main things that you did yesterday morning from the time you woke up until around noon/mid-day. Please also mention if you were talking or interacting with anyone for any parts of the morning. By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to stop with activities from around noon/mid-day.
3 DOING HOUSEWORK
1=Yes
2=No
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Please tell me the main things that you did yesterday morning from the time you woke up until around noon/mid-day. Please also mention if you were talking or interacting with anyone for any parts of the morning. By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to stop with activities from around noon/mid-day.
4 SUBSISTENCE FARMING
1=Yes
2=No
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Please tell me the main things that you did yesterday morning from the time you woke up until around noon/mid-day. Please also mention if you were talking or interacting with anyone for any parts of the morning. By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to stop with activities from around noon/mid-day.
5 WATCHING CHILDREN
1=Yes
2=No
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Please tell me the main things that you did yesterday morning from the time you woke up until around noon/mid-day. Please also mention if you were talking or interacting with anyone for any parts of the morning. By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to stop with activities from around noon/mid-day.
6 SHOPPING
1=Yes
2=No
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Please tell me the main things that you did yesterday morning from the time you woke up until around noon/mid-day. Please also mention if you were talking or interacting with anyone for any parts of the morning. By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to stop with activities from around noon/mid-day.
7 WALKING SOMEWHERE
1=Yes
2=No
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Please tell me the main things that you did yesterday morning from the time you woke up until around noon/mid-day. Please also mention if you were talking or interacting with anyone for any parts of the morning. By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to stop with activities from around noon/mid-day.
8 TRAVELING BY BICYCLE
1=Yes
2=No
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Please tell me the main things that you did yesterday morning from the time you woke up until around noon/mid-day. Please also mention if you were talking or interacting with anyone for any parts of the morning. By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to stop with activities from around noon/mid-day.
9 TRAVELING BY CAR/BUS/TRAIN
1=Yes
2=No
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Please tell me the main things that you did yesterday morning from the time you woke up until around noon/mid-day. Please also mention if you were talking or interacting with anyone for any parts of the morning. By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to stop with activities from around noon/mid-day.
10 REST (INCLUDES TEA/COFFEE BREAK)
1=Yes
2=No
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Please tell me the main things that you did yesterday morning from the time you woke up until around noon/mid-day. Please also mention if you were talking or interacting with anyone for any parts of the morning. By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to stop with activities from around noon/mid-day.
11 CHATTING WITH SOMEONE
1=Yes
2=No
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Please tell me the main things that you did yesterday morning from the time you woke up until around noon/mid-day. Please also mention if you were talking or interacting with anyone for any parts of the morning. By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to stop with activities from around noon/mid-day.
12 PLAYING (INCLUDES CARDS/GAMES)
1=Yes
2=No
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Please tell me the main things that you did yesterday morning from the time you woke up until around noon/mid-day. Please also mention if you were talking or interacting with anyone for any parts of the morning. By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to stop with activities from around noon/mid-day.
13 READING
1=Yes
2=No
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Please tell me the main things that you did yesterday morning from the time you woke up until around noon/mid-day. Please also mention if you were talking or interacting with anyone for any parts of the morning. By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to stop with activities from around noon/mid-day.
14 LISTENING TO RADIO
1=Yes
2=No
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Please tell me the main things that you did yesterday morning from the time you woke up until around noon/mid-day. Please also mention if you were talking or interacting with anyone for any parts of the morning. By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to stop with activities from around noon/mid-day.
15 WATCHING TV
1=Yes
2=No
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Please tell me the main things that you did yesterday morning from the time you woke up until around noon/mid-day. Please also mention if you were talking or interacting with anyone for any parts of the morning. By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to stop with activities from around noon/mid-day.
16 EXERCISING OR LEISURELY WALK
1=Yes
2=No
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Please tell me the main things that you did yesterday morning from the time you woke up until around noon/mid-day. Please also mention if you were talking or interacting with anyone for any parts of the morning. By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to stop with activities from around noon/mid-day.
17 OTHER LEISURELY ACTIVITY
1=Yes
2=No
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Please tell me the main things that you did yesterday morning from the time you woke up until around noon/mid-day. Please also mention if you were talking or interacting with anyone for any parts of the morning. By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to stop with activities from around noon/mid-day.
18 GROOMING OR BATHING
1=Yes
2=No
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Please tell me the main things that you did yesterday morning from the time you woke up until around noon/mid-day. Please also mention if you were talking or interacting with anyone for any parts of the morning. By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to stop with activities from around noon/mid-day.
19 EATING
1=Yes
2=No
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Please tell me the main things that you did yesterday morning from the time you woke up until around noon/mid-day. Please also mention if you were talking or interacting with anyone for any parts of the morning. By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to stop with activities from around noon/mid-day.
20 RELIGIOUS ACTIVITY
1=Yes
2=No
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Please tell me the main things that you did yesterday morning from the time you woke up until around noon/mid-day. Please also mention if you were talking or interacting with anyone for any parts of the morning. By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to stop with activities from around noon/mid-day.
21 PROVIDING CARE TO SOMEONE
1=Yes
2=No
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Please tell me the main things that you did yesterday morning from the time you woke up until around noon/mid-day. Please also mention if you were talking or interacting with anyone for any parts of the morning. By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to stop with activities from around noon/mid-day.
22 INTIMATE RELATIONS/SEX
1=Yes
2=No
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Q7015: Activity (Morning)
Please tell me the main things that you did yesterday morning from the time you woke up until around noon/mid-day. Please also mention if you were talking or interacting with anyone for any parts of the morning. By interacting with, I mean were you consistently paying attention to someone. For example, if you were bathing a young child you would be interacting with them even if you were not talking. On the other hand, talking to someone for less than 5 minutes does not count as interacting.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to stop with activities from around noon/mid-day.
23 WENT TO SLEEP FOR THE NIGHT
1=Yes
2=No
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
1 Alone
1=Yes
2=No
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
2 Spouse
1=Yes
2=No
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
3 Adult children (aged 18 years and older)
1=Yes
2=No
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
4 Young children or grandchildren
1=Yes
2=No
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
5 Family (other than spouse, children or grandchildren)
1=Yes
2=No
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
6 Friends
1=Yes
2=No
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
7 Co-workers
1=Yes
2=No
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
Q7016: Interacting with (Morning)
87 Other, specify:
1=Yes
2=No
Q7019: Worried
Q7019: Worried
Q7019: Worried
Q7019: Worried
Q7019: Worried
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday morning. For the following questions, please respond "not at all", "a little", or "very much"
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7020: Rushed
Q7020: Rushed
Q7020: Rushed
Q7020: Rushed
Q7020: Rushed
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday morning. For the following questions, please respond "not at all", "a little", or "very much"
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7021: Irritated/angry
Q7021: Irritated/angry
Q7021: Irritated/angry
Q7021: Irritated/angry
Q7021: Irritated/angry
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday morning. For the following questions, please respond "not at all", "a little", or "very much"
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7022: Depressed
Q7022: Depressed
Q7022: Depressed
Q7022: Depressed
Q7022: Depressed
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday morning. For the following questions, please respond "not at all", "a little", or "very much"
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7023: Tense/stressed
Q7023: Tense/stressed
Q7023: Tense/stressed
Q7023: Tense/stressed
Q7023: Tense/stressed
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday morning. For the following questions, please respond "not at all", "a little", or "very much"
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7024: Calm/relaxed
Q7024: Calm/relaxed
Q7024: Calm/relaxed
Q7024: Calm/relaxed
Q7024: Calm/relaxed
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday morning. For the following questions, please respond "not at all", "a little", or "very much"
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7025: Enjoying
Q7025: Enjoying
Q7025: Enjoying
Q7025: Enjoying
Q7025: Enjoying
We often feel different things during different parts of the day. Sometimes we feel good, sometimes we feel less good. And some of the things we do are enjoyable, while some activities are not so enjoyable. Now, please think about how you felt yesterday morning. For the following questions, please respond "not at all", "a little", or "very much"
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Please tell me the main things that you did yesterday afternoon from around noon/mid-day until evening time (around 18.00 or 6pm). Please also mention if anyone was with you for any parts of the afternoon.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to describe only the activities from your afternoon yesterday between mid-day and evening.
1 WORKING
1=Yes
2=No
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Please tell me the main things that you did yesterday afternoon from around noon/mid-day until evening time (around 18.00 or 6pm). Please also mention if anyone was with you for any parts of the afternoon.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to describe only the activities from your afternoon yesterday between mid-day and evening.
2 PREPARING FOOD
1=Yes
2=No
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Please tell me the main things that you did yesterday afternoon from around noon/mid-day until evening time (around 18.00 or 6pm). Please also mention if anyone was with you for any parts of the afternoon.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to describe only the activities from your afternoon yesterday between mid-day and evening.
3 DOING HOUSEWORK
1=Yes
2=No
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Please tell me the main things that you did yesterday afternoon from around noon/mid-day until evening time (around 18.00 or 6pm). Please also mention if anyone was with you for any parts of the afternoon.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to describe only the activities from your afternoon yesterday between mid-day and evening.
4 SUBSISTENCE FARMING
1=Yes
2=No
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Please tell me the main things that you did yesterday afternoon from around noon/mid-day until evening time (around 18.00 or 6pm). Please also mention if anyone was with you for any parts of the afternoon.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to describe only the activities from your afternoon yesterday between mid-day and evening.
5 WATCHING CHILDREN
1=Yes
2=No
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Please tell me the main things that you did yesterday afternoon from around noon/mid-day until evening time (around 18.00 or 6pm). Please also mention if anyone was with you for any parts of the afternoon.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to describe only the activities from your afternoon yesterday between mid-day and evening.
6 SHOPPING
1=Yes
2=No
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Please tell me the main things that you did yesterday afternoon from around noon/mid-day until evening time (around 18.00 or 6pm). Please also mention if anyone was with you for any parts of the afternoon.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to describe only the activities from your afternoon yesterday between mid-day and evening.
7 WALKING SOMEWHERE
1=Yes
2=No
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Please tell me the main things that you did yesterday afternoon from around noon/mid-day until evening time (around 18.00 or 6pm). Please also mention if anyone was with you for any parts of the afternoon.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to describe only the activities from your afternoon yesterday between mid-day and evening.
8 TRAVELING BY BICYCLE
1=Yes
2=No
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Please tell me the main things that you did yesterday afternoon from around noon/mid-day until evening time (around 18.00 or 6pm). Please also mention if anyone was with you for any parts of the afternoon.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to describe only the activities from your afternoon yesterday between mid-day and evening.
9 TRAVELING BY CAR/BUS/TRAIN
1=Yes
2=No
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Please tell me the main things that you did yesterday afternoon from around noon/mid-day until evening time (around 18.00 or 6pm). Please also mention if anyone was with you for any parts of the afternoon.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to describe only the activities from your afternoon yesterday between mid-day and evening.
10 REST (INCLUDES TEA/COFFEE BREAK)
1=Yes
2=No
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Please tell me the main things that you did yesterday afternoon from around noon/mid-day until evening time (around 18.00 or 6pm). Please also mention if anyone was with you for any parts of the afternoon.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to describe only the activities from your afternoon yesterday between mid-day and evening.
11 CHATTING WITH SOMEONE
1=Yes
2=No
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Please tell me the main things that you did yesterday afternoon from around noon/mid-day until evening time (around 18.00 or 6pm). Please also mention if anyone was with you for any parts of the afternoon.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to describe only the activities from your afternoon yesterday between mid-day and evening.
12 PLAYING (INCLUDES CARDS/GAMES)
1=Yes
2=No
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Please tell me the main things that you did yesterday afternoon from around noon/mid-day until evening time (around 18.00 or 6pm). Please also mention if anyone was with you for any parts of the afternoon.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to describe only the activities from your afternoon yesterday between mid-day and evening.
13 READING
1=Yes
2=No
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Please tell me the main things that you did yesterday afternoon from around noon/mid-day until evening time (around 18.00 or 6pm). Please also mention if anyone was with you for any parts of the afternoon.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to describe only the activities from your afternoon yesterday between mid-day and evening.
14 LISTENING TO RADIO
1=Yes
2=No
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Please tell me the main things that you did yesterday afternoon from around noon/mid-day until evening time (around 18.00 or 6pm). Please also mention if anyone was with you for any parts of the afternoon.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to describe only the activities from your afternoon yesterday between mid-day and evening.
15 WATCHING TV
1=Yes
2=No
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Please tell me the main things that you did yesterday afternoon from around noon/mid-day until evening time (around 18.00 or 6pm). Please also mention if anyone was with you for any parts of the afternoon.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to describe only the activities from your afternoon yesterday between mid-day and evening.
16 EXERCISING OR LEISURELY WALK
1=Yes
2=No
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Please tell me the main things that you did yesterday afternoon from around noon/mid-day until evening time (around 18.00 or 6pm). Please also mention if anyone was with you for any parts of the afternoon.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to describe only the activities from your afternoon yesterday between mid-day and evening.
17 OTHER LEISURELY ACTIVITY
1=Yes
2=No
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Please tell me the main things that you did yesterday afternoon from around noon/mid-day until evening time (around 18.00 or 6pm). Please also mention if anyone was with you for any parts of the afternoon.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to describe only the activities from your afternoon yesterday between mid-day and evening.
18 GROOMING OR BATHING
1=Yes
2=No
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Please tell me the main things that you did yesterday afternoon from around noon/mid-day until evening time (around 18.00 or 6pm). Please also mention if anyone was with you for any parts of the afternoon.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to describe only the activities from your afternoon yesterday between mid-day and evening.
19 EATING
1=Yes
2=No
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Please tell me the main things that you did yesterday afternoon from around noon/mid-day until evening time (around 18.00 or 6pm). Please also mention if anyone was with you for any parts of the afternoon.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to describe only the activities from your afternoon yesterday between mid-day and evening.
20 RELIGIOUS ACTIVITY
1=Yes
2=No
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Please tell me the main things that you did yesterday afternoon from around noon/mid-day until evening time (around 18.00 or 6pm). Please also mention if anyone was with you for any parts of the afternoon.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to describe only the activities from your afternoon yesterday between mid-day and evening.
21 PROVIDING CARE TO SOMEONE
1=Yes
2=No
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Please tell me the main things that you did yesterday afternoon from around noon/mid-day until evening time (around 18.00 or 6pm). Please also mention if anyone was with you for any parts of the afternoon.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to describe only the activities from your afternoon yesterday between mid-day and evening.
22 INTIMATE RELATIONS/SEX
1=Yes
2=No
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Q7050: Activity (Afternoon)
Please tell me the main things that you did yesterday afternoon from around noon/mid-day until evening time (around 18.00 or 6pm). Please also mention if anyone was with you for any parts of the afternoon.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way. Be sure to describe only the activities from your afternoon yesterday between mid-day and evening.
23 WENT TO SLEEP FOR THE NIGHT
1=Yes
2=No
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
1 Alone
1=Yes
2=No
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
2 Spouse
1=Yes
2=No
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
3 Adult children (aged 18 years and older)
1=Yes
2=No
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
4 Young children or grandchildren
1=Yes
2=No
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
5 Family (other than spouse, children or grandchildren)
1=Yes
2=No
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
6 Friends
1=Yes
2=No
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
7 Co-workers
1=Yes
2=No
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
Q7051: Interacting with (Afternoon)
87 Other, specify:
1=Yes
2=No
Q7054: Worried
Q7054: Worried
Q7054: Worried
Q7054: Worried
Q7054: Worried
Now, please think about how you felt yesterday afternoon. For the following questions, please respond "not at all", "a little", or "very much"
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7055: Rushed
Q7055: Rushed
Q7055: Rushed
Q7055: Rushed
Q7055: Rushed
Now, please think about how you felt yesterday afternoon. For the following questions, please respond "not at all", "a little", or "very much"
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7056: Irritated/angry
Q7056: Irritated/angry
Q7056: Irritated/angry
Q7056: Irritated/angry
Q7056: Irritated/angry
Now, please think about how you felt yesterday afternoon. For the following questions, please respond "not at all", "a little", or "very much"
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7057: Depressed
Q7057: Depressed
Q7057: Depressed
Q7057: Depressed
Q7057: Depressed
Now, please think about how you felt yesterday afternoon. For the following questions, please respond "not at all", "a little", or "very much"
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7058: Tense/stressed
Q7058: Tense/stressed
Q7058: Tense/stressed
Q7058: Tense/stressed
Q7058: Tense/stressed
Now, please think about how you felt yesterday afternoon. For the following questions, please respond "not at all", "a little", or "very much"
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7059: Calm/relaxed
Q7059: Calm/relaxed
Q7059: Calm/relaxed
Q7059: Calm/relaxed
Q7059: Calm/relaxed
Now, please think about how you felt yesterday afternoon. For the following questions, please respond "not at all", "a little", or "very much"
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7060: Enjoying
Q7060: Enjoying
Q7060: Enjoying
Q7060: Enjoying
Q7060: Enjoying
Now, please think about how you felt yesterday afternoon. For the following questions, please respond "not at all", "a little", or "very much"
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Please tell me the main things that you did yesterday evening from around 6pm (18.00) until you went to sleep. Please also mention if anyone was with you for any parts of the evening.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way.
1 WORKING
1=Yes
2=No
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Please tell me the main things that you did yesterday evening from around 6pm (18.00) until you went to sleep. Please also mention if anyone was with you for any parts of the evening.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way.
2 PREPARING FOOD
1=Yes
2=No
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Please tell me the main things that you did yesterday evening from around 6pm (18.00) until you went to sleep. Please also mention if anyone was with you for any parts of the evening.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way.
3 DOING HOUSEWORK
1=Yes
2=No
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Please tell me the main things that you did yesterday evening from around 6pm (18.00) until you went to sleep. Please also mention if anyone was with you for any parts of the evening.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way.
4 SUBSISTENCE FARMING
1=Yes
2=No
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Please tell me the main things that you did yesterday evening from around 6pm (18.00) until you went to sleep. Please also mention if anyone was with you for any parts of the evening.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way.
5 WATCHING CHILDREN
1=Yes
2=No
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Please tell me the main things that you did yesterday evening from around 6pm (18.00) until you went to sleep. Please also mention if anyone was with you for any parts of the evening.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way.
6 SHOPPING
1=Yes
2=No
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Please tell me the main things that you did yesterday evening from around 6pm (18.00) until you went to sleep. Please also mention if anyone was with you for any parts of the evening.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way.
7 WALKING SOMEWHERE
1=Yes
2=No
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Please tell me the main things that you did yesterday evening from around 6pm (18.00) until you went to sleep. Please also mention if anyone was with you for any parts of the evening.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way.
8 TRAVELING BY BICYCLE
1=Yes
2=No
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Please tell me the main things that you did yesterday evening from around 6pm (18.00) until you went to sleep. Please also mention if anyone was with you for any parts of the evening.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way.
9 TRAVELING BY CAR/BUS/TRAIN
1=Yes
2=No
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Please tell me the main things that you did yesterday evening from around 6pm (18.00) until you went to sleep. Please also mention if anyone was with you for any parts of the evening.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way.
10 REST (INCLUDES TEA/COFFEE BREAK)
1=Yes
2=No
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Please tell me the main things that you did yesterday evening from around 6pm (18.00) until you went to sleep. Please also mention if anyone was with you for any parts of the evening.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way.
11 CHATTING WITH SOMEONE
1=Yes
2=No
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Please tell me the main things that you did yesterday evening from around 6pm (18.00) until you went to sleep. Please also mention if anyone was with you for any parts of the evening.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way.
12 PLAYING (INCLUDES CARDS/GAMES)
1=Yes
2=No
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Please tell me the main things that you did yesterday evening from around 6pm (18.00) until you went to sleep. Please also mention if anyone was with you for any parts of the evening.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way.
13 READING
1=Yes
2=No
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Please tell me the main things that you did yesterday evening from around 6pm (18.00) until you went to sleep. Please also mention if anyone was with you for any parts of the evening.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way.
14 LISTENING TO RADIO
1=Yes
2=No
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Please tell me the main things that you did yesterday evening from around 6pm (18.00) until you went to sleep. Please also mention if anyone was with you for any parts of the evening.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way.
15 WATCHING TV
1=Yes
2=No
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Please tell me the main things that you did yesterday evening from around 6pm (18.00) until you went to sleep. Please also mention if anyone was with you for any parts of the evening.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way.
16 EXERCISING OR LEISURELY WALK
1=Yes
2=No
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Please tell me the main things that you did yesterday evening from around 6pm (18.00) until you went to sleep. Please also mention if anyone was with you for any parts of the evening.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way.
17 OTHER LEISURELY ACTIVITY
1=Yes
2=No
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Please tell me the main things that you did yesterday evening from around 6pm (18.00) until you went to sleep. Please also mention if anyone was with you for any parts of the evening.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way.
18 GROOMING OR BATHING
1=Yes
2=No
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Please tell me the main things that you did yesterday evening from around 6pm (18.00) until you went to sleep. Please also mention if anyone was with you for any parts of the evening.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way.
19 EATING
1=Yes
2=No
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Please tell me the main things that you did yesterday evening from around 6pm (18.00) until you went to sleep. Please also mention if anyone was with you for any parts of the evening.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way.
20 RELIGIOUS ACTIVITY
1=Yes
2=No
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Please tell me the main things that you did yesterday evening from around 6pm (18.00) until you went to sleep. Please also mention if anyone was with you for any parts of the evening.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way.
21 PROVIDING CARE TO SOMEONE
1=Yes
2=No
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Please tell me the main things that you did yesterday evening from around 6pm (18.00) until you went to sleep. Please also mention if anyone was with you for any parts of the evening.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way.
22 INTIMATE RELATIONS/SEX
1=Yes
2=No
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Q7100: Activity (Evening)
Please tell me the main things that you did yesterday evening from around 6pm (18.00) until you went to sleep. Please also mention if anyone was with you for any parts of the evening.
Be sure to cover as much as you can remember. You don't have to go in order, but it's probably easier that way.
23 WENT TO SLEEP FOR THE NIGHT
1=Yes
2=No
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
1 Alone
1=Yes
2=No
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
2 Spouse
1=Yes
2=No
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
3 Adult children (aged 18 years and older)
1=Yes
2=No
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
4 Young children or grandchildren
1=Yes
2=No
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
5 Family (other than spouse, children or grandchildren)
1=Yes
2=No
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
6 Friends
1=Yes
2=No
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
7 Co-workers
1=Yes
2=No
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
Q7101: Interacting with (Evening)
87 Other, specify
1=Yes
2=No
Q7104: Worried
Q7104: Worried
Q7104: Worried
Q7104: Worried
Q7104: Worried
Think about how you felt while doing this activity yesterday evening.
How worried were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7105: Rushed
Q7105: Rushed
Q7105: Rushed
Q7105: Rushed
Q7105: Rushed
Think about how you felt while doing this activity yesterday evening.
How rushed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7106: Irritated/angry
Q7106: Irritated/angry
Q7106: Irritated/angry
Q7106: Irritated/angry
Q7106: Irritated/angry
Think about how you felt while doing this activity yesterday evening.
How irritated or angry were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7107: Depressed
Q7107: Depressed
Q7107: Depressed
Q7107: Depressed
Q7107: Depressed
Think about how you felt while doing this activity yesterday evening.
How depressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7108: Tense/stressed
Q7108: Tense/stressed
Q7108: Tense/stressed
Q7108: Tense/stressed
Q7108: Tense/stressed
Think about how you felt while doing this activity yesterday evening.
How tense or stressed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7109: Calm/relaxed
Q7109: Calm/relaxed
Q7109: Calm/relaxed
Q7109: Calm/relaxed
Q7109: Calm/relaxed
Think about how you felt while doing this activity yesterday evening.
How calm or relaxed were you feeling?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
Q7110: Enjoying
Q7110: Enjoying
Q7110: Enjoying
Q7110: Enjoying
Q7110: Enjoying
Think about how you felt while doing this activity yesterday evening.
How much were you enjoying what you were doing?
1 Not at all
2 A little
3 Very much
1
Not at all
2
A little
3
Very much
8
Don't know
9
Not applicable
S8000: HH begin
S8000: HH begin
S8000: HH begin
S8000: HH begin
S8000: HH begin
Time Begin
S8000: MM begin
S8000: MM begin
S8000: MM begin
S8000: MM begin
S8000: MM begin
Time Begin
S8000: HH end
S8000: HH end
S8000: HH end
S8000: HH end
S8000: HH end
Time END
S8000: MM end
S8000: MM end
S8000: MM end
S8000: MM end
S8000: MM end
Time END
Q8001: HIV/AIDS aware?
Q8001: HIV/AIDS aware?
Q8001: HIV/AIDS aware?
Q8001: HIV/AIDS aware?
Q8001: HIV/AIDS aware?
n the following questions, we want to find out about how families and households cope and support each other through prolonged illnesses and death. I would like to spend some time talking to you about people in your household, adults and/or children, who have been ill or died in the last 12 months.
I will ask you a few questions about people in your household who need/needed care, due to illness or other reasons, or have been ill and died in the last 12 months. I would like to know more about any adult and any children and their caregiver in the household. The information you provide will be kept strictly confidential and will be used to improve programs for families and children in need. It is possible that you may feel uncomfortable answering some of the questions. You can choose if you don't want to answer some questions.
I acknowledge that there are many conditions, illnesses and situations that require household members to provide care for other household members. But I will start with a question about a specific condition which often creates a high need for care.
Have you ever heard of an illness called AIDS [or use local term] or a virus called HIV [or use local term]?
1Yes
2No
8 Don't know
1
Yes
2
No
8
Don't know
Q8002: Caregiving?
Q8002: Caregiving?
Q8002: Caregiving?
Q8002: Caregiving?
Q8002: Caregiving?
People who are seriously ill usually need to be given care and assistance. This includes both daily personal care such as help with eating, dressing, bathing, moving around in the house as well as assistance with their affairs outside the house such as transportation to see doctors, going to buy medicine, or managing the ill person's financial situation, health care, emotional well-being or other personal affairs. I want to know who in your household has needed care or support and what level they needed.
Over the last 12 months, have any members of your household, adults or children, needed care or support for any reason? This could include financial, physical, emotional, health or personal care or support.***
1Yes
2 No … Q9001
1
Yes
2
No
8
Don't know
9
Not applicable
Q8003: How many need care
Q8003: How many need care
Q8003: How many need care
Q8003: How many need care
Q8003: How many need care
would like to start with the adults aged 18 and older in your household - and will then ask about children later. This adult may still need care or may no longer be living in the household or may have died as a result of an illness or other reason.
In total, how many adult household (HH) members have needed care or support in the last 12 months?
NTERVIEWER: Using Section 0400 HH Roster from the HH QUESTIONNAIRE - determine who in the household needed caregiving. This may include people who are not currently in the household, but needed care from a HH member in the last 12 months. Start with adults aged 18 and older.
Q8012: Average time [HH]
Q8012: Average time [HH]
Q8012: Average time [HH]
Q8012: Average time [HH]
Q8012: Average time [HH]
As the main or other caregiver in the household, how much time per day on average did/do you usually spend providing care for adults?
hours :minutes
8888 DON'T KNOW
-9
Not applicable
-8
Don't know
88
Don't know
98
Not applicable
Q8012: Average time [MM]
Q8012: Average time [MM]
Q8012: Average time [MM]
Q8012: Average time [MM]
Q8012: Average time [MM]
As the main or other caregiver in the household, how much time per day on average did/do you usually spend providing care for adults?
hours :minutes
8888 DON'T KNOW
-9
Not applicable
-8
Don't know
88
Don't know
98
Not applicable
Q8013: How many contribute
Q8013: How many contribute
Q8013: How many contribute
Q8013: How many contribute
Q8013: How many contribute
How many of these household members, who had a prolonged illness or died in the last 12 months, were contributing an income to the household and now have stopped?
-8
DK
88
Don't know
Q8014: Main economic provider
Q8014: Main economic provider
Q8014: Main economic provider
Q8014: Main economic provider
Q8014: Main economic provider
Was one of these persons (who have/had a prolonged illness or who died) from your household the main income earner?
1Yes
2No
8 Don't know
1
Yes
2
No
8
Don't know
9
Not applicable
Q8015: Assistance
Q8015: Assistance
Q8015: Assistance
Q8015: Assistance
Q8015: Assistance
In relation to providing care and support in the last 12 months, has your household received any help or assistance from outside the household?
1Yes
2No ……………………….Q8018
8 Don't know ….. ..........Q8018
1
Yes
2
No
8
Don't know
9
Not applicable
Q8016: Type of help (single)
Q8016: Type of help (single)
Q8016: Type of help (single)
Q8016: Type of help (single)
Q8016: Type of help (single)
The next few questions ask about what help or assistance you, as a caregiver, received from other people or groups to assist you in providing care.
What kind of support have you, as a caregiver, received?
1Financial, such as cash, paying for bills, fees, food or medicines, clothing or other provisions
2Emotional, like social support, counseling, time with friends
3Health, including providing health care, administering medicines, changing bandages, arranging health care providers
4Physical including household chores, transportation
5Personal care, help with bathing, eating, dressing, toileting, moving around
7 Other, specify:
INTERVIEWER: Read each option and circle all that apply
Q8016: Type of help (single)
Q8016: Type of help (single)
Q8016: Type of help (single)
Q8016: Type of help (single)
Q8016: Type of help (single)
The next few questions ask about what help or assistance you, as a caregiver, received from other people or groups to assist you in providing care.
What kind of support have you, as a caregiver, received?
1Financial, such as cash, paying for bills, fees, food or medicines, clothing or other provisions
2Emotional, like social support, counseling, time with friends
3Health, including providing health care, administering medicines, changing bandages, arranging health care providers
4Physical including household chores, transportation
5Personal care, help with bathing, eating, dressing, toileting, moving around
7 Other, specify:
INTERVIEWER: Read each option and circle all that apply
Q8016: Type of help (single)
Q8016: Type of help (single)
Q8016: Type of help (single)
Q8016: Type of help (single)
Q8016: Type of help (single)
The next few questions ask about what help or assistance you, as a caregiver, received from other people or groups to assist you in providing care.
What kind of support have you, as a caregiver, received?
1Financial, such as cash, paying for bills, fees, food or medicines, clothing or other provisions
2Emotional, like social support, counseling, time with friends
3Health, including providing health care, administering medicines, changing bandages, arranging health care providers
4Physical including household chores, transportation
5Personal care, help with bathing, eating, dressing, toileting, moving around
7 Other, specify:
INTERVIEWER: Read each option and circle all that apply
Q8016: Type of help (single)
Q8016: Type of help (single)
Q8016: Type of help (single)
Q8016: Type of help (single)
Q8016: Type of help (single)
The next few questions ask about what help or assistance you, as a caregiver, received from other people or groups to assist you in providing care.
What kind of support have you, as a caregiver, received?
1Financial, such as cash, paying for bills, fees, food or medicines, clothing or other provisions
2Emotional, like social support, counseling, time with friends
3Health, including providing health care, administering medicines, changing bandages, arranging health care providers
4Physical including household chores, transportation
5Personal care, help with bathing, eating, dressing, toileting, moving around
7 Other, specify:
INTERVIEWER: Read each option and circle all that apply
Q8016: Type of help (single)
Q8016: Type of help (single)
Q8016: Type of help (single)
Q8016: Type of help (single)
Q8016: Type of help (single)
The next few questions ask about what help or assistance you, as a caregiver, received from other people or groups to assist you in providing care.
What kind of support have you, as a caregiver, received?
1Financial, such as cash, paying for bills, fees, food or medicines, clothing or other provisions
2Emotional, like social support, counseling, time with friends
3Health, including providing health care, administering medicines, changing bandages, arranging health care providers
4Physical including household chores, transportation
5Personal care, help with bathing, eating, dressing, toileting, moving around
7 Other, specify:
INTERVIEWER: Read each option and circle all that apply
Q8016: Type of help (single)
Q8016: Type of help (single)
Q8016: Type of help (single)
Q8016: Type of help (single)
Q8016: Type of help (single)
The next few questions ask about what help or assistance you, as a caregiver, received from other people or groups to assist you in providing care.
What kind of support have you, as a caregiver, received?
1Financial, such as cash, paying for bills, fees, food or medicines, clothing or other provisions
2Emotional, like social support, counseling, time with friends
3Health, including providing health care, administering medicines, changing bandages, arranging health care providers
4Physical including household chores, transportation
5Personal care, help with bathing, eating, dressing, toileting, moving around
7 Other, specify:
INTERVIEWER: Read each option and circle all that apply
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Who provided this support or assistance?
Anyone else?
1Family outside household
2Neighbours/community
3Government
4Church
5NGOs
7 Other
8 Don't know
INTERVIEWER: Circle ALL answers that the respondent spontaneously mentions
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Who provided this support or assistance?
Anyone else?
1Family outside household
2Neighbours/community
3Government
4Church
5NGOs
7 Other
8 Don't know
INTERVIEWER: Circle ALL answers that the respondent spontaneously mentions
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Who provided this support or assistance?
Anyone else?
1Family outside household
2Neighbours/community
3Government
4Church
5NGOs
7 Other
8 Don't know
INTERVIEWER: Circle ALL answers that the respondent spontaneously mentions
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Who provided this support or assistance?
Anyone else?
1Family outside household
2Neighbours/community
3Government
4Church
5NGOs
7 Other
8 Don't know
INTERVIEWER: Circle ALL answers that the respondent spontaneously mentions
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Who provided this support or assistance?
Anyone else?
1Family outside household
2Neighbours/community
3Government
4Church
5NGOs
7 Other
8 Don't know
INTERVIEWER: Circle ALL answers that the respondent spontaneously mentions
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Who provided this support or assistance?
Anyone else?
1Family outside household
2Neighbours/community
3Government
4Church
5NGOs
7 Other
8 Don't know
INTERVIEWER: Circle ALL answers that the respondent spontaneously mentions
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Q8017: Who provided help (single)
Who provided this support or assistance?
Anyone else?
1Family outside household
2Neighbours/community
3Government
4Church
5NGOs
7 Other
8 Don't know
INTERVIEWER: Circle ALL answers that the respondent spontaneously mentions
Q8018: Enough sleep
Q8018: Enough sleep
Q8018: Enough sleep
Q8018: Enough sleep
Q8018: Enough sleep
The next questions ask about the impact of providing care on you. I am going to ask whether you face some problems related to your health and well-being since you began providing care for any household members. We want to know how you and your health have been affected by your caregiving duties.
As a result of providing care, or the increase in providing care, over the last 12 months, how much difficulty have you had with:getting enough sleep?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q8019: Enough food
Q8019: Enough food
Q8019: Enough food
Q8019: Enough food
Q8019: Enough food
The next questions ask about the impact of providing care on you. I am going to ask whether you face some problems related to your health and well-being since you began providing care for any household members. We want to know how you and your health have been affected by your caregiving duties.
As a result of providing care, or the increase in providing care, over the last 12 months, how much difficulty have you had with:eating enough food?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q8020: Enough energy
Q8020: Enough energy
Q8020: Enough energy
Q8020: Enough energy
Q8020: Enough energy
The next questions ask about the impact of providing care on you. I am going to ask whether you face some problems related to your health and well-being since you began providing care for any household members. We want to know how you and your health have been affected by your caregiving duties.
As a result of providing care, or the increase in providing care, over the last 12 months, how much difficulty have you had with:having enough energy to do the extra work?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q8021: Taking care of your health
Q8021: Taking care of your health
Q8021: Taking care of your health
Q8021: Taking care of your health
Q8021: Taking care of your health
The next questions ask about the impact of providing care on you. I am going to ask whether you face some problems related to your health and well-being since you began providing care for any household members. We want to know how you and your health have been affected by your caregiving duties.
As a result of providing care, or the increase in providing care, over the last 12 months, how much difficulty have you had with:taking care of your health, ailments or chronic condition (if exist ) - including impact of caregiving on your own health (such as, stress, fatigue, muscle strains, insomnia, anxiety, grief)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q8022: Able to pay for medications/treatments
Q8022: Able to pay for medications/treatments
Q8022: Able to pay for medications/treatments
Q8022: Able to pay for medications/treatments
Q8022: Able to pay for medications/treatments
The next questions ask about the impact of providing care on you. I am going to ask whether you face some problems related to your health and well-being since you began providing care for any household members. We want to know how you and your health have been affected by your caregiving duties.
As a result of providing care, or the increase in providing care, over the last 12 months, how much difficulty have you had with:paying for medication/treatments for your own ailments / chronic conditions?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q0823: Visiting friends
Q0823: Visiting friends
Q0823: Visiting friends
Q0823: Visiting friends
Q0823: Visiting friends
The next questions ask about the impact of providing care on you. I am going to ask whether you face some problems related to your health and well-being since you began providing care for any household members. We want to know how you and your health have been affected by your caregiving duties.
As a result of providing care, or the increase in providing care, over the last 12 months, how much difficulty have you had with:visiting friends and relatives as much as before you were providing this level of care?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q8024: Sharing feelings
Q8024: Sharing feelings
Q8024: Sharing feelings
Q8024: Sharing feelings
Q8024: Sharing feelings
The next questions ask about the impact of providing care on you. I am going to ask whether you face some problems related to your health and well-being since you began providing care for any household members. We want to know how you and your health have been affected by your caregiving duties.
As a result of providing care, or the increase in providing care, over the last 12 months, how much difficulty have you had with:sharing feelings about caregiving responsibility with others?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q0825: Financial
Q0825: Financial
Q0825: Financial
Q0825: Financial
Q0825: Financial
The next questions ask about the impact of providing care on you. I am going to ask whether you face some problems related to your health and well-being since you began providing care for any household members. We want to know how you and your health have been affected by your caregiving duties.
As a result of providing care, or the increase in providing care, over the last 12 months, how much difficulty have you had with:inancial problems due to loss of income, decreased time available for paid employment, or increased costs or expenses?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q8026: Knowledge
Q8026: Knowledge
Q8026: Knowledge
Q8026: Knowledge
Q8026: Knowledge
The next questions ask about the impact of providing care on you. I am going to ask whether you face some problems related to your health and well-being since you began providing care for any household members. We want to know how you and your health have been affected by your caregiving duties.
As a result of providing care, or the increase in providing care, over the last 12 months, how much difficulty have you had with:knowing the correct care to provide for health problems for this person(s) (for example, knowing the best treatment, getting access to medicines (like anti-retrovirals), knowing how to protect yourself, as the caregiver, from getting the illness/disease)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q8027: Stigma
Q8027: Stigma
Q8027: Stigma
Q8027: Stigma
Q8027: Stigma
The next questions ask about the impact of providing care on you. I am going to ask whether you face some problems related to your health and well-being since you began providing care for any household members. We want to know how you and your health have been affected by your caregiving duties.
As a result of providing care, or the increase in providing care, over the last 12 months, how much difficulty have you had with:experiencing stigma or problems as a result of or associated with the illness or death (that is, have you been treated differently or poorly by the community, friends or family members outside your household)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q8028: Care for children?
Q8028: Care for children?
Q8028: Care for children?
Q8028: Care for children?
Q8028: Care for children?
Caregiving to children in the household
The following questions ask about care you provide or have provided to children in the household over the last 12 months - specifically care provided to children aged 15 years or younger for whom one or both parents are ill or absent (prolonged illness or absent through death or migration or other reason). Care could be related to physical care, health care, financial support or other reasons, where you are responsible for the well-being of the child/children.
Has anyone in your household provided care for any child aged 15 or under in the household in the last 12 months?
1Yes
2 No....Q8047
1
Yes
2
No
8
Don't know
9
Not applicable
Q8028a: How many children
Q8028a: How many children
Q8028a: How many children
Q8028a: How many children
Q8028a: How many children
Caregiving to children in the household
The following questions ask about care you provide or have provided to children in the household over the last 12 months - specifically care provided to children aged 15 years or younger for whom one or both parents are ill or absent (prolonged illness or absent through death or migration or other reason). Care could be related to physical care, health care, financial support or other reasons, where you are responsible for the well-being of the child/children.
In total, how many child household (HH) members have needed care or support in the last 12 months?
-9
Not applicable
-8
Don't know
1
One child
2
Two children
3
Three children
Q8033: Time in child care [HH]
Q8033: Time in child care [HH]
Q8033: Time in child care [HH]
Q8033: Time in child care [HH]
Q8033: Time in child care [HH]
The following questions ask about the time involved with care you provide to children and if you, as the caregiver, receive any assistance.
As the main or other caregiver in the household, how much time per day on average did/do you usually spend providing care for children?
hours :minutes 8888 DON'T KNOW
-9
Not applicable
-8
Don't know
88
Don't know
98
Not applicable
Q8033: Time in child care [MM]
Q8033: Time in child care [MM]
Q8033: Time in child care [MM]
Q8033: Time in child care [MM]
Q8033: Time in child care [MM]
The following questions ask about the time involved with care you provide to children and if you, as the caregiver, receive any assistance.
As the main or other caregiver in the household, how much time per day on average did/do you usually spend providing care for children?
hours :minutes 8888 DON'T KNOW
-9
Not applicable
-8
Don't know
88
Don't know
98
Not applicable
Q8034: Support from outside HH
Q8034: Support from outside HH
Q8034: Support from outside HH
Q8034: Support from outside HH
Q8034: Support from outside HH
The following questions ask about the time involved with care you provide to children and if you, as the caregiver, receive any assistance.
n relation to providing care and support in the last 12 months, has your household received any help or assistance from outside the household?
1Yes
2No ………………………Q8037
8 Don't know .........Q8037
1
Yes
2
No
8
Don't know
9
Not applicable
Q8035: Help received (single)
Q8035: Help received (single)
Q8035: Help received (single)
Q8035: Help received (single)
Q8035: Help received (single)
The next few questions ask about what help or assistance you, as a caregiver, received from other people or groups to assist you in providing care for the child/children.
What kind of help have you, as a caregiver, received?
1Financial, such as cash, paying for bills, fees, food or medicines, clothing or other provisions
2Emotional, like social support, counseling, time with friends
3Health, including providing health care, administering medicines, changing bandages, arranging health care providers
4Physical including household chores, transportation
5Personal care, help with bathing, eating, dressing, toileting, moving around
7 Other, specify:
INTERVIEWER: Read each option and circle all that apply
Q8035: Help received (single)
Q8035: Help received (single)
Q8035: Help received (single)
Q8035: Help received (single)
Q8035: Help received (single)
The next few questions ask about what help or assistance you, as a caregiver, received from other people or groups to assist you in providing care for the child/children.
What kind of help have you, as a caregiver, received?
1Financial, such as cash, paying for bills, fees, food or medicines, clothing or other provisions
2Emotional, like social support, counseling, time with friends
3Health, including providing health care, administering medicines, changing bandages, arranging health care providers
4Physical including household chores, transportation
5Personal care, help with bathing, eating, dressing, toileting, moving around
7 Other, specify:
INTERVIEWER: Read each option and circle all that apply
Q8035: Help received (single)
Q8035: Help received (single)
Q8035: Help received (single)
Q8035: Help received (single)
Q8035: Help received (single)
The next few questions ask about what help or assistance you, as a caregiver, received from other people or groups to assist you in providing care for the child/children.
What kind of help have you, as a caregiver, received?
1Financial, such as cash, paying for bills, fees, food or medicines, clothing or other provisions
2Emotional, like social support, counseling, time with friends
3Health, including providing health care, administering medicines, changing bandages, arranging health care providers
4Physical including household chores, transportation
5Personal care, help with bathing, eating, dressing, toileting, moving around
7 Other, specify:
INTERVIEWER: Read each option and circle all that apply
Q8035: Help received (single)
Q8035: Help received (single)
Q8035: Help received (single)
Q8035: Help received (single)
Q8035: Help received (single)
The next few questions ask about what help or assistance you, as a caregiver, received from other people or groups to assist you in providing care for the child/children.
What kind of help have you, as a caregiver, received?
1Financial, such as cash, paying for bills, fees, food or medicines, clothing or other provisions
2Emotional, like social support, counseling, time with friends
3Health, including providing health care, administering medicines, changing bandages, arranging health care providers
4Physical including household chores, transportation
5Personal care, help with bathing, eating, dressing, toileting, moving around
7 Other, specify:
INTERVIEWER: Read each option and circle all that apply
Q8035: Help received (single)
Q8035: Help received (single)
Q8035: Help received (single)
Q8035: Help received (single)
Q8035: Help received (single)
The next few questions ask about what help or assistance you, as a caregiver, received from other people or groups to assist you in providing care for the child/children.
What kind of help have you, as a caregiver, received?
1Financial, such as cash, paying for bills, fees, food or medicines, clothing or other provisions
2Emotional, like social support, counseling, time with friends
3Health, including providing health care, administering medicines, changing bandages, arranging health care providers
4Physical including household chores, transportation
5Personal care, help with bathing, eating, dressing, toileting, moving around
7 Other, specify:
INTERVIEWER: Read each option and circle all that apply
Q8035: Help received (single)
Q8035: Help received (single)
Q8035: Help received (single)
Q8035: Help received (single)
Q8035: Help received (single)
The next few questions ask about what help or assistance you, as a caregiver, received from other people or groups to assist you in providing care for the child/children.
What kind of help have you, as a caregiver, received?
1Financial, such as cash, paying for bills, fees, food or medicines, clothing or other provisions
2Emotional, like social support, counseling, time with friends
3Health, including providing health care, administering medicines, changing bandages, arranging health care providers
4Physical including household chores, transportation
5Personal care, help with bathing, eating, dressing, toileting, moving around
7 Other, specify:
INTERVIEWER: Read each option and circle all that apply
Q8036: Who provided help (single)
Q8036: Who provided help (single)
Q8036: Who provided help (single)
Q8036: Who provided help (single)
Q8036: Who provided help (single)
The next few questions ask about what help or assistance you, as a caregiver, received from other people or groups to assist you in providing care for the child/children.
Who provided this help or assistance?
Anyone else?
1Family outside household
2Neighbours/community
3Government
4Church
5NGOs
7 Other
8 Don't know
INTERVIEWER: Circle ALL answers that the respondent spontaneously mentions
Q8036: Who provided help (single)
Q8036: Who provided help (single)
Q8036: Who provided help (single)
Q8036: Who provided help (single)
Q8036: Who provided help (single)
The next few questions ask about what help or assistance you, as a caregiver, received from other people or groups to assist you in providing care for the child/children.
Who provided this help or assistance?
Anyone else?
1Family outside household
2Neighbours/community
3Government
4Church
5NGOs
7 Other
8 Don't know
INTERVIEWER: Circle ALL answers that the respondent spontaneously mentions
Q8036: Who provided help (single)
Q8036: Who provided help (single)
Q8036: Who provided help (single)
Q8036: Who provided help (single)
Q8036: Who provided help (single)
The next few questions ask about what help or assistance you, as a caregiver, received from other people or groups to assist you in providing care for the child/children.
Who provided this help or assistance?
Anyone else?
1Family outside household
2Neighbours/community
3Government
4Church
5NGOs
7 Other
8 Don't know
INTERVIEWER: Circle ALL answers that the respondent spontaneously mentions
Q8036: Who provided help (single)
Q8036: Who provided help (single)
Q8036: Who provided help (single)
Q8036: Who provided help (single)
Q8036: Who provided help (single)
The next few questions ask about what help or assistance you, as a caregiver, received from other people or groups to assist you in providing care for the child/children.
Who provided this help or assistance?
Anyone else?
1Family outside household
2Neighbours/community
3Government
4Church
5NGOs
7 Other
8 Don't know
INTERVIEWER: Circle ALL answers that the respondent spontaneously mentions
Q8036: Who provided help (single)
Q8036: Who provided help (single)
Q8036: Who provided help (single)
Q8036: Who provided help (single)
Q8036: Who provided help (single)
The next few questions ask about what help or assistance you, as a caregiver, received from other people or groups to assist you in providing care for the child/children.
Who provided this help or assistance?
Anyone else?
1Family outside household
2Neighbours/community
3Government
4Church
5NGOs
7 Other
8 Don't know
INTERVIEWER: Circle ALL answers that the respondent spontaneously mentions
Q8036: Who provided help (single)
Q8036: Who provided help (single)
Q8036: Who provided help (single)
Q8036: Who provided help (single)
Q8036: Who provided help (single)
The next few questions ask about what help or assistance you, as a caregiver, received from other people or groups to assist you in providing care for the child/children.
Who provided this help or assistance?
Anyone else?
1Family outside household
2Neighbours/community
3Government
4Church
5NGOs
7 Other
8 Don't know
INTERVIEWER: Circle ALL answers that the respondent spontaneously mentions
Q8036: Who provided help (single)
Q8036: Who provided help (single)
Q8036: Who provided help (single)
Q8036: Who provided help (single)
Q8036: Who provided help (single)
The next few questions ask about what help or assistance you, as a caregiver, received from other people or groups to assist you in providing care for the child/children.
Who provided this help or assistance?
Anyone else?
1Family outside household
2Neighbours/community
3Government
4Church
5NGOs
7 Other
8 Don't know
INTERVIEWER: Circle ALL answers that the respondent spontaneously mentions
Q8037: Enough sleep
Q8037: Enough sleep
Q8037: Enough sleep
Q8037: Enough sleep
Q8037: Enough sleep
The next questions ask about the impact of providing care on you. I am going to ask whether you face some problems related to your health and well-being since you began providing care for any household members. We want to know how you and your health have been affected by your caregiving duties
As a result of providing care, or the increase in providing care, over the last 12 months, how much difficulty have you had with:getting enough sleep?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q8038: Enough food
Q8038: Enough food
Q8038: Enough food
Q8038: Enough food
Q8038: Enough food
The next questions ask about the impact of providing care on you. I am going to ask whether you face some problems related to your health and well-being since you began providing care for any household members. We want to know how you and your health have been affected by your caregiving duties
As a result of providing care, or the increase in providing care, over the last 12 months, how much difficulty have you had with:eating enough food?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q8039: Enough energy
Q8039: Enough energy
Q8039: Enough energy
Q8039: Enough energy
Q8039: Enough energy
The next questions ask about the impact of providing care on you. I am going to ask whether you face some problems related to your health and well-being since you began providing care for any household members. We want to know how you and your health have been affected by your caregiving duties
As a result of providing care, or the increase in providing care, over the last 12 months, how much difficulty have you had with:…having enough energy to do the extra work?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q8040: Taking care of your health
Q8040: Taking care of your health
Q8040: Taking care of your health
Q8040: Taking care of your health
Q8040: Taking care of your health
The next questions ask about the impact of providing care on you. I am going to ask whether you face some problems related to your health and well-being since you began providing care for any household members. We want to know how you and your health have been affected by your caregiving duties
As a result of providing care, or the increase in providing care, over the last 12 months, how much difficulty have you had with:taking care of your health, ailments or chronic condition (if exist ) - including impact of caregiving on your own health (such as, stress, fatigue, muscle strains, insomnia, anxiety, grief)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q8041: Able to pay for medications/treatments
Q8041: Able to pay for medications/treatments
Q8041: Able to pay for medications/treatments
Q8041: Able to pay for medications/treatments
Q8041: Able to pay for medications/treatments
The next questions ask about the impact of providing care on you. I am going to ask whether you face some problems related to your health and well-being since you began providing care for any household members. We want to know how you and your health have been affected by your caregiving duties
As a result of providing care, or the increase in providing care, over the last 12 months, how much difficulty have you had with:paying for medication/treatments for your own ailments / chronic conditions?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q0842: Visiting friends
Q0842: Visiting friends
Q0842: Visiting friends
Q0842: Visiting friends
Q0842: Visiting friends
The next questions ask about the impact of providing care on you. I am going to ask whether you face some problems related to your health and well-being since you began providing care for any household members. We want to know how you and your health have been affected by your caregiving duties
As a result of providing care, or the increase in providing care, over the last 12 months, how much difficulty have you had with:visiting friends and relatives as much as before you were providing this level of care?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q8043: Sharing feelings
Q8043: Sharing feelings
Q8043: Sharing feelings
Q8043: Sharing feelings
Q8043: Sharing feelings
The next questions ask about the impact of providing care on you. I am going to ask whether you face some problems related to your health and well-being since you began providing care for any household members. We want to know how you and your health have been affected by your caregiving duties
As a result of providing care, or the increase in providing care, over the last 12 months, how much difficulty have you had with:sharing feelings about caregiving responsibility with others?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q0844: Financial
Q0844: Financial
Q0844: Financial
Q0844: Financial
Q0844: Financial
The next questions ask about the impact of providing care on you. I am going to ask whether you face some problems related to your health and well-being since you began providing care for any household members. We want to know how you and your health have been affected by your caregiving duties
As a result of providing care, or the increase in providing care, over the last 12 months, how much difficulty have you had with:financial problems due to loss of income, decreased time available for paid employment, or increased costs or expenses?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q8045: Knowledge
Q8045: Knowledge
Q8045: Knowledge
Q8045: Knowledge
Q8045: Knowledge
The next questions ask about the impact of providing care on you. I am going to ask whether you face some problems related to your health and well-being since you began providing care for any household members. We want to know how you and your health have been affected by your caregiving duties
As a result of providing care, or the increase in providing care, over the last 12 months, how much difficulty have you had with:knowing and providing the correct care for health problems for this person(s) (for example, knowing the best treatment, getting access to medicines (like anti-retrovirals), knowing how to protect yourself, as the caregiver, from getting the illness/disease)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q8046: Stigma
Q8046: Stigma
Q8046: Stigma
Q8046: Stigma
Q8046: Stigma
The next questions ask about the impact of providing care on you. I am going to ask whether you face some problems related to your health and well-being since you began providing care for any household members. We want to know how you and your health have been affected by your caregiving duties
As a result of providing care, or the increase in providing care, over the last 12 months, how much difficulty have you had with:experiencing stigma or problems as a result of or associated with the illness or death (that is, have you been treated differently or poorly by the community, friends or family members outside your household)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
Q8047: Your access to health care
Q8047: Your access to health care
Q8047: Your access to health care
Q8047: Your access to health care
Q8047: Your access to health care
One final question about the impact of caregiving on your health.
Think about the care you have given to the ill household member(s) or to the orphaned child(ren) in your home over the last 12 months and think about your own health.
Because of this caregiving, how often have you been going to seek medical care or consultation or check ups for your own health? Have you been going more than you used to, less than you used or has it stayed about the same?
1More than used to
2About the same
3 Less than used to
1
More
2
Same
3
Less
8
Don't know
9
Not applicable
Q8004: Member number
Q8004: Member number
Q8004: Member number
Q8004: Member number
Q8004: Member number
Please tell me about the adults needing and receiving care.
Person (HH member) number from Section 0400: HH Roster - or row number from WHS HH roster. For adults not on either roster, enter 66, 67, 68 or 69.
Q8005: Alive or dead?
Q8005: Alive or dead?
Q8005: Alive or dead?
Q8005: Alive or dead?
Q8005: Alive or dead?
Is this adult alive or dead?
1 = alive; 2 = dead
1
Alive
2
Dead
8
Don't know
9
Not applicable
Q8005a: Relationship
Q8005a: Relationship
Q8005a: Relationship
Q8005a: Relationship
Q8005a: Relationship
What is your relationship to this person? The person is/was your…
02=Spouse/partner;
03=Daughter/Son;
04=Daughter- or Son-in-law;
05=Grandchild;
06=Parent;
07=Parent-in-law;
08=Brother/Sister;
11= Other relative, adult (e.g. cousin);
12=Not related, Adult
-9
Not applicable
-8
Don't know
2
Spouse
3
Son or daughter
4
Son- or daughter-in-law
5
Grandchild
6
Parent
7
Parent-in-law
8
Sibling (brother or sister)
11
Other relative
12
Not related
Q8006: Reason needing care/why dead?
Q8006: Reason needing care/why dead?
Q8006: Reason needing care/why dead?
Q8006: Reason needing care/why dead?
Q8006: Reason needing care/why dead?
Why does/did this person need care or support?* OR
Why did this person die?*
01 = HIV/AIDS related
02 = Other health-related reason
87 = Other reason (not health-related)
-9
NA
-8
DK
1
HIV-related
2
Other health related
87
Other reason
88
Don't know
98
Not applicable
Q8007: Main care provider
Q8007: Main care provider
Q8007: Main care provider
Q8007: Main care provider
Q8007: Main care provider
Who is or was the main person providing care for this adult? Is it you yourself, someone else in this household, or someone outside of this household?**
1=Respondent ..…è Q8009
2=Someone else in HH
3=Someone outside HH
1
Respondent
2
Other HH member
3
Other outside HH
8
Don't know
9
Not applicable
Q8008: Other care provider
Q8008: Other care provider
Q8008: Other care provider
Q8008: Other care provider
Q8008: Other care provider
Even if you were not the main caregiver, did/do you provide care or support to this person?
1=Yes
2=No .…è next person or Q8013 if last person.
1
Yes
2
No
8
Don't know
9
Not applicable
Q8009: Duration of caregiving
Q8009: Duration of caregiving
Q8009: Duration of caregiving
Q8009: Duration of caregiving
Q8009: Duration of caregiving
For how long have/had you been providing care? (over the last 12 months)
1 = Less than 30 days
2 = 1 to 3 months
3 = More than 3 months but less than 6 months
4 = 6 months or more
1
less than 30 days
2
1 to 3 months
3
3 mos. < time < 6 mos.
4
6 months or more
8
Don't know
9
Not applicable
Q8010: Type of care
Q8010: Type of care
Q8010: Type of care
Q8010: Type of care
Q8010: Type of care
What type of care or support is/was provided?
1 = Financial
2 = Social/Emotional
3 = Health
4 = Physical
5 = Personal
INTERVIEWER: Circle all that apply
INTERVIEWER: If Q8010 includes "5=Personal care", answer Q8011. If not, go to next person, or if last person, go to Q8012
Q8010: Type of care
Q8010: Type of care
Q8010: Type of care
Q8010: Type of care
Q8010: Type of care
What type of care or support is/was provided?
1 = Financial
2 = Social/Emotional
3 = Health
4 = Physical
5 = Personal
INTERVIEWER: Circle all that apply
INTERVIEWER: If Q8010 includes "5=Personal care", answer Q8011. If not, go to next person, or if last person, go to Q8012
Q8010: Type of care
Q8010: Type of care
Q8010: Type of care
Q8010: Type of care
Q8010: Type of care
What type of care or support is/was provided?
1 = Financial
2 = Social/Emotional
3 = Health
4 = Physical
5 = Personal
INTERVIEWER: Circle all that apply
INTERVIEWER: If Q8010 includes "5=Personal care", answer Q8011. If not, go to next person, or if last person, go to Q8012
Q8010: Type of care
Q8010: Type of care
Q8010: Type of care
Q8010: Type of care
Q8010: Type of care
What type of care or support is/was provided?
1 = Financial
2 = Social/Emotional
3 = Health
4 = Physical
5 = Personal
INTERVIEWER: Circle all that apply
INTERVIEWER: If Q8010 includes "5=Personal care", answer Q8011. If not, go to next person, or if last person, go to Q8012
Q8010: Type of care
Q8010: Type of care
Q8010: Type of care
Q8010: Type of care
Q8010: Type of care
What type of care or support is/was provided?
1 = Financial
2 = Social/Emotional
3 = Health
4 = Physical
5 = Personal
INTERVIEWER: Circle all that apply
INTERVIEWER: If Q8010 includes "5=Personal care", answer Q8011. If not, go to next person, or if last person, go to Q8012
Q8011: Personal care
Q8011: Personal care
Q8011: Personal care
Q8011: Personal care
Q8011: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8011: Personal care
Q8011: Personal care
Q8011: Personal care
Q8011: Personal care
Q8011: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8011: Personal care
Q8011: Personal care
Q8011: Personal care
Q8011: Personal care
Q8011: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8011: Personal care
Q8011: Personal care
Q8011: Personal care
Q8011: Personal care
Q8011: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8011: Personal care
Q8011: Personal care
Q8011: Personal care
Q8011: Personal care
Q8011: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8011: Personal care
Q8011: Personal care
Q8011: Personal care
Q8011: Personal care
Q8011: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8004B: Member number
Q8004B: Member number
Q8004B: Member number
Q8004B: Member number
Q8004B: Member number
Please tell me about the adults needing and receiving care.
Person (HH member) number from Section 0400: HH Roster - or row number from WHS HH roster. For adults not on either roster, enter 66, 67, 68 or 69.
Q8005B: Alive or dead?
Q8005B: Alive or dead?
Q8005B: Alive or dead?
Q8005B: Alive or dead?
Q8005B: Alive or dead?
Is this adult alive or dead?
1 = alive; 2 = dead
1
Alive
2
Dead
8
Don't know
9
Not applicable
Q8005aB: Relationship
Q8005aB: Relationship
Q8005aB: Relationship
Q8005aB: Relationship
Q8005aB: Relationship
What is your relationship to this person? The person is/was your…
02=Spouse/partner;
03=Daughter/Son;
04=Daughter- or Son-in-law;
05=Grandchild;
06=Parent;
07=Parent-in-law;
08=Brother/Sister;
11= Other relative, adult (e.g. cousin);
12=Not related, Adult
-9
Not applicable
-8
Don't know
2
Spouse
3
Son or daughter
4
Son- or daughter-in-law
5
Grandchild
6
Parent
7
Parent-in-law
8
Sibling (brother or sister)
11
Other relative
12
Not related
Q8006B: Reason needing care/why dead?
Q8006B: Reason needing care/why dead?
Q8006B: Reason needing care/why dead?
Q8006B: Reason needing care/why dead?
Q8006B: Reason needing care/why dead?
Why does/did this person need care or support?* OR
Why did this person die?*
01 = HIV/AIDS related
02 = Other health-related reason
87 = Other reason (not health-related)
-9
NA
-8
DK
1
HIV-related
2
Other health related
87
Other reason
88
Don't know
98
Not applicable
Q8007B: Main care provider
Q8007B: Main care provider
Q8007B: Main care provider
Q8007B: Main care provider
Q8007B: Main care provider
Who is or was the main person providing care for this adult? Is it you yourself, someone else in this household, or someone outside of this household?**
1=Respondent ..…è Q8009
2=Someone else in HH
3=Someone outside HH
1
Respondent
2
Other HH member
3
Other outside HH
8
Don't know
9
Not applicable
Q8008B: Other care provider
Q8008B: Other care provider
Q8008B: Other care provider
Q8008B: Other care provider
Q8008B: Other care provider
Even if you were not the main caregiver, did/do you provide care or support to this person?
1=Yes
2=No .…è next person or Q8013 if last person.
1
Yes
2
No
8
Don't know
9
Not applicable
Q8009B: Duration of caregiving
Q8009B: Duration of caregiving
Q8009B: Duration of caregiving
Q8009B: Duration of caregiving
Q8009B: Duration of caregiving
For how long have/had you been providing care? (over the last 12 months)
1 = Less than 30 days
2 = 1 to 3 months
3 = More than 3 months but less than 6 months
4 = 6 months or more
1
less than 30 days
2
1 to 3 months
3
3 mos. < time < 6 mos.
4
6 months or more
8
Don't know
9
Not applicable
Q8010B: Type of care
Q8010B: Type of care
Q8010B: Type of care
Q8010B: Type of care
Q8010B: Type of care
What type of care or support is/was provided?What type of care or support is/was provided?
1 = Financial
2 = Social/Emotional
3 = Health
4 = Physical
5 = Personal
INTERVIEWER: Circle all that apply
INTERVIEWER: If Q8010 includes "5=Personal care", answer Q8011. If not, go to next person, or if last person, go to Q8012
Q8010B: Type of care
Q8010B: Type of care
Q8010B: Type of care
Q8010B: Type of care
Q8010B: Type of care
What type of care or support is/was provided?What type of care or support is/was provided?
1 = Financial
2 = Social/Emotional
3 = Health
4 = Physical
5 = Personal
INTERVIEWER: Circle all that apply
INTERVIEWER: If Q8010 includes "5=Personal care", answer Q8011. If not, go to next person, or if last person, go to Q8012
Q8010B: Type of care
Q8010B: Type of care
Q8010B: Type of care
Q8010B: Type of care
Q8010B: Type of care
What type of care or support is/was provided?What type of care or support is/was provided?
1 = Financial
2 = Social/Emotional
3 = Health
4 = Physical
5 = Personal
INTERVIEWER: Circle all that apply
INTERVIEWER: If Q8010 includes "5=Personal care", answer Q8011. If not, go to next person, or if last person, go to Q8012
Q8010B: Type of care
Q8010B: Type of care
Q8010B: Type of care
Q8010B: Type of care
Q8010B: Type of care
What type of care or support is/was provided?What type of care or support is/was provided?
1 = Financial
2 = Social/Emotional
3 = Health
4 = Physical
5 = Personal
INTERVIEWER: Circle all that apply
INTERVIEWER: If Q8010 includes "5=Personal care", answer Q8011. If not, go to next person, or if last person, go to Q8012
Q8010B: Type of care
Q8010B: Type of care
Q8010B: Type of care
Q8010B: Type of care
Q8010B: Type of care
What type of care or support is/was provided?What type of care or support is/was provided?
1 = Financial
2 = Social/Emotional
3 = Health
4 = Physical
5 = Personal
INTERVIEWER: Circle all that apply
INTERVIEWER: If Q8010 includes "5=Personal care", answer Q8011. If not, go to next person, or if last person, go to Q8012
Q8011B: Personal care
Q8011B: Personal care
Q8011B: Personal care
Q8011B: Personal care
Q8011B: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8011B: Personal care
Q8011B: Personal care
Q8011B: Personal care
Q8011B: Personal care
Q8011B: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8011B: Personal care
Q8011B: Personal care
Q8011B: Personal care
Q8011B: Personal care
Q8011B: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8011B: Personal care
Q8011B: Personal care
Q8011B: Personal care
Q8011B: Personal care
Q8011B: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8011B: Personal care
Q8011B: Personal care
Q8011B: Personal care
Q8011B: Personal care
Q8011B: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8011B: Personal care
Q8011B: Personal care
Q8011B: Personal care
Q8011B: Personal care
Q8011B: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8004C: Member number
Q8004C: Member number
Q8004C: Member number
Q8004C: Member number
Q8004C: Member number
Please tell me about the adults needing and receiving care.
Person (HH member) number from Section 0400: HH Roster - or row number from WHS HH roster. For adults not on either roster, enter 66, 67, 68 or 69.
Q8005C: Alive or dead?
Q8005C: Alive or dead?
Q8005C: Alive or dead?
Q8005C: Alive or dead?
Q8005C: Alive or dead?
Is this adult alive or dead?
1 = alive; 2 = dead
1
Alive
2
Dead
8
Don't know
9
Not applicable
Q8005aC: Relationship
Q8005aC: Relationship
Q8005aC: Relationship
Q8005aC: Relationship
Q8005aC: Relationship
What is your relationship to this person? The person is/was your…
02=Spouse/partner;
03=Daughter/Son;
04=Daughter- or Son-in-law;
05=Grandchild;
06=Parent;
07=Parent-in-law;
08=Brother/Sister;
11= Other relative, adult (e.g. cousin);
12=Not related, Adult
-9
Not applicable
-8
Don't know
2
Spouse
3
Son or daughter
4
Son- or daughter-in-law
5
Grandchild
6
Parent
7
Parent-in-law
8
Sibling (brother or sister)
11
Other relative
12
Not related
Q8006C: Reason needing care/why dead?
Q8006C: Reason needing care/why dead?
Q8006C: Reason needing care/why dead?
Q8006C: Reason needing care/why dead?
Q8006C: Reason needing care/why dead?
Why does/did this person need care or support?* OR
Why did this person die?*
01 = HIV/AIDS related
02 = Other health-related reason
87 = Other reason (not health-related)
-9
NA
-8
DK
1
HIV-related
2
Other health related
87
Other reason
88
Don't know
98
Not applicable
Q8007C: Main care provider
Q8007C: Main care provider
Q8007C: Main care provider
Q8007C: Main care provider
Q8007C: Main care provider
Who is or was the main person providing care for this adult? Is it you yourself, someone else in this household, or someone outside of this household?**
1=Respondent ..…è Q8009
2=Someone else in HH
3=Someone outside HH
1
Respondent
2
Other HH member
3
Other outside HH
8
Don't know
9
Not applicable
Q8008C: Other care provider
Q8008C: Other care provider
Q8008C: Other care provider
Q8008C: Other care provider
Q8008C: Other care provider
Even if you were not the main caregiver, did/do you provide care or support to this person?
1=Yes
2=No .…è next person or Q8013 if last person.
1
Yes
2
No
8
Don't know
9
Not applicable
Q8009C: Duration of caregiving
Q8009C: Duration of caregiving
Q8009C: Duration of caregiving
Q8009C: Duration of caregiving
Q8009C: Duration of caregiving
For how long have/had you been providing care? (over the last 12 months)
1 = Less than 30 days
2 = 1 to 3 months
3 = More than 3 months but less than 6 months
4 = 6 months or more
1
less than 30 days
2
1 to 3 months
3
3 mos. < time < 6 mos.
4
6 months or more
8
Don't know
9
Not applicable
Q8010C: Type of care
Q8010C: Type of care
Q8010C: Type of care
Q8010C: Type of care
Q8010C: Type of care
What type of care or support is/was provided?What type of care or support is/was provided?
1 = Financial
2 = Social/Emotional
3 = Health
4 = Physical
5 = Personal
INTERVIEWER: Circle all that apply
Q8010C: Type of care
Q8010C: Type of care
Q8010C: Type of care
Q8010C: Type of care
Q8010C: Type of care
What type of care or support is/was provided?What type of care or support is/was provided?
1 = Financial
2 = Social/Emotional
3 = Health
4 = Physical
5 = Personal
INTERVIEWER: Circle all that apply
Q8010C: Type of care
Q8010C: Type of care
Q8010C: Type of care
Q8010C: Type of care
Q8010C: Type of care
What type of care or support is/was provided?What type of care or support is/was provided?
1 = Financial
2 = Social/Emotional
3 = Health
4 = Physical
5 = Personal
INTERVIEWER: Circle all that apply
Q8010C: Type of care
Q8010C: Type of care
Q8010C: Type of care
Q8010C: Type of care
Q8010C: Type of care
What type of care or support is/was provided?What type of care or support is/was provided?
1 = Financial
2 = Social/Emotional
3 = Health
4 = Physical
5 = Personal
INTERVIEWER: Circle all that apply
Q8010C: Type of care
Q8010C: Type of care
Q8010C: Type of care
Q8010C: Type of care
Q8010C: Type of care
What type of care or support is/was provided?What type of care or support is/was provided?
1 = Financial
2 = Social/Emotional
3 = Health
4 = Physical
5 = Personal
INTERVIEWER: Circle all that apply
Q8011C: Personal care
Q8011C: Personal care
Q8011C: Personal care
Q8011C: Personal care
Q8011C: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8011C: Personal care
Q8011C: Personal care
Q8011C: Personal care
Q8011C: Personal care
Q8011C: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8011C: Personal care
Q8011C: Personal care
Q8011C: Personal care
Q8011C: Personal care
Q8011C: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8011C: Personal care
Q8011C: Personal care
Q8011C: Personal care
Q8011C: Personal care
Q8011C: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8011C: Personal care
Q8011C: Personal care
Q8011C: Personal care
Q8011C: Personal care
Q8011C: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8011C: Personal care
Q8011C: Personal care
Q8011C: Personal care
Q8011C: Personal care
Q8011C: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8004D: Member number
Q8004D: Member number
Q8004D: Member number
Q8004D: Member number
Q8004D: Member number
Please tell me about the adults needing and receiving care.
Person (HH member) number from Section 0400: HH Roster - or row number from WHS HH roster. For adults not on either roster, enter 66, 67, 68 or 69.
Q8005D: Alive or dead?
Q8005D: Alive or dead?
Q8005D: Alive or dead?
Q8005D: Alive or dead?
Q8005D: Alive or dead?
Is this adult alive or dead?
1 = alive; 2 = dead
1
Alive
2
Dead
8
Don't know
9
Not applicable
Q8005aD: Relationship
Q8005aD: Relationship
Q8005aD: Relationship
Q8005aD: Relationship
Q8005aD: Relationship
What is your relationship to this person? The person is/was your…
02=Spouse/partner;
03=Daughter/Son;
04=Daughter- or Son-in-law;
05=Grandchild;
06=Parent;
07=Parent-in-law;
08=Brother/Sister;
11= Other relative, adult (e.g. cousin);
12=Not related, Adult
-9
Not applicable
-8
Don't know
2
Spouse
3
Son or daughter
4
Son- or daughter-in-law
5
Grandchild
6
Parent
7
Parent-in-law
8
Sibling (brother or sister)
11
Other relative
12
Not related
Q8006D: Reason needing care/why dead?
Q8006D: Reason needing care/why dead?
Q8006D: Reason needing care/why dead?
Q8006D: Reason needing care/why dead?
Q8006D: Reason needing care/why dead?
Why does/did this person need care or support?* OR
Why did this person die?*
01 = HIV/AIDS related
02 = Other health-related reason
87 = Other reason (not health-related)
-9
NA
-8
DK
1
HIV-related
2
Other health related
87
Other reason
88
Don't know
98
Not applicable
Q8007D: Main care provider
Q8007D: Main care provider
Q8007D: Main care provider
Q8007D: Main care provider
Q8007D: Main care provider
Who is or was the main person providing care for this adult? Is it you yourself, someone else in this household, or someone outside of this household?**
1=Respondent ..…è Q8009
2=Someone else in HH
3=Someone outside HH
1
Respondent
2
Other HH member
3
Other outside HH
8
Don't know
9
Not applicable
Q8008D: Other care provider
Q8008D: Other care provider
Q8008D: Other care provider
Q8008D: Other care provider
Q8008D: Other care provider
Even if you were not the main caregiver, did/do you provide care or support to this person?
1=Yes
2=No .…è next person or Q8013 if last person.
1
Yes
2
No
8
Don't know
9
Not applicable
Q8009D: Duration of caregiving
Q8009D: Duration of caregiving
Q8009D: Duration of caregiving
Q8009D: Duration of caregiving
Q8009D: Duration of caregiving
For how long have/had you been providing care? (over the last 12 months)
1 = Less than 30 days
2 = 1 to 3 months
3 = More than 3 months but less than 6 months
4 = 6 months or more
1
less than 30 days
2
1 to 3 months
3
3 mos. < time < 6 mos.
4
6 months or more
8
Don't know
9
Not applicable
Q8010D: Type of care
Q8010D: Type of care
Q8010D: Type of care
Q8010D: Type of care
Q8010D: Type of care
What type of care or support is/was provided?What type of care or support is/was provided?
1 = Financial
2 = Social/Emotional
3 = Health
4 = Physical
5 = Personal
INTERVIEWER: Circle all that apply
Q8010D: Type of care
Q8010D: Type of care
Q8010D: Type of care
Q8010D: Type of care
Q8010D: Type of care
What type of care or support is/was provided?What type of care or support is/was provided?
1 = Financial
2 = Social/Emotional
3 = Health
4 = Physical
5 = Personal
INTERVIEWER: Circle all that apply
Q8010D: Type of care
Q8010D: Type of care
Q8010D: Type of care
Q8010D: Type of care
Q8010D: Type of care
What type of care or support is/was provided?What type of care or support is/was provided?
1 = Financial
2 = Social/Emotional
3 = Health
4 = Physical
5 = Personal
INTERVIEWER: Circle all that apply
Q8010D: Type of care
Q8010D: Type of care
Q8010D: Type of care
Q8010D: Type of care
Q8010D: Type of care
What type of care or support is/was provided?What type of care or support is/was provided?
1 = Financial
2 = Social/Emotional
3 = Health
4 = Physical
5 = Personal
INTERVIEWER: Circle all that apply
Q8010D: Type of care
Q8010D: Type of care
Q8010D: Type of care
Q8010D: Type of care
Q8010D: Type of care
What type of care or support is/was provided?What type of care or support is/was provided?
1 = Financial
2 = Social/Emotional
3 = Health
4 = Physical
5 = Personal
INTERVIEWER: Circle all that apply
Q8011D: Personal care
Q8011D: Personal care
Q8011D: Personal care
Q8011D: Personal care
Q8011D: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8011D: Personal care
Q8011D: Personal care
Q8011D: Personal care
Q8011D: Personal care
Q8011D: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8011D: Personal care
Q8011D: Personal care
Q8011D: Personal care
Q8011D: Personal care
Q8011D: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8011D: Personal care
Q8011D: Personal care
Q8011D: Personal care
Q8011D: Personal care
Q8011D: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8011D: Personal care
Q8011D: Personal care
Q8011D: Personal care
Q8011D: Personal care
Q8011D: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8011D: Personal care
Q8011D: Personal care
Q8011D: Personal care
Q8011D: Personal care
Q8011D: Personal care
What type of personal care is/was provided? Help with…
1 = Bathing
2 = Eating
3 = Dressing
4 = Toileting
5 = Moving around
6 = Incontinence
INTERVIEWER: Circle all that apply
Q8029: SAGE (ID) column number
Q8029: SAGE (ID) column number
Q8029: SAGE (ID) column number
Q8029: SAGE (ID) column number
Q8029: SAGE (ID) column number
Please think of the oldest of the children aged 15 years or younger. Who is that?
Enter person (HH member) number from Section 0400: HH Roster OR row number from WHS roster. Enter '66' in a) for child who is not listed on either roster.
Q8029: WHS (ID) row number
Q8029: WHS (ID) row number
Q8029: WHS (ID) row number
Q8029: WHS (ID) row number
Q8029: WHS (ID) row number
Please think of the oldest of the children aged 15 years or younger. Who is that?
Enter person (HH member) number from Section 0400: HH Roster OR row number from WHS roster. Enter '66' in a) for child who is not listed on either roster.
Q8029a: Relationship
Q8029a: Relationship
Q8029a: Relationship
Q8029a: Relationship
Q8029a: Relationship
Q8029a. What is this child [NAME]'s relationship to you?
1Daughter or son
2Grandchild
3Other family related child
4Not family-related child
7 Other
1
Daughter/son
2
Grandchild
3
Other relative
4
Non-relative
7
Other
Q8029b: Alive or dead
Q8029b: Alive or dead
Q8029b: Alive or dead
Q8029b: Alive or dead
Q8029b: Alive or dead
Is this child alive or dead?
1Alive
2 Dead
1
Alive
2
Dead
8
Don't know
9
Not applicable
Q8029c: Parent status
Q8029c: Parent status
Q8029c: Parent status
Q8029c: Parent status
Q8029c: Parent status
Which of [NAME]'s parents are ill, absent or dead? Neither, only his/her mother, only his/her father or both parents?
1Neither parent …………………Q8029e
2Only mother
3Only father
4 Both parents
1
Neither
2
Only mother
3
Only father
4
Both
8
Don't know
9
Not applicable
Q8029d: Reasons (single)
Q8029d: Reasons (single)
Q8029d: Reasons (single)
Q8029d: Reasons (single)
Q8029d: Reasons (single)
What was/were the reasons for parent(s) being ill or absent (or reasons for death)?*
1HIV/AIDS related
2Other health reason
3Other reason (not health related)
7 Other, specify:
INTERVIEWER: Circle all that apply.
Q8029d: Reasons (single)
Q8029d: Reasons (single)
Q8029d: Reasons (single)
Q8029d: Reasons (single)
Q8029d: Reasons (single)
What was/were the reasons for parent(s) being ill or absent (or reasons for death)?*
1HIV/AIDS related
2Other health reason
3Other reason (not health related)
7 Other, specify:
INTERVIEWER: Circle all that apply.
Q8029d: Reasons (single)
Q8029d: Reasons (single)
Q8029d: Reasons (single)
Q8029d: Reasons (single)
Q8029d: Reasons (single)
What was/were the reasons for parent(s) being ill or absent (or reasons for death)?*
1HIV/AIDS related
2Other health reason
3Other reason (not health related)
7 Other, specify:
INTERVIEWER: Circle all that apply.
Q8029d: Reasons (single)
Q8029d: Reasons (single)
Q8029d: Reasons (single)
Q8029d: Reasons (single)
Q8029d: Reasons (single)
What was/were the reasons for parent(s) being ill or absent (or reasons for death)?*
1HIV/AIDS related
2Other health reason
3Other reason (not health related)
7 Other, specify:
INTERVIEWER: Circle all that apply.
Q8029e: Main caregiver
Q8029e: Main caregiver
Q8029e: Main caregiver
Q8029e: Main caregiver
Q8029e: Main caregiver
Now, please tell me, who is or was the main person providing care for this child? Is it you yourself, someone else in this household, or someone outside of this household?
1Respondent……………………Q8029e
2Someone else in household
3 Someone outside household
1
Respondent
2
Other HH member
3
Other outside HH
8
Don't know
9
Not applicable
Q8029f: Other caregiver
Q8029f: Other caregiver
Q8029f: Other caregiver
Q8029f: Other caregiver
Q8029f: Other caregiver
Even if you are/were not the main caregiver, did/do you provide care or support to this child?
1Yes
2 No ............
Q8030 or Q8034 if only one child
1
Yes
2
No
8
Don't know
9
Not applicable
Q8029g: Type of care (group)
Q8029g: Type of care (group)
Q8029g: Type of care (group)
Q8029g: Type of care (group)
Q8029g: Type of care (group)
What type of care or support is/was provided?
1Financial
2Social/Emotional
3Health
4Physical
5 Personal
INTERVIEWER: Read each and circle all that apply
Q8029g: Type of care (single)
Q8029g: Type of care (single)
Q8029g: Type of care (single)
Q8029g: Type of care (single)
Q8029g: Type of care (single)
What type of care or support is/was provided?
1Financial
2Social/Emotional
3Health
4Physical
5 Personal
INTERVIEWER: Read each and circle all that apply
Q8029g: Type of care (single)
Q8029g: Type of care (single)
Q8029g: Type of care (single)
Q8029g: Type of care (single)
Q8029g: Type of care (single)
What type of care or support is/was provided?
1Financial
2Social/Emotional
3Health
4Physical
5 Personal
INTERVIEWER: Read each and circle all that apply
Q8029g: Type of care (single)
Q8029g: Type of care (single)
Q8029g: Type of care (single)
Q8029g: Type of care (single)
Q8029g: Type of care (single)
What type of care or support is/was provided?
1Financial
2Social/Emotional
3Health
4Physical
5 Personal
INTERVIEWER: Read each and circle all that apply
Q8029g: Type of care (single)
Q8029g: Type of care (single)
Q8029g: Type of care (single)
Q8029g: Type of care (single)
Q8029g: Type of care (single)
What type of care or support is/was provided?
1Financial
2Social/Emotional
3Health
4Physical
5 Personal
INTERVIEWER: Read each and circle all that apply
Q8029g: Type of care (single)
Q8029g: Type of care (single)
Q8029g: Type of care (single)
Q8029g: Type of care (single)
Q8029g: Type of care (single)
What type of care or support is/was provided?
1Financial
2Social/Emotional
3Health
4Physical
5 Personal
INTERVIEWER: Read each and circle all that apply
Q8030: SAGE (ID) column number
Q8030: SAGE (ID) column number
Q8030: SAGE (ID) column number
Q8030: SAGE (ID) column number
Q8030: SAGE (ID) column number
Please think of the next youngest of the children aged 15 years or younger. Who is that?
Enter person (HH member) number from Section 0400: HH Roster OR row number from WHS roster. Enter '67' in a) for child who is not listed on either roster.
Q8030: WHS (ID) row number
Q8030: WHS (ID) row number
Q8030: WHS (ID) row number
Q8030: WHS (ID) row number
Q8030: WHS (ID) row number
Please think of the next youngest of the children aged 15 years or younger. Who is that?
Enter person (HH member) number from Section 0400: HH Roster OR row number from WHS roster. Enter '67' in a) for child who is not listed on either roster.
Q8030a: Relationship
Q8030a: Relationship
Q8030a: Relationship
Q8030a: Relationship
Q8030a: Relationship
What is this child [NAME]'s relationship to you?
1Daughter or son
2Grandchild
3Other family related child
4Not family-related child
7 Other
1
Daughter/son
2
Grandchild
3
Other relative
4
Non-relative
7
Other
Q8030b: Alive or dead
Q8030b: Alive or dead
Q8030b: Alive or dead
Q8030b: Alive or dead
Q8030b: Alive or dead
Is the child alive or dead?
1Alive
2 Dead
1
Alive
2
Dead
8
Don't know
9
Not applicable
Q8030c: Parent status
Q8030c: Parent status
Q8030c: Parent status
Q8030c: Parent status
Q8030c: Parent status
Which of [NAME]'s parents are ill, absent or dead? Only his/her mother, only his/her father or both parents?
1Neither parent …………………Q8030e
2Only mother
3Only father
4 Both parents
1
Neither
2
Only mother
3
Only father
4
Both
8
Don't know
9
Not applicable
Q8030d: Reasons (single)
Q8030d: Reasons (single)
Q8030d: Reasons (single)
Q8030d: Reasons (single)
Q8030d: Reasons (single)
What was/were the reasons for parent(s) being ill or absent (or reasons for death)?
1HIV/AIDS related
2Other health reason
3Other reason (not health related)
7 Other, specify:
INTERVIEWER: Circle all that apply
Q8030d: Reasons (single)
Q8030d: Reasons (single)
Q8030d: Reasons (single)
Q8030d: Reasons (single)
Q8030d: Reasons (single)
What was/were the reasons for parent(s) being ill or absent (or reasons for death)?
1HIV/AIDS related
2Other health reason
3Other reason (not health related)
7 Other, specify:
INTERVIEWER: Circle all that apply
Q8030d: Reasons (single)
Q8030d: Reasons (single)
Q8030d: Reasons (single)
Q8030d: Reasons (single)
Q8030d: Reasons (single)
What was/were the reasons for parent(s) being ill or absent (or reasons for death)?
1HIV/AIDS related
2Other health reason
3Other reason (not health related)
7 Other, specify:
INTERVIEWER: Circle all that apply
Q8030d: Reasons (single)
Q8030d: Reasons (single)
Q8030d: Reasons (single)
Q8030d: Reasons (single)
Q8030d: Reasons (single)
What was/were the reasons for parent(s) being ill or absent (or reasons for death)?
1HIV/AIDS related
2Other health reason
3Other reason (not health related)
7 Other, specify:
INTERVIEWER: Circle all that apply
Q8030e: Main caregiver
Q8030e: Main caregiver
Q8030e: Main caregiver
Q8030e: Main caregiver
Q8030e: Main caregiver
Now, please tell me, who is or was the main person providing care for these children? Is it you yourself, someone else in this household, or someone outside of this household?*
1Respondent………………..…Q8030g
2Someone else in household
3 Someone outside household
1
Respondent
2
Other HH member
3
Other outside HH
8
Don't know
9
Not applicable
Q8030f: Other caregiver
Q8030f: Other caregiver
Q8030f: Other caregiver
Q8030f: Other caregiver
Q8030f: Other caregiver
1Yes
2 No ……Q8031 or Q8034 if only two children
1
Yes
2
No
8
Don't know
9
Not applicable
Q8030g: Type of care (single)
Q8030g: Type of care (single)
Q8030g: Type of care (single)
Q8030g: Type of care (single)
Q8030g: Type of care (single)
What type of care or support is/was provided?
1Financial
2Social/Emotional
3Health
4Physical
5 Personal
INTERVIEWER: Read each and circle all that apply
Q8030g: Type of care (single)
Q8030g: Type of care (single)
Q8030g: Type of care (single)
Q8030g: Type of care (single)
Q8030g: Type of care (single)
What type of care or support is/was provided?
1Financial
2Social/Emotional
3Health
4Physical
5 Personal
INTERVIEWER: Read each and circle all that apply
Q8030g: Type of care (single)
Q8030g: Type of care (single)
Q8030g: Type of care (single)
Q8030g: Type of care (single)
Q8030g: Type of care (single)
What type of care or support is/was provided?
1Financial
2Social/Emotional
3Health
4Physical
5 Personal
INTERVIEWER: Read each and circle all that apply
Q8030g: Type of care (single)
Q8030g: Type of care (single)
Q8030g: Type of care (single)
Q8030g: Type of care (single)
Q8030g: Type of care (single)
What type of care or support is/was provided?
1Financial
2Social/Emotional
3Health
4Physical
5 Personal
INTERVIEWER: Read each and circle all that apply
Q8030g: Type of care (single)
Q8030g: Type of care (single)
Q8030g: Type of care (single)
Q8030g: Type of care (single)
Q8030g: Type of care (single)
What type of care or support is/was provided?
1Financial
2Social/Emotional
3Health
4Physical
5 Personal
INTERVIEWER: Read each and circle all that apply
Q8031: SAGE (ID) column number
Q8031: SAGE (ID) column number
Q8031: SAGE (ID) column number
Q8031: SAGE (ID) column number
Q8031: SAGE (ID) column number
Please think of the next youngest of the children aged 15 years or younger. Who is that?
Enter person (HH member) number from Section 0400: HH Roster OR row number from WHS roster. Enter '68' in a) for child who is not listed on either roster.
Q8031: WHS (ID) row number
Q8031: WHS (ID) row number
Q8031: WHS (ID) row number
Q8031: WHS (ID) row number
Q8031: WHS (ID) row number
Please think of the next youngest of the children aged 15 years or younger. Who is that?
Enter person (HH member) number from Section 0400: HH Roster OR row number from WHS roster. Enter '68' in a) for child who is not listed on either roster.
Q8031a: Relationship
Q8031a: Relationship
Q8031a: Relationship
Q8031a: Relationship
Q8031a: Relationship
What is the child [NAME]'s relationship to you?
1Daughter or son
2Grandchild
3Other family related child
4Not family-related child
7 Other
1
Daughter/son
2
Grandchild
3
Other relative
4
Non-relative
7
Other
Q8031b: Alive or dead
Q8031b: Alive or dead
Q8031b: Alive or dead
Q8031b: Alive or dead
Q8031b: Alive or dead
Is the child alive or dead?
1Alive
2 Dead
1
Alive
2
Dead
8
Don't know
9
Not applicable
Q8031c: Parent status
Q8031c: Parent status
Q8031c: Parent status
Q8031c: Parent status
Q8031c: Parent status
Which of [NAME]'s parents are ill, absent or dead? Only his/her mother, only his/her father or both parents?
1Neither parent …………………Q8031e
2Only mother
3Only father
4 Both parents
1
Neither
2
Only mother
3
Only father
4
Both
8
Don't know
9
Not applicable
Q8031d: Reasons (single)
Q8031d: Reasons (single)
Q8031d: Reasons (single)
Q8031d: Reasons (single)
Q8031d: Reasons (single)
What was/were the reasons for parent(s) being ill or absent (or reason for death)?
1HIV/AIDS related
2Other health reason
3Other reason (not health related)
7 Other, specify:
Q8031d: Reasons (single)
Q8031d: Reasons (single)
Q8031d: Reasons (single)
Q8031d: Reasons (single)
Q8031d: Reasons (single)
What was/were the reasons for parent(s) being ill or absent (or reason for death)?
1HIV/AIDS related
2Other health reason
3Other reason (not health related)
7 Other, specify:
Q8031d: Reasons (single)
Q8031d: Reasons (single)
Q8031d: Reasons (single)
Q8031d: Reasons (single)
Q8031d: Reasons (single)
What was/were the reasons for parent(s) being ill or absent (or reason for death)?
1HIV/AIDS related
2Other health reason
3Other reason (not health related)
7 Other, specify:
Q8031d: Reasons (single)
Q8031d: Reasons (single)
Q8031d: Reasons (single)
Q8031d: Reasons (single)
Q8031d: Reasons (single)
What was/were the reasons for parent(s) being ill or absent (or reason for death)?
1HIV/AIDS related
2Other health reason
3Other reason (not health related)
7 Other, specify:
Q8031e: Main caregiver
Q8031e: Main caregiver
Q8031e: Main caregiver
Q8031e: Main caregiver
Q8031e: Main caregiver
Now, please tell me, who is or was the main person providing care for these children? Is it you yourself, someone else in this household, or someone outside of this household?
1Respondent…………….….…Q8031g
2Someone else in household
3 Someone outside household
1
Respondent
2
Other HH member
3
Other outside HH
8
Don't know
9
Not applicable
Q8031f: Other caregiver
Q8031f: Other caregiver
Q8031f: Other caregiver
Q8031f: Other caregiver
Q8031f: Other caregiver
Even if you were not the main caregiver, did/do you provide care or support to any members of the household?
1Yes
2 No …......Q8032 or Q8034 if only three children
1
Yes
2
No
8
Don't know
9
Not applicable
Q8031g: Type of care (single)
Q8031g: Type of care (single)
Q8031g: Type of care (single)
Q8031g: Type of care (single)
Q8031g: Type of care (single)
What type of care or support is/was provided
1Financial
2Social/Emotional
3Health
4Physical
5 Personal
INTERVIEWER: Circle all that apply
Q8031g: Type of care (single)
Q8031g: Type of care (single)
Q8031g: Type of care (single)
Q8031g: Type of care (single)
Q8031g: Type of care (single)
What type of care or support is/was provided
1Financial
2Social/Emotional
3Health
4Physical
5 Personal
INTERVIEWER: Circle all that apply
Q8031g: Type of care (single)
Q8031g: Type of care (single)
Q8031g: Type of care (single)
Q8031g: Type of care (single)
Q8031g: Type of care (single)
What type of care or support is/was provided
1Financial
2Social/Emotional
3Health
4Physical
5 Personal
INTERVIEWER: Circle all that apply
Q8031g: Type of care (single)
Q8031g: Type of care (single)
Q8031g: Type of care (single)
Q8031g: Type of care (single)
Q8031g: Type of care (single)
What type of care or support is/was provided
1Financial
2Social/Emotional
3Health
4Physical
5 Personal
INTERVIEWER: Circle all that apply
Q8031g: Type of care (single)
Q8031g: Type of care (single)
Q8031g: Type of care (single)
Q8031g: Type of care (single)
Q8031g: Type of care (single)
What type of care or support is/was provided
1Financial
2Social/Emotional
3Health
4Physical
5 Personal
INTERVIEWER: Circle all that apply
Q8032: SAGE (ID) column number
Q8032: SAGE (ID) column number
Q8032: SAGE (ID) column number
Q8032: SAGE (ID) column number
Q8032: SAGE (ID) column number
Please think of the next youngest of the children aged 15 years or younger. Who is that?
Enter person (HH member) number from Section 0400: HH Roster OR row number from WHS roster. Enter '69' in a) for child who is not listed on either roster.
Q8032: WHS (ID) row number
Q8032: WHS (ID) row number
Q8032: WHS (ID) row number
Q8032: WHS (ID) row number
Q8032: WHS (ID) row number
Please think of the next youngest of the children aged 15 years or younger. Who is that?
Enter person (HH member) number from Section 0400: HH Roster OR row number from WHS roster. Enter '69' in a) for child who is not listed on either roster.
Q8032a: Relationship
Q8032a: Relationship
Q8032a: Relationship
Q8032a: Relationship
Q8032a: Relationship
What is the child [NAME]'s relationship to you?
1Daughter or son
2Grandchild
3Other family related child
4Not family-related child
7 Other
1
Daughter/son
2
Grandchild
3
Other relative
4
Non-relative
7
Other
Q8032b: Alive or dead
Q8032b: Alive or dead
Q8032b: Alive or dead
Q8032b: Alive or dead
Q8032b: Alive or dead
Is the child alive or dead?
1Alive
2 Dead
1
Alive
2
Dead
8
Don't know
9
Not applicable
Q8032c: Parent status
Q8032c: Parent status
Q8032c: Parent status
Q8032c: Parent status
Q8032c: Parent status
Which of [NAME]'s parents are ill, absent or dead? Only his/her mother, only his/her father or both parents?
1Neither parent …………………Q8032e
2Only mother
3Only father
4 Both parents
1
Neither
2
Only mother
3
Only father
4
Both
8
Don't know
9
Not applicable
Q8032d: Reasons (single)
Q8032d: Reasons (single)
Q8032d: Reasons (single)
Q8032d: Reasons (single)
Q8032d: Reasons (single)
What was/were the reasons for parent(s) being ill or absent (or reason for death)?
1HIV/AIDS related
2Other health reason
3Other reason (not health related)
7 Other, specify
Q8032d: Reasons (single)
Q8032d: Reasons (single)
Q8032d: Reasons (single)
Q8032d: Reasons (single)
Q8032d: Reasons (single)
What was/were the reasons for parent(s) being ill or absent (or reason for death)?
1HIV/AIDS related
2Other health reason
3Other reason (not health related)
7 Other, specify
Q8032d: Reasons (single)
Q8032d: Reasons (single)
Q8032d: Reasons (single)
Q8032d: Reasons (single)
Q8032d: Reasons (single)
What was/were the reasons for parent(s) being ill or absent (or reason for death)?
1HIV/AIDS related
2Other health reason
3Other reason (not health related)
7 Other, specify
Q8032d: Reasons (single)
Q8032d: Reasons (single)
Q8032d: Reasons (single)
Q8032d: Reasons (single)
Q8032d: Reasons (single)
What was/were the reasons for parent(s) being ill or absent (or reason for death)?
1HIV/AIDS related
2Other health reason
3Other reason (not health related)
7 Other, specify
Q8032e: Main caregiver
Q8032e: Main caregiver
Q8032e: Main caregiver
Q8032e: Main caregiver
Q8032e: Main caregiver
Now, please tell me, who is or was the main person providing care for these children? Is it you yourself, someone else in this household, or someone outside of this household?
1Respondent………………...…Q8032g
2Someone else in household
3 Someone outside household
1
Respondent
2
Other HH member
3
Other outside HH
8
Don't know
9
Not applicable
Q8032f: Other caregiver
Q8032f: Other caregiver
Q8032f: Other caregiver
Q8032f: Other caregiver
Q8032f: Other caregiver
Even if you were not the main caregiver, did/do you provide care or support to any members of the household?
1Yes
2 No …Q8034
1
Yes
2
No
8
Don't know
9
Not applicable
Q8032g: Type of care (single)
Q8032g: Type of care (single)
Q8032g: Type of care (single)
Q8032g: Type of care (single)
Q8032g: Type of care (single)
What type of care or support is/was provided?
1Financial
2Social/Emotional
3Health
4Physical
5 Personal
INTERVIEWER: Circle all that apply
Q8032g: Type of care (single)
Q8032g: Type of care (single)
Q8032g: Type of care (single)
Q8032g: Type of care (single)
Q8032g: Type of care (single)
What type of care or support is/was provided?
1Financial
2Social/Emotional
3Health
4Physical
5 Personal
INTERVIEWER: Circle all that apply
Q8032g: Type of care (single)
Q8032g: Type of care (single)
Q8032g: Type of care (single)
Q8032g: Type of care (single)
Q8032g: Type of care (single)
What type of care or support is/was provided?
1Financial
2Social/Emotional
3Health
4Physical
5 Personal
INTERVIEWER: Circle all that apply
Q8032g: Type of care (single)
Q8032g: Type of care (single)
Q8032g: Type of care (single)
Q8032g: Type of care (single)
Q8032g: Type of care (single)
What type of care or support is/was provided?
1Financial
2Social/Emotional
3Health
4Physical
5 Personal
INTERVIEWER: Circle all that apply
Q8032g: Type of care (single)
Q8032g: Type of care (single)
Q8032g: Type of care (single)
Q8032g: Type of care (single)
Q8032g: Type of care (single)
What type of care or support is/was provided?
1Financial
2Social/Emotional
3Health
4Physical
5 Personal
INTERVIEWER: Circle all that apply
Q9001: Others present?
Q9001: Others present?
Q9001: Others present?
Q9001: Others present?
Q9001: Others present?
Was someone else present during the interview?
Did respondent have
1 Yes
2 No
1
Yes
2
No
8
DK
9
NA
Q9002: Hearing
Q9002: Hearing
Q9002: Hearing
Q9002: Hearing
Q9002: Hearing
Hearing problem?
1 Yes
2 No
1
Yes
2
No
8
DK
9
NA
Q9003: Vision
Q9003: Vision
Q9003: Vision
Q9003: Vision
Q9003: Vision
Vision problem?
1 Yes
2 No
1
Yes
2
No
8
DK
9
NA
Q9004: Wheelchair
Q9004: Wheelchair
Q9004: Wheelchair
Q9004: Wheelchair
Q9004: Wheelchair
Use wheelchair?
1 Yes
2 No
1
Yes
2
No
8
DK
9
NA
Q9005: Walking aid
Q9005: Walking aid
Q9005: Walking aid
Q9005: Walking aid
Q9005: Walking aid
Use cane/crutches/walker?
1 Yes
2 No
1
Yes
2
No
8
DK
9
NA
Q9006: Walking
Q9006: Walking
Q9006: Walking
Q9006: Walking
Q9006: Walking
Have difficulties walking?
1 Yes
2 No
1
Yes
2
No
8
DK
9
NA
Q9007: Paralysis
Q9007: Paralysis
Q9007: Paralysis
Q9007: Paralysis
Q9007: Paralysis
Paralysis?
1 Yes
2 No
1
Yes
2
No
8
DK
9
NA
Q9008: Cough
Q9008: Cough
Q9008: Cough
Q9008: Cough
Q9008: Cough
Cough continually?
1 Yes
2 No
1
Yes
2
No
8
DK
9
NA
Q9009: Breathing
Q9009: Breathing
Q9009: Breathing
Q9009: Breathing
Q9009: Breathing
Shortness of breath?
1 Yes
2 No
1
Yes
2
No
8
DK
9
NA
Q9010: Mental
Q9010: Mental
Q9010: Mental
Q9010: Mental
Q9010: Mental
Mental problems?
1 Yes
2 No
1
Yes
2
No
8
DK
9
NA
Q9011: Other
Q9011: Other
Q9011: Other
Q9011: Other
Q9011: Other
Other health problem?
1 Yes
2 No
1
Yes
2
No
8
DK
9
NA
Q9012: Amputation
Q9012: Amputation
Q9012: Amputation
Q9012: Amputation
Q9012: Amputation
Amputated limb (arm or leg)?
1 Yes
2 No
1
Yes
2
No
8
DK
9
NA
Q9013: Cooperation
Q9013: Cooperation
Q9013: Cooperation
Q9013: Cooperation
Q9013: Cooperation
What is your assessment of the respondent's cooperation?
1 Very good
2 Good
3 Moderate
4 Bad
5 Very bad
1
VG
2
G
3
M
4
B
5
VB
8
DK
9
NA
Q9014: Accuracy
Q9014: Accuracy
Q9014: Accuracy
Q9014: Accuracy
Q9014: Accuracy
What is your evaluation of the accuracy and completeness of the respondent's answers?
1Very high
2High
3Average
4Low
5 Very low
1
VH
2
H
3
A
4
L
5
VL
8
DK
9
NA
strata code
strata code
strata code
strata code
strata code
post stratified person weight
post stratified person weight
post stratified person weight
post stratified person weight
post stratified person weight
permanent income continuous
permanent income continuous
permanent income continuous
permanent income continuous
permanent income continuous
permanent income quintile
permanent income quintile
permanent income quintile
permanent income quintile
permanent income quintile
Individual Case ID 1st wave
Individual Case ID 1st wave
Individual Case ID 1st wave
Individual Case ID 1st wave
Individual Case ID 1st wave
Individual Case ID 2nd wave
Individual Case ID 2nd wave
Individual Case ID 2nd wave
Individual Case ID 2nd wave
Individual Case ID 2nd wave
Q0001: Research Center Number
Q0001: Research Center Number
Q0001: Research Center Number
Q0001: Research Center Number
Q0001: Research Center Number
Research Centre Number
101
China
106
India
140
Mexico
152
Russian Federation
155
South Africa
241
Ghana
Q0002: Household ID number
Q0002: Household ID number
Q0002: Household ID number
Q0002: Household ID number
Q0002: Household ID number
Household ID
Q0003: Type of interview (new, f/u, retest, proxy, validatio
Q0003: Type of interview (new, f/u, retest, proxy, validatio
Q0003: Type of interview (new, f/u, retest, proxy, validatio
Q0003: Type of interview (new, f/u, retest, proxy, validatio
Q0003: Type of interview (new, f/u, retest, proxy, validatio
Is this a new, second (follow-up from WHS), retest or proxy interview?
1
New interview
2
Follow-up interview from WHS
3
Retest
4
Proxy
5
Proxy validation
Q1007: Respondent Number
Q1007: Respondent Number
Q1007: Respondent Number
Q1007: Respondent Number
Q1007: Respondent Number
Person (HH member) number from HH roster (number from column)
-9
Not applicable
-8
Don't know
P1000: HH begin
P1000: HH begin
P1000: HH begin
P1000: HH begin
P1000: HH begin
P1000: MM begin
P1000: MM begin
P1000: MM begin
P1000: MM begin
P1000: MM begin
P1000: HH end
P1000: HH end
P1000: HH end
P1000: HH end
P1000: HH end
P1000: MM end
P1000: MM end
P1000: MM end
P1000: MM end
P1000: MM end
P1006: HH ID number
P1006: HH ID number
P1006: HH ID number
P1006: HH ID number
P1006: HH ID number
Household ID
P1006b: New or follow-up?
P1006b: New or follow-up?
P1006b: New or follow-up?
P1006b: New or follow-up?
P1006b: New or follow-up?
Is this a first (new) or second (follow-up) interview?
P1007: Respondent # in HH roster
P1007: Respondent # in HH roster
P1007: Respondent # in HH roster
P1007: Respondent # in HH roster
P1007: Respondent # in HH roster
Person (HH member) number of selected respondent from HH roster (number from column)
P1007a: Proxy # in HH roster
P1007a: Proxy # in HH roster
P1007a: Proxy # in HH roster
P1007a: Proxy # in HH roster
P1007a: Proxy # in HH roster
Person (HH member) number of PROXY respondent from HH roster (number from column)
P1007b: Intv/Supv ID #
P1007b: Intv/Supv ID #
P1007b: Intv/Supv ID #
P1007b: Intv/Supv ID #
P1007b: Intv/Supv ID #
Interviewer ID or Supervisor ID
P1008: Mother tongue
P1008: Mother tongue
P1008: Mother tongue
P1008: Mother tongue
P1008: Mother tongue
As described in the consent form, [respondent's name] was selected to be part of this study, but may find it difficult to complete the interview. The health and well-being of people like [respondent's name] is important for this research and this is why we want to ask the following questions. I will be asking you a number of questions about the health and well being of the respondent.
What is the respondent's mother tongue?
By mother tongue we mean the language the respondent learned first, the language that the respondent expressed her/himself fully in, or voluntarily would identify with.
1Assamee
2Bengali
3English
4Gujarati
5Hindi
6Kannada
7Kashmiri
8Konkani
9Malayam
10Manipuri
11Marathi
12Nepali
13Oriya
14Punjabi
15Sindhi
16Tamil
17Telugu
18Urdu
87 Other, specify:
1
Chinese, Mandarin
2
Chinese, other, specify
87
Other, specify:
88
Don't know
P1009: Sex
P1009: Sex
P1009: Sex
P1009: Sex
P1009: Sex
Sex
1Male
2 Female
Record sex of the respondent:
NOTE - NOT the sex of the proxy.
1
Male
2
Female
P1010: DD
P1010: DD
P1010: DD
P1010: DD
P1010: DD
-8
Don't know
P1010: MM
P1010: MM
P1010: MM
P1010: MM
P1010: MM
-8
DK
P1010: YYYY
P1010: YYYY
P1010: YYYY
P1010: YYYY
P1010: YYYY
-8
DK
P1011: Age (n)
P1011: Age (n)
P1011: Age (n)
P1011: Age (n)
P1011: Age (n)
How old are you now?
INTERVIEWER: This would be age at last birthday. If don't know - probe.
-8
DK
P1012: Marital status
P1012: Marital status
P1012: Marital status
P1012: Marital status
P1012: Marital status
What is the respondent's current marital status?
1Never married
2currently married
3cohabiting
4separated/divorced
5 widowed
1
Never married
2
Currently married
3
Cohabiting
4
Separated/divorced
5
Widowed
8
Don't know
9
Not applicable
P1015: Ever schooled
P1015: Ever schooled
P1015: Ever schooled
P1015: Ever schooled
P1015: Ever schooled
Has the respondent ever been to school?
1Yes
2 No ………………………P2000
1
Yes
2
No
8
Don't know
9
Not applicable
P1016: Highest level
P1016: Highest level
P1016: Highest level
P1016: Highest level
P1016: Highest level
What is the highest level of education that s/he completed?
1Less than primary school
2Primary school completed
3Secondary school completed
4High school( or equivalent) completed
5College/Pre-university/ University completed
6 Post graduate degree completed
1
Less than primary
2
Completed primary
3
Completed secondary
4
Completed HS
5
Completed college
6
Completed post-grad
8
Don't know
9
Not applicable
P1018: Ethnic background
P1018: Ethnic background
P1018: Ethnic background
P1018: Ethnic background
P1018: Ethnic background
What is her/his caste or tribe?
1Scheduled tribe
2Scheduled caste
3No caste or tribe
7 Other, specify:
1
EG 1
2
EG 2
3
EG 3
4
EG 4
5
EG 5
6
EG 6
87
Other
88
Don't know
98
Not applicable
P1019: Religion
P1019: Religion
P1019: Religion
P1019: Religion
P1019: Religion
Did s/he belong to a religious denomination?
1No, none
2Buddhism
3Chinese traditional religion
4Christianity (including Roman Catholic, Protestant, Orthodox, other)
5Hinduism
6Islam
7Jainism
8Judaism
9Primal indigenous (including African traditional and diasporic)
10Sikhism
87 Other , specify:
97 Refused
Interviewer: allow the Proxy to reply without reading categories. Clarify as needed
1
None, atheist, agnostic, secular
2
Buddhism
3
Chinese traditional
4
Christianity
5
Hinduism
6
Islam
7
Jainism
8
Judaism
9
Primal indigenous (including African trad&diasporic)
10
Sikhism
87
Other
88
Don't know
97
Refused
98
Not applicable
P1020: Length of acquaintance
P1020: Length of acquaintance
P1020: Length of acquaintance
P1020: Length of acquaintance
P1020: Length of acquaintance
How long have you known [respondent's name]?
INTERVIEWER: If less than 1 year, enter "00".
-9
NA
-8
DK
P1022: Recent events
P1022: Recent events
P1022: Recent events
P1022: Recent events
P1022: Recent events
Now we want you to remember what your friend or relative was like [10 years] ago and to compare it with what he/she is like now. Ten years ago was in 1996. Below are situations where this person has to use his/her memory or intelligence and we want you to indicate whether this has improved, stayed the same or got worse in that situation over the past [10 years]. Note the importance of comparing his/her present performance with [10 years] ago.
For example, if [10 years] ago this person always forgot where he/she had left things, and he/she still does, then this would be considered "not much change".
Compared with [10 years] ago how is this person at remembering things that have happened recently?
1 MUCH IMPROVED
2 A BIT IMPROVED
3 NOT MUCH CHANGE
4 A BIT WORSE
5 MUCH WORSE
6 DON'T KNOW
INTERVIEWER: can show the respondent the scale and read the categories.
1
Much improved
2
A bit improved
3
Not much change
4
A bit worse
5
Much worse
8
Don't know
9
Not applicable
P1023: Conversations
P1023: Conversations
P1023: Conversations
P1023: Conversations
P1023: Conversations
Now we want you to remember what your friend or relative was like [10 years] ago and to compare it with what he/she is like now. Ten years ago was in 1996. Below are situations where this person has to use his/her memory or intelligence and we want you to indicate whether this has improved, stayed the same or got worse in that situation over the past [10 years]. Note the importance of comparing his/her present performance with [10 years] ago.
For example, if [10 years] ago this person always forgot where he/she had left things, and he/she still does, then this would be considered "not much change".
Compared with [10 years] ago how is this person at…recalling conversations a few days later?
1 MUCH IMPROVED
2 A BIT IMPROVED
3 NOT MUCH CHANGE
4 A BIT WORSE
5 MUCH WORSE
6 DON'T KNOW
INTERVIEWER: can show the respondent the scale and read the categories.
1
Much improved
2
A bit improved
3
Not much change
4
A bit worse
5
Much worse
8
Don't know
9
Not applicable
P1024: Personal data
P1024: Personal data
P1024: Personal data
P1024: Personal data
P1024: Personal data
Now we want you to remember what your friend or relative was like [10 years] ago and to compare it with what he/she is like now. Ten years ago was in 1996. Below are situations where this person has to use his/her memory or intelligence and we want you to indicate whether this has improved, stayed the same or got worse in that situation over the past [10 years]. Note the importance of comparing his/her present performance with [10 years] ago.
For example, if [10 years] ago this person always forgot where he/she had left things, and he/she still does, then this would be considered "not much change".
Compared with [10 years] ago how is this person at remembering his/her address and telephone number?
1 MUCH IMPROVED
2 A BIT IMPROVED
3 NOT MUCH CHANGE
4 A BIT WORSE
5 MUCH WORSE
6 DON'T KNOW
INTERVIEWER: can show the respondent the scale and read the categories.
1
Much improved
2
A bit improved
3
Not much change
4
A bit worse
5
Much worse
8
Don't know
9
Not applicable
P1025: Date
P1025: Date
P1025: Date
P1025: Date
P1025: Date
Now we want you to remember what your friend or relative was like [10 years] ago and to compare it with what he/she is like now. Ten years ago was in 1996. Below are situations where this person has to use his/her memory or intelligence and we want you to indicate whether this has improved, stayed the same or got worse in that situation over the past [10 years]. Note the importance of comparing his/her present performance with [10 years] ago.
For example, if [10 years] ago this person always forgot where he/she had left things, and he/she still does, then this would be considered "not much change".
Compared with [10 years] ago how is this person at…remembering what day and month it is?
1 MUCH IMPROVED
2 A BIT IMPROVED
3 NOT MUCH CHANGE
4 A BIT WORSE
5 MUCH WORSE
6 DON'T KNOW
INTERVIEWER: can show the respondent the scale and read the categories.
1
Much improved
2
A bit improved
3
Not much change
4
A bit worse
5
Much worse
8
Don't know
9
Not applicable
P1026: Remembering where things
P1026: Remembering where things
P1026: Remembering where things
P1026: Remembering where things
P1026: Remembering where things
Now we want you to remember what your friend or relative was like [10 years] ago and to compare it with what he/she is like now. Ten years ago was in 1996. Below are situations where this person has to use his/her memory or intelligence and we want you to indicate whether this has improved, stayed the same or got worse in that situation over the past [10 years]. Note the importance of comparing his/her present performance with [10 years] ago.
For example, if [10 years] ago this person always forgot where he/she had left things, and he/she still does, then this would be considered "not much change".
Compared with [10 years] ago how is this person at…remembering where things are usually kept?
1 MUCH IMPROVED
2 A BIT IMPROVED
3 NOT MUCH CHANGE
4 A BIT WORSE
5 MUCH WORSE
6 DON'T KNOW
INTERVIEWER: can show the respondent the scale and read the categories.
1
Much improved
2
A bit improved
3
Not much change
4
A bit worse
5
Much worse
8
Don't know
9
Not applicable
P1027: Finding things
P1027: Finding things
P1027: Finding things
P1027: Finding things
P1027: Finding things
Now we want you to remember what your friend or relative was like [10 years] ago and to compare it with what he/she is like now. Ten years ago was in 1996. Below are situations where this person has to use his/her memory or intelligence and we want you to indicate whether this has improved, stayed the same or got worse in that situation over the past [10 years]. Note the importance of comparing his/her present performance with [10 years] ago.
For example, if [10 years] ago this person always forgot where he/she had left things, and he/she still does, then this would be considered "not much change".
Compared with [10 years] ago how is this person at…remembering where to find things which have been put in a different place from usual?
1 MUCH IMPROVED
2 A BIT IMPROVED
3 NOT MUCH CHANGE
4 A BIT WORSE
5 MUCH WORSE
6 DON'T KNOW
INTERVIEWER: can show the respondent the scale and read the categories.
1
Much improved
2
A bit improved
3
Not much change
4
A bit worse
5
Much worse
8
Don't know
9
Not applicable
P1028: Working things
P1028: Working things
P1028: Working things
P1028: Working things
P1028: Working things
Now we want you to remember what your friend or relative was like [10 years] ago and to compare it with what he/she is like now. Ten years ago was in 1996. Below are situations where this person has to use his/her memory or intelligence and we want you to indicate whether this has improved, stayed the same or got worse in that situation over the past [10 years]. Note the importance of comparing his/her present performance with [10 years] ago.
For example, if [10 years] ago this person always forgot where he/she had left things, and he/she still does, then this would be considered "not much change".
Compared with [10 years] ago how is this person at…knowing how to work familiar machines around the house?
1 MUCH IMPROVED
2 A BIT IMPROVED
3 NOT MUCH CHANGE
4 A BIT WORSE
5 MUCH WORSE
6 DON'T KNOW
INTERVIEWER: can show the respondent the scale and read the categories.
1
Much improved
2
A bit improved
3
Not much change
4
A bit worse
5
Much worse
8
Don't know
9
Not applicable
P1029: New HH machine
P1029: New HH machine
P1029: New HH machine
P1029: New HH machine
P1029: New HH machine
Now we want you to remember what your friend or relative was like [10 years] ago and to compare it with what he/she is like now. Ten years ago was in 1996. Below are situations where this person has to use his/her memory or intelligence and we want you to indicate whether this has improved, stayed the same or got worse in that situation over the past [10 years]. Note the importance of comparing his/her present performance with [10 years] ago.
For example, if [10 years] ago this person always forgot where he/she had left things, and he/she still does, then this would be considered "not much change".
Compared with [10 years] ago how is this person at…learning to use a new gadget or machine around the house?
1 MUCH IMPROVED
2 A BIT IMPROVED
3 NOT MUCH CHANGE
4 A BIT WORSE
5 MUCH WORSE
6 DON'T KNOW
INTERVIEWER: can show the respondent the scale and read the categories.
1
Much improved
2
A bit improved
3
Not much change
4
A bit worse
5
Much worse
8
Don't know
9
Not applicable
P1030: New things
P1030: New things
P1030: New things
P1030: New things
P1030: New things
Now we want you to remember what your friend or relative was like [10 years] ago and to compare it with what he/she is like now. Ten years ago was in 1996. Below are situations where this person has to use his/her memory or intelligence and we want you to indicate whether this has improved, stayed the same or got worse in that situation over the past [10 years]. Note the importance of comparing his/her present performance with [10 years] ago.
For example, if [10 years] ago this person always forgot where he/she had left things, and he/she still does, then this would be considered "not much change".
Compared with [10 years] ago how is this person at…learning new things in general?
1 MUCH IMPROVED
2 A BIT IMPROVED
3 NOT MUCH CHANGE
4 A BIT WORSE
5 MUCH WORSE
6 DON'T KNOW
INTERVIEWER: can show the respondent the scale and read the categories.
1
Much improved
2
A bit improved
3
Not much change
4
A bit worse
5
Much worse
8
Don't know
9
Not applicable
P1031: Book, TV
P1031: Book, TV
P1031: Book, TV
P1031: Book, TV
P1031: Book, TV
Now we want you to remember what your friend or relative was like [10 years] ago and to compare it with what he/she is like now. Ten years ago was in 1996. Below are situations where this person has to use his/her memory or intelligence and we want you to indicate whether this has improved, stayed the same or got worse in that situation over the past [10 years]. Note the importance of comparing his/her present performance with [10 years] ago.
For example, if [10 years] ago this person always forgot where he/she had left things, and he/she still does, then this would be considered "not much change".
Compared with [10 years] ago how is this person at…following a story in a book or on TV?
1 MUCH IMPROVED
2 A BIT IMPROVED
3 NOT MUCH CHANGE
4 A BIT WORSE
5 MUCH WORSE
6 DON'T KNOW
INTERVIEWER: can show the respondent the scale and read the categories.
1
Much improved
2
A bit improved
3
Not much change
4
A bit worse
5
Much worse
8
Don't know
9
Not applicable
P1032: Decisions
P1032: Decisions
P1032: Decisions
P1032: Decisions
P1032: Decisions
Now we want you to remember what your friend or relative was like [10 years] ago and to compare it with what he/she is like now. Ten years ago was in 1996. Below are situations where this person has to use his/her memory or intelligence and we want you to indicate whether this has improved, stayed the same or got worse in that situation over the past [10 years]. Note the importance of comparing his/her present performance with [10 years] ago.
For example, if [10 years] ago this person always forgot where he/she had left things, and he/she still does, then this would be considered "not much change".
Compared with [10 years] ago how is this person at…making decisions on everyday matters?
1 MUCH IMPROVED
2 A BIT IMPROVED
3 NOT MUCH CHANGE
4 A BIT WORSE
5 MUCH WORSE
6 DON'T KNOW
INTERVIEWER: can show the respondent the scale and read the categories.
1
Much improved
2
A bit improved
3
Not much change
4
A bit worse
5
Much worse
8
Don't know
9
Not applicable
P1033: Handling money
P1033: Handling money
P1033: Handling money
P1033: Handling money
P1033: Handling money
Now we want you to remember what your friend or relative was like [10 years] ago and to compare it with what he/she is like now. Ten years ago was in 1996. Below are situations where this person has to use his/her memory or intelligence and we want you to indicate whether this has improved, stayed the same or got worse in that situation over the past [10 years]. Note the importance of comparing his/her present performance with [10 years] ago.
For example, if [10 years] ago this person always forgot where he/she had left things, and he/she still does, then this would be considered "not much change".
Compared with [10 years] ago how is this person at…handling money for shopping?
1 MUCH IMPROVED
2 A BIT IMPROVED
3 NOT MUCH CHANGE
4 A BIT WORSE
5 MUCH WORSE
6 DON'T KNOW
INTERVIEWER: can show the respondent the scale and read the categories.
1
Much improved
2
A bit improved
3
Not much change
4
A bit worse
5
Much worse
8
Don't know
9
Not applicable
P1034: Financial matters
P1034: Financial matters
P1034: Financial matters
P1034: Financial matters
P1034: Financial matters
Now we want you to remember what your friend or relative was like [10 years] ago and to compare it with what he/she is like now. Ten years ago was in 1996. Below are situations where this person has to use his/her memory or intelligence and we want you to indicate whether this has improved, stayed the same or got worse in that situation over the past [10 years]. Note the importance of comparing his/her present performance with [10 years] ago.
For example, if [10 years] ago this person always forgot where he/she had left things, and he/she still does, then this would be considered "not much change".
Compared with [10 years] ago how is this person at…handling financial matters, for example, a pension or dealing with the bank?
1 MUCH IMPROVED
2 A BIT IMPROVED
3 NOT MUCH CHANGE
4 A BIT WORSE
5 MUCH WORSE
6 DON'T KNOW
INTERVIEWER: can show the respondent the scale and read the categories.
1
Much improved
2
A bit improved
3
Not much change
4
A bit worse
5
Much worse
8
Don't know
9
Not applicable
P1035: Arithmetic
P1035: Arithmetic
P1035: Arithmetic
P1035: Arithmetic
P1035: Arithmetic
Now we want you to remember what your friend or relative was like [10 years] ago and to compare it with what he/she is like now. Ten years ago was in 1996. Below are situations where this person has to use his/her memory or intelligence and we want you to indicate whether this has improved, stayed the same or got worse in that situation over the past [10 years]. Note the importance of comparing his/her present performance with [10 years] ago.
For example, if [10 years] ago this person always forgot where he/she had left things, and he/she still does, then this would be considered "not much change".
Compared with [10 years] ago how is this person at…handling other everyday arithmetic problems, for example, knowing how much food to buy, knowing how long between visits from family or friends?
1 MUCH IMPROVED
2 A BIT IMPROVED
3 NOT MUCH CHANGE
4 A BIT WORSE
5 MUCH WORSE
6 DON'T KNOW
INTERVIEWER: can show the respondent the scale and read the categories.
1
Much improved
2
A bit improved
3
Not much change
4
A bit worse
5
Much worse
8
Don't know
9
Not applicable
P1036: Understanding events
P1036: Understanding events
P1036: Understanding events
P1036: Understanding events
P1036: Understanding events
Now we want you to remember what your friend or relative was like [10 years] ago and to compare it with what he/she is like now. Ten years ago was in 1996. Below are situations where this person has to use his/her memory or intelligence and we want you to indicate whether this has improved, stayed the same or got worse in that situation over the past [10 years]. Note the importance of comparing his/her present performance with [10 years] ago.
For example, if [10 years] ago this person always forgot where he/she had left things, and he/she still does, then this would be considered "not much change".
Compared with [10 years] ago how is this person at…using his/her intelligence to understand what's going on and to reason things through?
1 MUCH IMPROVED
2 A BIT IMPROVED
3 NOT MUCH CHANGE
4 A BIT WORSE
5 MUCH WORSE
6 DON'T KNOW
INTERVIEWER: can show the respondent the scale and read the categories.
1
Much improved
2
A bit improved
3
Not much change
4
A bit worse
5
Much worse
8
Don't know
9
Not applicable
P2000: HH begin
P2000: HH begin
P2000: HH begin
P2000: HH begin
P2000: HH begin
P2000: MM begin
P2000: MM begin
P2000: MM begin
P2000: MM begin
P2000: MM begin
P2000: HH end
P2000: HH end
P2000: HH end
P2000: HH end
P2000: HH end
P2000: MM end
P2000: MM end
P2000: MM end
P2000: MM end
P2000: MM end
P2000: Health today
P2000: Health today
P2000: Health today
P2000: Health today
P2000: Health today
Now I will switch to questions specifically about the respondent's health. The first questions are about her/his overall health, then I ask about his/her physical and mental health
In general, how would you rate [NAME's] health today?
1Very good
2Good
3Moderate
4Bad
5 Very bad
1
Very good
2
Good
3
Moderate
4
Bad
5
Very bad
8
Don't know
9
Not applicable
P2001: Activities
P2001: Activities
P2001: Activities
P2001: Activities
P2001: Activities
Now I will switch to questions specifically about the respondent's health. The first questions are about her/his overall health, then I ask about his/her physical and mental health
Overall in the last 30 days, how much difficulty did s/he have with work or household activities?
1None
2Mild
3Moderate
4Severe
5 Extreme/cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
P2002: Moving around
P2002: Moving around
P2002: Moving around
P2002: Moving around
P2002: Moving around
Now I would like to review the different functions of her/his body. When answering these questions, I would like you to think about the last 30 days, taking both good and bad days into account. When I ask about difficulty the respondent may have, I would like you to consider how much difficulty s/he had, on average, in the last 30 days, while doing the activity in the way that s/he usually does it. By difficulty, I mean requiring increased effort, discomfort or pain, slowness or changes in the way s/he does the activity
Overall in the last 30 days, how much difficulty did [NAME] have with moving around?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
INTERVIEWER: Read and show scale to proxy.
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
P2003: Vigorous activities
P2003: Vigorous activities
P2003: Vigorous activities
P2003: Vigorous activities
P2003: Vigorous activities
Now I would like to review the different functions of her/his body. When answering these questions, I would like you to think about the last 30 days, taking both good and bad days into account. When I ask about difficulty the respondent may have, I would like you to consider how much difficulty s/he had, on average, in the last 30 days, while doing the activity in the way that s/he usually does it. By difficulty, I mean requiring increased effort, discomfort or pain, slowness or changes in the way s/he does the activity
Overall in the last 30 days, how much difficulty did [NAME] have in vigorous activities ('vigorous activities' require hard physical effort and cause large increases in breathing or heart rate)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
INTERVIEWER: Read and show scale to proxy.
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
P2004: Self-care
P2004: Self-care
P2004: Self-care
P2004: Self-care
P2004: Self-care
Overall in the last 30 days, how much difficulty did [NAME] have with self-care, such as bathing/washing or dressing her/himself?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
P2005: Appearance
P2005: Appearance
P2005: Appearance
P2005: Appearance
P2005: Appearance
Overall in the last 30 days, how much difficulty did [NAME] have in taking care of and maintaining her/his general appearance (for example, grooming, looking neat and tidy)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
P2006: Time alone
P2006: Time alone
P2006: Time alone
P2006: Time alone
P2006: Time alone
Overall in the last 30 days, how much difficulty did [NAME] have … in staying by her/himself for a few days (3 to 7 days)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
P2007: Bodily pains
P2007: Bodily pains
P2007: Bodily pains
P2007: Bodily pains
P2007: Bodily pains
Overall in the last 30 days, …how much of bodily aches or pains did s/he have?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
P2008: Bodily discomfort
P2008: Bodily discomfort
P2008: Bodily discomfort
P2008: Bodily discomfort
P2008: Bodily discomfort
Overall in the last 30 days, …how much bodily discomfort did s/he have?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
If Q2007 and Q2008 are both = 1, "None"…to P2010
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
P2009: Difficulty b/c pain
P2009: Difficulty b/c pain
P2009: Difficulty b/c pain
P2009: Difficulty b/c pain
P2009: Difficulty b/c pain
Overall in the last 30 days, how much difficulty did s/he have in her/his daily life because of her/his pain?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
P2010: Memory
P2010: Memory
P2010: Memory
P2010: Memory
P2010: Memory
Overall in the last 30 days, how much difficulty did s/he have … with concentrating or remembering things?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
P2011: Learning
P2011: Learning
P2011: Learning
P2011: Learning
P2011: Learning
Overall in the last 30 days, how much difficulty did s/he have … in learning a new task (for example, learning how to get to a new place, learning a new game, learning a new recipe)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
P2012: Relationships
P2012: Relationships
P2012: Relationships
P2012: Relationships
P2012: Relationships
Overall in the last 30 days, how much difficulty did [NAME] have … with personal relationships or participation in the community?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
P2013: Conflicts
P2013: Conflicts
P2013: Conflicts
P2013: Conflicts
P2013: Conflicts
Overall in the last 30 days, how much difficulty did [NAME] have in dealing with conflicts and tensions with others?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
P2014: Friendships
P2014: Friendships
P2014: Friendships
P2014: Friendships
P2014: Friendships
Overall in the last 30 days, how much difficulty did [NAME] have … with making new friendships or maintaining current friendships?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
P2015: Dealing with strangers
P2015: Dealing with strangers
P2015: Dealing with strangers
P2015: Dealing with strangers
P2015: Dealing with strangers
Overall in the last 30 days, how much difficulty did [NAME] have … with dealing with strangers?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
P2016: Sleep
P2016: Sleep
P2016: Sleep
P2016: Sleep
P2016: Sleep
Overall in the last 30 days, how much of a problem did s/he have with sleeping, such as problems falling asleep, waking up frequently during the night or waking up too early in the morning?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
P2017: Rested
P2017: Rested
P2017: Rested
P2017: Rested
P2017: Rested
Overall in the last 30 days, how much of a problem did s/he have … due to not feeling rested and refreshed during the day (for example, feeling tired, not having energy)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
P2018: Depression
P2018: Depression
P2018: Depression
P2018: Depression
P2018: Depression
Overall in the last 30 days, how much of a problem did [NAME] have … with feeling sad, low or depressed?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
P2019: Worry
P2019: Worry
P2019: Worry
P2019: Worry
P2019: Worry
Overall in the last 30 days, how much of a problem did [NAME] have … have with worry or anxiety?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
P2020: Eyes examined
P2020: Eyes examined
P2020: Eyes examined
P2020: Eyes examined
P2020: Eyes examined
When was the last time you had your eyes examined by a medical professional?
years ago
-8 Don't know
98 Never
Interviewer: enter years or months ago. Enter "00" if less than 1 year.
88
Don't know
98
Never
P2021: Visual aids
P2021: Visual aids
P2021: Visual aids
P2021: Visual aids
P2021: Visual aids
Does s/he use eyeglasses or contact lenses to see far away (for example, across the street)?
1Yes
2 No
1
Yes
2
No visual aids
8
Don't know
9
Not applicable
P2022: Visual aids
P2022: Visual aids
P2022: Visual aids
P2022: Visual aids
P2022: Visual aids
Does s/he use eyeglasses or contact lenses to see up close (for example at arms length, like when s/he is reading)?
1Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P2023: Visual difficulty
P2023: Visual difficulty
P2023: Visual difficulty
P2023: Visual difficulty
P2023: Visual difficulty
n the last 30 days, how much difficulty did s/he have in seeing and recognising a person or object s/he knows across the road (from a distance of about 20 meters)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
P2024: Visual difficulty
P2024: Visual difficulty
P2024: Visual difficulty
P2024: Visual difficulty
P2024: Visual difficulty
In the last 30 days, how much difficulty did s/he have in seeing and recognising an object at arm's length (for example, reading)?
1 None
2 Mild
3 Moderate
4 Severe
5 Extreme/Cannot do
1
None
2
Mild
3
Moderate
4
Severe
5
Extreme
8
Don't know
9
Not applicable
P4000: HH begin
P4000: HH begin
P4000: HH begin
P4000: HH begin
P4000: HH begin
P4000: MM begin
P4000: MM begin
P4000: MM begin
P4000: MM begin
P4000: MM begin
P4000: HH end
P4000: HH end
P4000: HH end
P4000: HH end
P4000: HH end
P4000: MM end
P4000: MM end
P4000: MM end
P4000: MM end
P4000: MM end
P4001: Arthritis
P4001: Arthritis
P4001: Arthritis
P4001: Arthritis
P4001: Arthritis
Now I would like to read you questions about some health problems or health care needs that [NAME] may have experienced, and the treatment or medical care that s/he may have received.
Has [NAME] ever been told by a health professional that s/he has arthritis (or by other names rheumatism or osteoarthritis)?
1Yes
2 No ……………………………P4010
1
Yes
2
No
8
Don't know
9
Not applicable
P4002a: Treatment (2 wks)
P4002a: Treatment (2 wks)
P4002a: Treatment (2 wks)
P4002a: Treatment (2 wks)
P4002a: Treatment (2 wks)
Now I would like to read you questions about some health problems or health care needs that [NAME] may have experienced, and the treatment or medical care that s/he may have received.
Has s/he been taking medications or other treatment for it…in the last 2 weeks?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4002b: Treatment (12 mos)
P4002b: Treatment (12 mos)
P4002b: Treatment (12 mos)
P4002b: Treatment (12 mos)
P4002b: Treatment (12 mos)
Now I would like to read you questions about some health problems or health care needs that [NAME] may have experienced, and the treatment or medical care that s/he may have received.
Has s/he been taking medications or other treatment for it during the last 12 months?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4010: Stroke
P4010: Stroke
P4010: Stroke
P4010: Stroke
P4010: Stroke
Has [NAME] ever been told by a health professional that s/he had a stroke?
1 Yes
2 No..................P4014
1
Yes
2
No
8
Don't know
9
Not applicable
P4011a: Treatment (2 wks)
P4011a: Treatment (2 wks)
P4011a: Treatment (2 wks)
P4011a: Treatment (2 wks)
P4011a: Treatment (2 wks)
Has s/he been taking medications or other treatment for it …in the last 2 weeks?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4011b: Treatment (12 mos)
P4011b: Treatment (12 mos)
P4011b: Treatment (12 mos)
P4011b: Treatment (12 mos)
P4011b: Treatment (12 mos)
Has s/he been taking medications or other treatment for it . during the last 12 months?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4014: Angina
P4014: Angina
P4014: Angina
P4014: Angina
P4014: Angina
Has [NAME] ever been told by a health professional that s/he has angina or angina pectoris (a heart disease)?
1 Yes
2 No....................P4022
1
Yes
2
No
8
Don't know
9
Not applicable
P4015a: Treatment (2 wks)
P4015a: Treatment (2 wks)
P4015a: Treatment (2 wks)
P4015a: Treatment (2 wks)
P4015a: Treatment (2 wks)
Has s/he been taking medications or other treatment for it in the last 2 weeks?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4015b: Treatment (12 mos)
P4015b: Treatment (12 mos)
P4015b: Treatment (12 mos)
P4015b: Treatment (12 mos)
P4015b: Treatment (12 mos)
Has s/he been taking medications or other treatment for it …during the last 12 months?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4022: Diabetes
P4022: Diabetes
P4022: Diabetes
P4022: Diabetes
P4022: Diabetes
Has [NAME] ever been told by a health professional that s/he has diabetes (high blood sugar)?
(Not including diabetes associated with a pregnancy)
1 Yes
2 No...................P4025
1
Yes
2
No
8
Don't know
9
Not applicable
P4023a: Treatment (2 wks)
P4023a: Treatment (2 wks)
P4023a: Treatment (2 wks)
P4023a: Treatment (2 wks)
P4023a: Treatment (2 wks)
Has s/he been taking insulin or other blood sugar lowering medications in the last 2 weeks?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4023b: Treatment (12 mos)
P4023b: Treatment (12 mos)
P4023b: Treatment (12 mos)
P4023b: Treatment (12 mos)
P4023b: Treatment (12 mos)
Has s/he been taking insulin or other blood sugar lowering medications during the last 12 months?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4024: Diet or exercise
P4024: Diet or exercise
P4024: Diet or exercise
P4024: Diet or exercise
P4024: Diet or exercise
Has s/he been following a special diet, exercise regime or weight control program for diabetes during the last 2 weeks?
(as recommended by health professional)
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4025: Lung disease
P4025: Lung disease
P4025: Lung disease
P4025: Lung disease
P4025: Lung disease
Has [NAME] ever been diagnosed with chronic lung disease (emphysema, bronchitis, COPD)?
1 Yes
2 No................P4032
1
Yes
2
No
8
Don't know
9
Not applicable
P4026a: Treatment (2 wks)
P4026a: Treatment (2 wks)
P4026a: Treatment (2 wks)
P4026a: Treatment (2 wks)
P4026a: Treatment (2 wks)
Has s/he been taking medications or other treatment (like oxygen) for it … in the last 2 weeks?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4026b: Treatment (12 mos)
P4026b: Treatment (12 mos)
P4026b: Treatment (12 mos)
P4026b: Treatment (12 mos)
P4026b: Treatment (12 mos)
Has s/he been taking medications or other treatment (like oxygen) for it during the last 12 months?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4032: TB
P4032: TB
P4032: TB
P4032: TB
P4032: TB
In the last 12 months, have you had a tuberculosis (TB) test? I mean, has a doctor examined your sputum (taken a sample of the substance spit out from a deep cough and sent it to a laboratory for analysis) or made an x-ray of your chest?
1 Yes
2 No................P4033
1
Yes
2
No
8
Don't know
9
Not applicable
P4032a: Treatment (2 wks)
P4032a: Treatment (2 wks)
P4032a: Treatment (2 wks)
P4032a: Treatment (2 wks)
P4032a: Treatment (2 wks)
Have you been taking any medications or other treatment for it during the last 2 weeks?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4032b: Treatment (12 mos)
P4032b: Treatment (12 mos)
P4032b: Treatment (12 mos)
P4032b: Treatment (12 mos)
P4032b: Treatment (12 mos)
Have you been taking any medications or other treatment for it during the last 12 months?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4033: Asthma
P4033: Asthma
P4033: Asthma
P4033: Asthma
P4033: Asthma
Has [NAME] ever been diagnosed with asthma (an allergic respiratory disease)?
1 Yes
2 No..............P4040
1
Yes
2
No
8
Don't know
9
Not applicable
P4033a: Treatment (2 wks)
P4033a: Treatment (2 wks)
P4033a: Treatment (2 wks)
P4033a: Treatment (2 wks)
P4033a: Treatment (2 wks)
Has s/he been taking any medications or other treatment for it …in the last 2 weeks?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4033b: Treatment (12 mos)
P4033b: Treatment (12 mos)
P4033b: Treatment (12 mos)
P4033b: Treatment (12 mos)
P4033b: Treatment (12 mos)
Has s/he been taking any medications or other treatment for it during the last 12 months?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4040: Depression
P4040: Depression
P4040: Depression
P4040: Depression
P4040: Depression
Has [NAME] ever been diagnosed with depression?
1 Yes
2 No.................PP4060
1
Yes
2
No
8
Don't know
9
Not applicable
P4041a: Treatment (2 wks)
P4041a: Treatment (2 wks)
P4041a: Treatment (2 wks)
P4041a: Treatment (2 wks)
P4041a: Treatment (2 wks)
Has s/he been taking medications or other treatment for it……in the last 2 weeks?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4041b: Treatment (12 mos)
P4041b: Treatment (12 mos)
P4041b: Treatment (12 mos)
P4041b: Treatment (12 mos)
P4041b: Treatment (12 mos)
Has s/he been taking medications or other treatment for it……during the last 12 months?
(Other treatment can include attending therapy or counseling sessions.)
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4060: Hypertension
P4060: Hypertension
P4060: Hypertension
P4060: Hypertension
P4060: Hypertension
Has [NAME] ever been told by a health professional that s/he has high blood pressure (hypertension)?
1 Yes
2 No..............P4062
1
Yes
2
No
8
Don't know
9
Not applicable
P4061a: Treatment (2 wks)
P4061a: Treatment (2 wks)
P4061a: Treatment (2 wks)
P4061a: Treatment (2 wks)
P4061a: Treatment (2 wks)
Has s/he been taking medications or other treatment for it……in the last 2 weeks?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4061b: Treatment (12 mos)
P4061b: Treatment (12 mos)
P4061b: Treatment (12 mos)
P4061b: Treatment (12 mos)
P4061b: Treatment (12 mos)
Has s/he been taking medications or other treatment for it…during the last 12 months?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4062: Cataracts
P4062: Cataracts
P4062: Cataracts
P4062: Cataracts
P4062: Cataracts
In the last 5 years, was [NAME] diagnosed with a cataract in one or both of her/his eyes (a cloudiness in the lens of the eye)?
1 Yes
2 No.......................P4066
8 Don't know
1
Yes
2
No
8
Don't know
9
Not applicable
P4063: Surgery
P4063: Surgery
P4063: Surgery
P4063: Surgery
P4063: Surgery
In the last 5 years, has s/he had eye surgery to remove this cataract(s)?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4066: Lost all teeth?
P4066: Lost all teeth?
P4066: Lost all teeth?
P4066: Lost all teeth?
P4066: Lost all teeth?
Now I would like you to tell me about the condition of [NAME's] mouth and teeth - and any swallowing problems
Has [NAME] lost all of her/his natural teeth?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4067: Probs with mouth/teeth
P4067: Probs with mouth/teeth
P4067: Probs with mouth/teeth
P4067: Probs with mouth/teeth
P4067: Probs with mouth/teeth
Now I would like you to tell me about the condition of [NAME's] mouth and teeth - and any swallowing problems
During the last 12 months, did s/he have any problems with her/his mouth and/or teeth? (This includes troubles with swallowing.)
1 Yes
2 No...................P4069
1
Yes
2
No
8
Don't know
9
Not applicable
P4068a: Treatment (2 wks)
P4068a: Treatment (2 wks)
P4068a: Treatment (2 wks)
P4068a: Treatment (2 wks)
P4068a: Treatment (2 wks)
Now I would like you to tell me about the condition of [NAME's] mouth and teeth - and any swallowing problems
Has s/he been taking medications or other treatment (from a dentist or other oral health specialist) for it …in the last 2 weeks?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4068b: Treatment (12 mos)
P4068b: Treatment (12 mos)
P4068b: Treatment (12 mos)
P4068b: Treatment (12 mos)
P4068b: Treatment (12 mos)
Now I would like you to tell me about the condition of [NAME's] mouth and teeth - and any swallowing problems
Has s/he been taking medications or other treatment (from a dentist or other oral health specialist) for it…during the last 12 months?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4069: Road accident
P4069: Road accident
P4069: Road accident
P4069: Road accident
P4069: Road accident
In the last 12 months, has [NAME] been involved in a road traffic accident where s/he suffered from bodily injury?
PROBE: This could have been an accident in which s/he was involved either as the occupant of a motor vehicle, or when s/he was riding a motorcycle or bicycle or walking.
1 Yes (if more than one accident, select the most recent to ask about in more detail below)
2 No...................P4073
1
Yes
2
No
8
Don't know
9
Not applicable
P4070: How did happen?
P4070: How did happen?
P4070: How did happen?
P4070: How did happen?
P4070: How did happen?
How did the injury happen? Was it an accident, did someone else do this to her/him, or did s/he do this to herself/himself?
1It was an accident (unintentional)
2Someone else did it to her/him deliberately (intentional)
3did it to her/himself deliberately (self-inflicted)
8 Don't know
1
Unintentional
2
Intentional
3
Self-inflicted
8
Don't know
9
Not applicable
P4071: Treatment
P4071: Treatment
P4071: Treatment
P4071: Treatment
P4071: Treatment
Did s/he receive any medical care or treatment for her/his injuries?
1Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4072: Suffered disability?
P4072: Suffered disability?
P4072: Suffered disability?
P4072: Suffered disability?
P4072: Suffered disability?
Did s/he suffer a physical disability as a result of being injured?
1 Yes
2 No..............P4073
INTERVIEWER: disability is any restriction or lack of ability to perform an activity as before the injury.
1
Yes
2
No
8
Don't know
9
Not applicable
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
In what ways was s/he physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
INTERVIEWER: Circle all that proxy respondent selects.
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
In what ways was s/he physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
INTERVIEWER: Circle all that proxy respondent selects.
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
In what ways was s/he physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
INTERVIEWER: Circle all that proxy respondent selects.
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
In what ways was s/he physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
INTERVIEWER: Circle all that proxy respondent selects.
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
In what ways was s/he physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
INTERVIEWER: Circle all that proxy respondent selects.
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
In what ways was s/he physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
INTERVIEWER: Circle all that proxy respondent selects.
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
In what ways was s/he physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
INTERVIEWER: Circle all that proxy respondent selects.
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
In what ways was s/he physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
INTERVIEWER: Circle all that proxy respondent selects.
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
P4072a: Disability suffered
In what ways was s/he physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
INTERVIEWER: Circle all that proxy respondent selects.
P4073: Other injury
P4073: Other injury
P4073: Other injury
P4073: Other injury
P4073: Other injury
In the last 12 months, has [NAME] had any other event where s/he suffered from bodily injury?
1 Yes (if more than one event, select the most recent to ask about in more detail below)
2 No …………………… P4078
1
Yes
2
No
8
Don't know
9
Not applicable
P4073a: Where occurred
P4073a: Where occurred
P4073a: Where occurred
P4073a: Where occurred
P4073a: Where occurred
Where was s/he when s/he was injured?
1Home
2School
3Work
7 Other, specify :
8 Don't know
1
Home
2
School
3
Work
7
Other
8
Don't know
P4074: Cause of event
P4074: Cause of event
P4074: Cause of event
P4074: Cause of event
P4074: Cause of event
What was the cause of this injury?
1Fall
2Struck/hit by person or object
3Stabbed
4Gun shot
5Fire, flames or heat
6Drowning or near-drowning
7Poisoning
8Animal bite
9Electricity shock
87 Other, specify:
88 Don't know
1
Fall
2
Struck/hit by person
3
Stabbed
4
Gunshot
5
Fire, flames or heat
6
Drowning or near
7
Poisoning
8
Animal bite
9
Electric shock
87
Other
88
Don't know
P4075: How did happen?
P4075: How did happen?
P4075: How did happen?
P4075: How did happen?
P4075: How did happen?
How did the injury happen? Was it an accident, did someone else do this to her/him, or did s/he do this to herself/himself?
1It was an accident (unintentional)
2Someone else did it to her/him deliberately (intentional)
3did it to her/himself deliberately (self-inflicted)
8 Don't know
1
Unintentional
2
Intentional
3
Self-inflicted
8
Don't know
9
Not applicable
P4076: Treatment
P4076: Treatment
P4076: Treatment
P4076: Treatment
P4076: Treatment
Did s/he receive any medical care or treatment for her/his injuries?
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4077: Suffered disability?
P4077: Suffered disability?
P4077: Suffered disability?
P4077: Suffered disability?
P4077: Suffered disability?
Did s/he suffer a physical disability as a result of being injured?
1 Yes
2 No ……………………… P4078
INTERVIEWER: disability is any restriction or lack of ability to perform an activity as before the injury.
1
Yes
2
No
8
Don't know
9
Not applicable
P4077a: Disability
P4077a: Disability
P4077a: Disability
P4077a: Disability
P4077a: Disability
In what ways was s/he physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
INTERVIEWER: Circle all that proxy respondent selects.
P4077a: Disability
P4077a: Disability
P4077a: Disability
P4077a: Disability
P4077a: Disability
In what ways was s/he physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
INTERVIEWER: Circle all that proxy respondent selects.
P4077a: Disability
P4077a: Disability
P4077a: Disability
P4077a: Disability
P4077a: Disability
In what ways was s/he physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
INTERVIEWER: Circle all that proxy respondent selects.
P4077a: Disability
P4077a: Disability
P4077a: Disability
P4077a: Disability
P4077a: Disability
In what ways was s/he physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
INTERVIEWER: Circle all that proxy respondent selects.
P4077a: Disability
P4077a: Disability
P4077a: Disability
P4077a: Disability
P4077a: Disability
In what ways was s/he physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
INTERVIEWER: Circle all that proxy respondent selects.
P4077a: Disability
P4077a: Disability
P4077a: Disability
P4077a: Disability
P4077a: Disability
In what ways was s/he physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
INTERVIEWER: Circle all that proxy respondent selects.
P4077a: Disability
P4077a: Disability
P4077a: Disability
P4077a: Disability
P4077a: Disability
In what ways was s/he physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
INTERVIEWER: Circle all that proxy respondent selects.
P4077a: Disability
P4077a: Disability
P4077a: Disability
P4077a: Disability
P4077a: Disability
In what ways was s/he physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
INTERVIEWER: Circle all that proxy respondent selects.
P4077a: Disability
P4077a: Disability
P4077a: Disability
P4077a: Disability
P4077a: Disability
In what ways was s/he physically disabled?
1Unable to use hand or arm
2Difficulty to use hand or arm
3Walk with a limp
4Loss of hearing
5Loss of vision
6Weakness or shortness of breath
7Inability to remember things
8Inability to chew
87 Other, specify:
INTERVIEWER: Circle all that proxy respondent selects.
P4078: Pelvic exam
P4078: Pelvic exam
P4078: Pelvic exam
P4078: Pelvic exam
P4078: Pelvic exam
cervical cancer and breast cancer screening (Women only)
Female -> P4078 Male -> GO TO NEXT SECTION
Now I would like to ask you about some of the kinds of medical care or tests that [NAME] may have received.
When was the last time [NAME] had a pelvic examination, if ever? (By pelvic examination, I mean when a doctor or nurse examined her vagina and uterus?)
Years ago 98
Never had exam …………. P4080
INTERVIEWER: enter “00” if less than 1 year ago.
88
Don't know
98
Never
P4079: PAP smear
P4079: PAP smear
P4079: PAP smear
P4079: PAP smear
P4079: PAP smear
cervical cancer and breast cancer screening (Women only)
Female -> P4078 Male -> GO TO NEXT SECTION
Now I would like to ask you about some of the kinds of medical care or tests that [NAME] may have received.
The last time [NAME] had the pelvic examination, did she have a PAP smear test? (By PAP smear test, I mean did a doctor or nurse use a swab or stick to wipe from inside her vagina, take a sample and send it to a laboratory? )
1 Yes
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P4080: Mammogram
P4080: Mammogram
P4080: Mammogram
P4080: Mammogram
P4080: Mammogram
cervical cancer and breast cancer screening (Women only)
Female -> P4078 Male -> GO TO NEXT SECTION
Now I would like to ask you about some of the kinds of medical care or tests that [NAME] may have received.
When was the last time she had a mammography, if ever? (That is, an x-ray of her breasts taken to detect breast cancer at an early stage.)
Years ago
98 Never had exam
INTERVIEWER: enter “00” if less than 1 year ago.
88
Don't know
98
Never
P5000: HH begin
P5000: HH begin
P5000: HH begin
P5000: HH begin
P5000: HH begin
P5000: MM begin
P5000: MM begin
P5000: MM begin
P5000: MM begin
P5000: MM begin
P5000: HH end
P5000: HH end
P5000: HH end
P5000: HH end
P5000: HH end
P5000: MM end
P5000: MM end
P5000: MM end
P5000: MM end
P5000: MM end
P5001: Needed care YY ago
P5001: Needed care YY ago
P5001: Needed care YY ago
P5001: Needed care YY ago
P5001: Needed care YY ago
I would now like to know about [NAME] recent experiences with obtaining health care from health care workers, hospitals, clinics and the health care system. I want to know if [NAME] needed health care recently, and if so, why s/he needed health care and what type of health care provider s/he received care from.
When was the last time that [NAME] needed health care?
years ago
months ago
0000 never or more than 3 years ago to End P5005
8888 Don't know……to End P5005
INTERVIEWER: this can be inpatient , outpatient and/or home care
-8
Don't know
88
Don't know
98
Not applicable
P5001: Needed care MM ago
P5001: Needed care MM ago
P5001: Needed care MM ago
P5001: Needed care MM ago
P5001: Needed care MM ago
I would now like to know about [NAME] recent experiences with obtaining health care from health care workers, hospitals, clinics and the health care system. I want to know if [NAME] needed health care recently, and if so, why s/he needed health care and what type of health care provider s/he received care from.
When was the last time that [NAME] needed health care?
years ago
months ago
0000 never or more than 3 years ago to End P5005
8888 Don't know……to End P5005
INTERVIEWER: this can be inpatient , outpatient and/or home care
-8
Don't know
88
Don't know
98
Not applicable
P5002: Got care?
P5002: Got care?
P5002: Got care?
P5002: Got care?
P5002: Got care?
I would now like to know about [NAME] recent experiences with obtaining health care from health care workers, hospitals, clinics and the health care system. I want to know if [NAME] needed health care recently, and if so, why s/he needed health care and what type of health care provider s/he received care from.
The last time s/he needed health care, did s/he get health care?
1 Yes..............P5004
2 No
1
Yes
2
No
8
Don't know
9
Not applicable
P5002a: Why needed care
P5002a: Why needed care
P5002a: Why needed care
P5002a: Why needed care
P5002a: Why needed care
I would now like to know about [NAME] recent experiences with obtaining health care from health care workers, hospitals, clinics and the health care system. I want to know if [NAME] needed health care recently, and if so, why s/he needed health care and what type of health care provider s/he received care from.
What was the main reason s/he needed care, even if s/he did not get care?
1COMMUNICABLE DISEASE (INFECTIONS, MALARIA, TUBERCULOSIS, HIV)
2MATERNAL AND PERINATAL CONDITIONS (PREGNANCY)
3NUTRITIONAL DEFICIENCIES
4ACUTE CONDITIONS (DIARRHOEA, FEVER, FLU, HEADACHES, COUGH, OTHER)
5INJURY (not work related, see 8 below)
6SURGERY
7SLEEP PROBLEMS
8OCCUPATION/WORK RELATED CONDITION/INJURY
9CHRONIC PAIN IN YOUR JOINTS/ARTHRITIS (JOINTS, BACK, NECK)
10DIABETES OR RELATED COMPLICATIONS
11PROBLEMS WITH YOUR HEART INCLUDING UNEXPLAINED PAIN IN CHEST
12PROBLEMS WITH YOUR MOUTH, TEETH OR SWALLOWING
13PROBLEMS WITH YOUR BREATHING
14HIGH BLOOD PRESSURE / HYPERTENSION
15STROKE/SUDDEN PARALYSIS OF ONE SIDE OF BODY
16GENERALIZED PAIN (STOMACH, MUSCLE OR OTHER NONSPECIFIC PAIN)
17DEPRESSION OR ANXIETY
18CANCER
87 OTHER, SPECIFY:
88 Don't know
Interviewer: Respondent can select ONLY one main reason for visit. USE SHOWCARD.
1
Communicable
2
Maternal
3
Nutrition
4
Acute condition
5
Injury
6
Surgery
7
Sleep probs
8
Occupation
9
Pain in joints
10
Diabetes
11
Probs with heart
12
Probs with mouth
13
Probs with breathing
14
High BP
15
Stroke
16
Generalized pain
17
Depression or anxiety
18
Cancer
87
Other
88
Don't know
98
Not applicable
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
I would now like to know about [NAME] recent experiences with obtaining health care from health care workers, hospitals, clinics and the health care system. I want to know if [NAME] needed health care recently, and if so, why s/he needed health care and what type of health care provider s/he received care from.
Which reason(s) best explain why s/he did not get health care?
1Could not afford the cost of the visit
2No transport available
3Could not afford the cost of transport
4You were previously badly treated
5Could not take time off work or had other commitments
6The health care provider's drugs or equipment are inadequate
7The health care provider's skills are inadequate
8You did not know where to go
9You tried but were denied health care
10You thought you were not sick enough
87 Other, specify:
88 Don't know
Interviewer: Circle all that the respondent mentions
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
I would now like to know about [NAME] recent experiences with obtaining health care from health care workers, hospitals, clinics and the health care system. I want to know if [NAME] needed health care recently, and if so, why s/he needed health care and what type of health care provider s/he received care from.
Which reason(s) best explain why s/he did not get health care?
1Could not afford the cost of the visit
2No transport available
3Could not afford the cost of transport
4You were previously badly treated
5Could not take time off work or had other commitments
6The health care provider's drugs or equipment are inadequate
7The health care provider's skills are inadequate
8You did not know where to go
9You tried but were denied health care
10You thought you were not sick enough
87 Other, specify:
88 Don't know
Interviewer: Circle all that the respondent mentions
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
I would now like to know about [NAME] recent experiences with obtaining health care from health care workers, hospitals, clinics and the health care system. I want to know if [NAME] needed health care recently, and if so, why s/he needed health care and what type of health care provider s/he received care from.
Which reason(s) best explain why s/he did not get health care?
1Could not afford the cost of the visit
2No transport available
3Could not afford the cost of transport
4You were previously badly treated
5Could not take time off work or had other commitments
6The health care provider's drugs or equipment are inadequate
7The health care provider's skills are inadequate
8You did not know where to go
9You tried but were denied health care
10You thought you were not sick enough
87 Other, specify:
88 Don't know
Interviewer: Circle all that the respondent mentions
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
I would now like to know about [NAME] recent experiences with obtaining health care from health care workers, hospitals, clinics and the health care system. I want to know if [NAME] needed health care recently, and if so, why s/he needed health care and what type of health care provider s/he received care from.
Which reason(s) best explain why s/he did not get health care?
1Could not afford the cost of the visit
2No transport available
3Could not afford the cost of transport
4You were previously badly treated
5Could not take time off work or had other commitments
6The health care provider's drugs or equipment are inadequate
7The health care provider's skills are inadequate
8You did not know where to go
9You tried but were denied health care
10You thought you were not sick enough
87 Other, specify:
88 Don't know
Interviewer: Circle all that the respondent mentions
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
I would now like to know about [NAME] recent experiences with obtaining health care from health care workers, hospitals, clinics and the health care system. I want to know if [NAME] needed health care recently, and if so, why s/he needed health care and what type of health care provider s/he received care from.
Which reason(s) best explain why s/he did not get health care?
1Could not afford the cost of the visit
2No transport available
3Could not afford the cost of transport
4You were previously badly treated
5Could not take time off work or had other commitments
6The health care provider's drugs or equipment are inadequate
7The health care provider's skills are inadequate
8You did not know where to go
9You tried but were denied health care
10You thought you were not sick enough
87 Other, specify:
88 Don't know
Interviewer: Circle all that the respondent mentions
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
I would now like to know about [NAME] recent experiences with obtaining health care from health care workers, hospitals, clinics and the health care system. I want to know if [NAME] needed health care recently, and if so, why s/he needed health care and what type of health care provider s/he received care from.
Which reason(s) best explain why s/he did not get health care?
1Could not afford the cost of the visit
2No transport available
3Could not afford the cost of transport
4You were previously badly treated
5Could not take time off work or had other commitments
6The health care provider's drugs or equipment are inadequate
7The health care provider's skills are inadequate
8You did not know where to go
9You tried but were denied health care
10You thought you were not sick enough
87 Other, specify:
88 Don't know
Interviewer: Circle all that the respondent mentions
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
I would now like to know about [NAME] recent experiences with obtaining health care from health care workers, hospitals, clinics and the health care system. I want to know if [NAME] needed health care recently, and if so, why s/he needed health care and what type of health care provider s/he received care from.
Which reason(s) best explain why s/he did not get health care?
1Could not afford the cost of the visit
2No transport available
3Could not afford the cost of transport
4You were previously badly treated
5Could not take time off work or had other commitments
6The health care provider's drugs or equipment are inadequate
7The health care provider's skills are inadequate
8You did not know where to go
9You tried but were denied health care
10You thought you were not sick enough
87 Other, specify:
88 Don't know
Interviewer: Circle all that the respondent mentions
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
I would now like to know about [NAME] recent experiences with obtaining health care from health care workers, hospitals, clinics and the health care system. I want to know if [NAME] needed health care recently, and if so, why s/he needed health care and what type of health care provider s/he received care from.
Which reason(s) best explain why s/he did not get health care?
1Could not afford the cost of the visit
2No transport available
3Could not afford the cost of transport
4You were previously badly treated
5Could not take time off work or had other commitments
6The health care provider's drugs or equipment are inadequate
7The health care provider's skills are inadequate
8You did not know where to go
9You tried but were denied health care
10You thought you were not sick enough
87 Other, specify:
88 Don't know
Interviewer: Circle all that the respondent mentions
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
I would now like to know about [NAME] recent experiences with obtaining health care from health care workers, hospitals, clinics and the health care system. I want to know if [NAME] needed health care recently, and if so, why s/he needed health care and what type of health care provider s/he received care from.
Which reason(s) best explain why s/he did not get health care?
1Could not afford the cost of the visit
2No transport available
3Could not afford the cost of transport
4You were previously badly treated
5Could not take time off work or had other commitments
6The health care provider's drugs or equipment are inadequate
7The health care provider's skills are inadequate
8You did not know where to go
9You tried but were denied health care
10You thought you were not sick enough
87 Other, specify:
88 Don't know
Interviewer: Circle all that the respondent mentions
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
I would now like to know about [NAME] recent experiences with obtaining health care from health care workers, hospitals, clinics and the health care system. I want to know if [NAME] needed health care recently, and if so, why s/he needed health care and what type of health care provider s/he received care from.
Which reason(s) best explain why s/he did not get health care?
1Could not afford the cost of the visit
2No transport available
3Could not afford the cost of transport
4You were previously badly treated
5Could not take time off work or had other commitments
6The health care provider's drugs or equipment are inadequate
7The health care provider's skills are inadequate
8You did not know where to go
9You tried but were denied health care
10You thought you were not sick enough
87 Other, specify:
88 Don't know
Interviewer: Circle all that the respondent mentions
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
I would now like to know about [NAME] recent experiences with obtaining health care from health care workers, hospitals, clinics and the health care system. I want to know if [NAME] needed health care recently, and if so, why s/he needed health care and what type of health care provider s/he received care from.
Which reason(s) best explain why s/he did not get health care?
1Could not afford the cost of the visit
2No transport available
3Could not afford the cost of transport
4You were previously badly treated
5Could not take time off work or had other commitments
6The health care provider's drugs or equipment are inadequate
7The health care provider's skills are inadequate
8You did not know where to go
9You tried but were denied health care
10You thought you were not sick enough
87 Other, specify:
88 Don't know
Interviewer: Circle all that the respondent mentions
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
P5003: Reasons (single)
I would now like to know about [NAME] recent experiences with obtaining health care from health care workers, hospitals, clinics and the health care system. I want to know if [NAME] needed health care recently, and if so, why s/he needed health care and what type of health care provider s/he received care from.
Which reason(s) best explain why s/he did not get health care?
1Could not afford the cost of the visit
2No transport available
3Could not afford the cost of transport
4You were previously badly treated
5Could not take time off work or had other commitments
6The health care provider's drugs or equipment are inadequate
7The health care provider's skills are inadequate
8You did not know where to go
9You tried but were denied health care
10You thought you were not sick enough
87 Other, specify:
88 Don't know
Interviewer: Circle all that the respondent mentions
P5004: Where
P5004: Where
P5004: Where
P5004: Where
P5004: Where
I would now like to know about [NAME] recent experiences with obtaining health care from health care workers, hospitals, clinics and the health care system. I want to know if [NAME] needed health care recently, and if so, why s/he needed health care and what type of health care provider s/he received care from.
Where did s/he go most often when s/he felt sick or needed to consult someone about his/her health?
1Private doctor's office
2Private clinic or health care facility
3Private hospital
4Public clinic or health care facility
5Public hospital
6Charity or church run clinic
7Charity or church run hospital
8Traditional healer [use local term]
9Pharmacy or dispensary
87 Other, specify:
88 Don't know
Interviewer: Only one answer allowed
1
Private doctor
2
Private clinic
3
Private hospital
4
Public clinic
5
Public hospital
6
Charity clinic
7
Charity hospital
8
Traditional healer
9
Pharmacy/dispensary
87
Other
88
DK
98
NA
P5005: Overnight stay
P5005: Overnight stay
P5005: Overnight stay
P5005: Overnight stay
P5005: Overnight stay
The next 2 questions are about any overnight stay [NAME] had in a hospital or other health care facility in the last 3 years.
In the last 3 years, has [NAME] stayed overnight in a hospital or long-term care facility?
1 Yes, a hospital
2 Yes, long term care facility
3 Both (hospital and long term care facility)
4 No .......... P5026
1
Yes, hospital
2
Yes, long-term care
3
Yes, both
4
No
8
Don't know
9
Not applicable
P5006: MM ago (n)
P5006: MM ago (n)
P5006: MM ago (n)
P5006: MM ago (n)
P5006: MM ago (n)
The next 2 questions are about any overnight stay [NAME] had in a hospital or other health care facility in the last 3 years.
When was her/his last overnight stay in a hospital or long-term care facility?
years ago
months ago
88 Don't Know
If more than 3 years ago …....to P5026
-9
Not applicable
-8
Don't know
P5007: 12-mo. overnight
P5007: 12-mo. overnight
P5007: 12-mo. overnight
P5007: 12-mo. overnight
P5007: 12-mo. overnight
Now I would like to know about more recent times - if [NAME]had any overnight stays in a hospital or other type of health care facility in the last 12 months.
Over the last 12 months, how many different times was she/he a patient in a hospital/long-term care facility for at least one night?
TIMES
-8 Don't Know
-9
Not applicable
-8
Don't know
P5008: Type of facility
P5008: Type of facility
P5008: Type of facility
P5008: Type of facility
P5008: Type of facility
I want to know more about why [NAME] needed an overnight stay in a health care facility. I want to know more about her/his most recent overnight stay, including why s/he needed the overnight stay. Now I would like you to come back to thinking about [NAME's] last overnight hospital stay only.
What type of hospital or facility was it? Remember I am asking now about her/his last (most recent) overnight stay.
1Public hospital
2Private hospital
3Charity or church-run hospital
4Old person's home or long-term care facility
7 Other, specify
INTERVIEWER: one answer only
1
Public hosp
2
Private hosp
3
Charity hosp
4
Old person's home
7
Other
8
Don't know
9
Not applicable
P5008a: Reason for last overnight
P5008a: Reason for last overnight
P5008a: Reason for last overnight
P5008a: Reason for last overnight
P5008a: Reason for last overnight
I want to know more about why [NAME] needed an overnight stay in a health care facility. I want to know more about her/his most recent overnight stay, including why s/he needed the overnight stay. Now I would like you to come back to thinking about [NAME's] last overnight hospital stay only.
Which reason best describes why s/he was last hospitalized?
Circle one
1COMMUNICABLE DISEASE (INFECTIONS, MALARIA, TUBERCULOSIS, HIV)
2MATERNAL AND PERINATAL CONDITIONS (PREGNANCY)
3NUTRITIONAL DEFICIENCIES
4ACUTE CONDITIONS (DIARRHOEA, FEVER, FLU, HEADACHES, COUGH, OTHER)
5INJURY (not work related, see 8 below)
6SURGERY
7SLEEP PROBLEMS
8OCCUPATION/WORK RELATED CONDITION/INJURY
9CHRONIC PAIN IN YOUR JOINTS/ARTHRITIS (JOINTS, BACK, NECK)
10DIABETES OR RELATED COMPLICATIONS
11PROBLEMS WITH YOUR HEART INCLUDING UNEXPLAINED PAIN IN CHEST
12PROBLEMS WITH YOUR MOUTH, TEETH OR SWALLOWING
13PROBLEMS WITH YOUR BREATHING
14HIGH BLOOD PRESSURE / HYPERTENSION
15STROKE/SUDDEN PARALYSIS OF ONE SIDE OF BODY
16GENERALIZED PAIN (STOMACH, MUSCLE OR OTHER NONSPECIFIC PAIN)
17DEPRESSION OR ANXIETY
18CANCER
88 Don't know
-9
NA
-8
DK
1
Communicable
2
Maternal
3
Nutrition
4
Acute condition
5
Injury
6
Surgery
7
Sleep probs
8
Occupation
9
Pain in joints
10
Diabetes
11
Probs with heart
12
Probs with mouth
13
Probs with breathing
14
High BP
15
Stroke
16
Generalized pain
17
Depression or anxiety
18
Cancer
87
Other
88
Don't know
98
Not applicable
P5026: Outpatient
P5026: Outpatient
P5026: Outpatient
P5026: Outpatient
P5026: Outpatient
I have some additional questions about health care [NAME] received, but not health care which included an overnight hospital stay. So care s/he received at a hospital, health centre, clinic, private office or at home from a health care worker, but did not include an overnight stay.
Over the last 12 months, did [NAME} receive any health care NOT including an overnight stay in hospital or long-term care facility?
1 Yes
2 No ……………………to End
1
Yes
2
No
8
Don't know
9
Not applicable
P5027: Times
P5027: Times
P5027: Times
P5027: Times
P5027: Times
I have some additional questions about health care [NAME] received, but not health care which included an overnight hospital stay. So care s/he received at a hospital, health centre, clinic, private office or at home from a health care worker, but did not include an overnight stay.
-9
Not applicable
-8
Don't know
P5028: Last facility
P5028: Last facility
P5028: Last facility
P5028: Last facility
P5028: Last facility
I would like you to think about [NAME's] most recent visit - and to ask you questions specifically about her/his last or most recent visit.
What was the last health care facility s/he visited in the last 12 months ?
1Private doctor's office
2Private clinic or health care facility
3Private hospital
4Public clinic or health care facility
5Public hospital
6Charity or church run clinic
7Charity or church run hospital
8Home visit
87 Other, specify:
Interviewer:
read out responses, circle one option only
-8
Don't know
1
Private doctor
2
Private clinic
3
Private hospital
4
Public clinic
5
Public hospital
6
Charity clinic
7
Charity hospital
87
Other
88
Don't know
P5029: Provider
P5029: Provider
P5029: Provider
P5029: Provider
P5029: Provider
I would like you to think about [NAME's] most recent visit - and to ask you questions specifically about her/his last or most recent visit.
Which was last (most recent) health care provider s/he visited?
1Medical doctor (including gynecologist, psychiatrist, ophthalmologist, etc)
2Nurse/Midwife
3Dentist
4Physiotherapist or chiropractor
5Traditional medicine practitioner (use local name)
6Pharmacist, druggist
7Home health care worker
8 Don't know
Interviewer: After P5029 substitute the type of health care provider selected by the patient when you see [health care provider] in parentheses
1
Medical doctor
2
Nurse/midwife
3
Dentist
4
Physiotherapist
5
Traditional healer
6
Pharmacist
8
DK
P5029a: Sex of provider
P5029a: Sex of provider
P5029a: Sex of provider
P5029a: Sex of provider
P5029a: Sex of provider
I would like you to think about [NAME's] most recent visit - and to ask you questions specifically about her/his last or most recent visit.
What was the sex of the [health care provider]?
1Male
2 Female
1
Male
2
Female
P5029b: Chronic, new, both, routine check-up
P5029b: Chronic, new, both, routine check-up
P5029b: Chronic, new, both, routine check-up
P5029b: Chronic, new, both, routine check-up
P5029b: Chronic, new, both, routine check-up
I would like you to think about [NAME's] most recent visit - and to ask you questions specifically about her/his last or most recent visit.
. Was this visit to [health care provider] for a chronic (ongoing) condition, new condition or both?
1Chronic
2New
3Both
4 Other, specify
1
Chronic
2
New
3
Both
4
Routine check-up
8
Don't know
9
NA
P5029c: Reason for last outpt
P5029c: Reason for last outpt
P5029c: Reason for last outpt
P5029c: Reason for last outpt
P5029c: Reason for last outpt
I would like you to think about [NAME's] most recent visit - and to ask you questions specifically about her/his last or most recent visit.
Which reason best describes why [NAME] needed this visit?
Circle one
1COMMUNICABLE DISEASE (INFECTIONS, MALARIA, TUBERCULOSIS, HIV)
2MATERNAL AND PERINATAL CONDITIONS (PREGNANCY)
3NUTRITIONAL DEFICIENCIES
4ACUTE CONDITIONS (DIARRHOEA, FEVER, FLU, HEADACHES, COUGH, OTHER)
5INJURY (not work related, see 8 below)
6SURGERY
7SLEEP PROBLEMS
8OCCUPATION/WORK RELATED CONDITION/INJURY
9CHRONIC PAIN IN YOUR JOINTS/ARTHRITIS (JOINTS, BACK, NECK)
10DIABETES OR RELATED COMPLICATIONS
11PROBLEMS WITH YOUR HEART INCLUDING UNEXPLAINED PAIN IN CHEST
12PROBLEMS WITH YOUR MOUTH, TEETH OR SWALLOWING
13PROBLEMS WITH YOUR BREATHING
14HIGH BLOOD PRESSURE / HYPERTENSION
15STROKE/SUDDEN PARALYSIS OF ONE SIDE OF BODY
16GENERALIZED PAIN (STOMACH, MUSCLE OR OTHER NONSPECIFIC PAIN)
17DEPRESSION OR ANXIETY
18CANCER
87 OTHER, SPECIFY:
-9
NA
-8
DK
1
Communicable
2
Maternal
3
Nutrition
4
Acute condition
5
Injury
6
Surgery
7
Sleep probs
8
Occupation
9
Pain in joints
10
Diabetes
11
Probs with heart
12
Probs with mouth
13
Probs with breathing
14
High BP
15
Stroke
16
Generalized pain
17
Depression or anxiety
18
Cancer
87
Other
88
Don't know
98
Not applicable
Household Case ID 1st wave
Household Case ID 1st wave
Household Case ID 1st wave
Household Case ID 1st wave
Household Case ID 1st wave
Household Case ID 2nd wave
Household Case ID 2nd wave
Household Case ID 2nd wave
Household Case ID 2nd wave
Household Case ID 2nd wave
Q0001: Research Center Number
Q0001: Research Center Number
Q0001: Research Center Number
Q0001: Research Center Number
Q0001: Research Center Number
Research Centre Number
101
China
106
India
140
Mexico
152
Russian Federation
155
South Africa
241
Ghana
Q0002: Household ID number
Q0002: Household ID number
Q0002: Household ID number
Q0002: Household ID number
Q0002: Household ID number
Household ID
Q0003: Type of interview (new, f/u, retest, proxy, validatio
Q0003: Type of interview (new, f/u, retest, proxy, validatio
Q0003: Type of interview (new, f/u, retest, proxy, validatio
Q0003: Type of interview (new, f/u, retest, proxy, validatio
Q0003: Type of interview (new, f/u, retest, proxy, validatio
Is this a new, second (follow-up from WHS), retest or proxy interview?
1
New interview
2
Follow-up interview from WHS
3
Retest
4
Proxy
5
Proxy validation
Q0002a: Household type (18-49, 50+)
Q0002a: Household type (18-49, 50+)
Q0002a: Household type (18-49, 50+)
Q0002a: Household type (18-49, 50+)
Q0002a: Household type (18-49, 50+)
Is this a (18-49 years) or (50+ years) household?
1
HH for 18-49 year old
2
HH for 50+ year old
3
HH for 18-49 year old (Females only) (India only)
Q0007a: Final result code - HHQ
Q0007a: Final result code - HHQ
Q0007a: Final result code - HHQ
Q0007a: Final result code - HHQ
Q0007a: Final result code - HHQ
Final result code Household Q:
Q0008: Rotation code
Q0008: Rotation code
Q0008: Rotation code
Q0008: Rotation code
Q0008: Rotation code
Rotation code (Circle One)
Q0101b: PSU Code
Q0101b: PSU Code
Q0101b: PSU Code
Q0101b: PSU Code
Q0101b: PSU Code
PSU Code
Q0104: Urban/Rural
Q0104: Urban/Rural
Q0104: Urban/Rural
Q0104: Urban/Rural
Q0104: Urban/Rural
An urban area that has been legally proclaimed as being urban. Such areas include towns, cities and metropolitan areas.
All other areas that are not classified as being urban. This includes commercial farms, small settlements, rural villages and other areas which are further away from towns and cities.
1 = Urban
2 = Rural
1
Urban
2
Rural
8
Don't know
9
Not Applicable
Time begin: HH
Time begin: HH
Time begin: HH
Time begin: HH
Time begin: HH
-9
Not applicable
-8
Don't know
Time begin: mm
Time begin: mm
Time begin: mm
Time begin: mm
Time begin: mm
-9
Not applicable
-8
Don't know
Time end: HH
Time end: HH
Time end: HH
Time end: HH
Time end: HH
-9
Not applicable
-8
Don't know
Time end: mm
Time end: mm
Time end: mm
Time end: mm
Time end: mm
-9
Not applicable
-8
Don't know
Q0908a: HH Number
Q0908a: HH Number
Q0908a: HH Number
Q0908a: HH Number
Q0908a: HH Number
SAGE Household ID
Q0908b: Interviewer ID
Q0908b: Interviewer ID
Q0908b: Interviewer ID
Q0908b: Interviewer ID
Q0908b: Interviewer ID
Interviewer ID
Q0908c: Day of interview (DD)
Q0908c: Day of interview (DD)
Q0908c: Day of interview (DD)
Q0908c: Day of interview (DD)
Q0908c: Day of interview (DD)
Date of interview (DD/MM/YYYY)
-8
Don't know
Q0908c: Month of interview (MM)
Q0908c: Month of interview (MM)
Q0908c: Month of interview (MM)
Q0908c: Month of interview (MM)
Q0908c: Month of interview (MM)
Date of interview (DD/MM/YYYY)
-8
Don't know
Q0908c: Year of interview (YYYY)
Q0908c: Year of interview (YYYY)
Q0908c: Year of interview (YYYY)
Q0908c: Year of interview (YYYY)
Q0908c: Year of interview (YYYY)
Date of interview (DD/MM/YYYY)
-8
Don't know
Q0908d: Person number (HH member)
Q0908d: Person number (HH member)
Q0908d: Person number (HH member)
Q0908d: Person number (HH member)
Q0908d: Person number (HH member)
Person (HH member) number from SAGE roster for RESPONDENT
87
Other
Q0920a: Cause of death - Person 1
Q0920a: Cause of death - Person 1
Q0920a: Cause of death - Person 1
Q0920a: Cause of death - Person 1
Q0920a: Cause of death - Person 1
What do you think was the cause of death?Person 1
INTERVIEW: Write exactly what the respondent tells you.
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person1
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person1
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person1
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person1
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person1
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person1
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person1
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person1
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person1
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person1
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person1
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Q0921a: Condition - Person 1
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person1
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0922a: Events leading to death - Person 1
Q0922a: Events leading to death - Person 1
Q0922a: Events leading to death - Person 1
Q0922a: Events leading to death - Person 1
Q0922a: Events leading to death - Person 1
Would you please briefly describe the events leading up to the death of this person? Person1
Q0920b: Cause of death - Person 2
Q0920b: Cause of death - Person 2
Q0920b: Cause of death - Person 2
Q0920b: Cause of death - Person 2
Q0920b: Cause of death - Person 2
What do you think was the cause of death? Person2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person2
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person2
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person2
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person2
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person2
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person2
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person2
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person2
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person2
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person2
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person2
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Q0921b: Condition - Person 2
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person2
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0922b: Events leading to death - Person 2
Q0922b: Events leading to death - Person 2
Q0922b: Events leading to death - Person 2
Q0922b: Events leading to death - Person 2
Q0922b: Events leading to death - Person 2
Would you please briefly describe the events leading up to the death of this person? Person2
Q0920c: Cause of death - Person 3
Q0920c: Cause of death - Person 3
Q0920c: Cause of death - Person 3
Q0920c: Cause of death - Person 3
Q0920c: Cause of death - Person 3
What do you think was the cause of death? person3
INTERVIEW: Write exactly what the respondent tells you.
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Did the deceased ever suffer from any of the following conditions? Person3
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
Previously diagnosed medical conditions.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Did the deceased ever suffer from any of the following conditions? Person3
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
Previously diagnosed medical conditions.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Did the deceased ever suffer from any of the following conditions? Person3
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
Previously diagnosed medical conditions.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Did the deceased ever suffer from any of the following conditions? Person3
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
Previously diagnosed medical conditions.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Did the deceased ever suffer from any of the following conditions? Person3
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
Previously diagnosed medical conditions.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Did the deceased ever suffer from any of the following conditions? Person3
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
Previously diagnosed medical conditions.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Did the deceased ever suffer from any of the following conditions? Person3
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
Previously diagnosed medical conditions.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Did the deceased ever suffer from any of the following conditions? Person3
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
Previously diagnosed medical conditions.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Did the deceased ever suffer from any of the following conditions? Person3
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
Previously diagnosed medical conditions.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Did the deceased ever suffer from any of the following conditions? Person3
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
Previously diagnosed medical conditions.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Did the deceased ever suffer from any of the following conditions? Person3
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
Previously diagnosed medical conditions.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Q0921c: Condition - Person 3
Did the deceased ever suffer from any of the following conditions? Person3
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
Previously diagnosed medical conditions.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0922c: Events leading to death - Person 3
Q0922c: Events leading to death - Person 3
Q0922c: Events leading to death - Person 3
Q0922c: Events leading to death - Person 3
Q0922c: Events leading to death - Person 3
Would you please briefly describe the events leading up to the death of this person? Person 3
Q0920d: Cause of death - Person 4
Q0920d: Cause of death - Person 4
Q0920d: Cause of death - Person 4
Q0920d: Cause of death - Person 4
Q0920d: Cause of death - Person 4
What do you think was the cause of death?Person4
INTERVIEW: Write exactly what the respondent tells you.
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person4
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person4
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person4
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person4
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person4
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person4
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person4
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person4
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person4
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person4
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person4
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Q0921d: Condition - Person 4
Previously diagnosed medical conditions.
Did the deceased ever suffer from any of the following conditions? Person4
1= Asthma;
2= Cancer;
3= Diabetes;
4= Heart disease;
5= HIV/AIDS;
6= Hypertension (high blood pressure);
7= Injury/violence;
8= Malaria;
9= Stroke;
10= Tuberculosis (TB);
11= Other infectious illness; and/or,
12= Other chronic illness.
INTERVIEWER: ASK ABOUT EACH CONDITION.
INTERVIEWER: ASK ABOUT EACH CONDITION - If yes, then circle the corresponding number
Q0922d: Events leading to death - Person 4
Q0922d: Events leading to death - Person 4
Q0922d: Events leading to death - Person 4
Q0922d: Events leading to death - Person 4
Q0922d: Events leading to death - Person 4
Would you please briefly describe the events leading up to the death of this person?Person 4
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Health services used by the deceased during his/her illness in the period leading to death?
Person1
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Health services used by the deceased during his/her illness in the period leading to death?
Person1
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Health services used by the deceased during his/her illness in the period leading to death?
Person1
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Health services used by the deceased during his/her illness in the period leading to death?
Person1
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Health services used by the deceased during his/her illness in the period leading to death?
Person1
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Health services used by the deceased during his/her illness in the period leading to death?
Person1
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Health services used by the deceased during his/her illness in the period leading to death?
Person1
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Health services used by the deceased during his/her illness in the period leading to death?
Person1
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Health services used by the deceased during his/her illness in the period leading to death?
Person1
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Health services used by the deceased during his/her illness in the period leading to death?
Person1
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Health services used by the deceased during his/her illness in the period leading to death?
Person1
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Health services used by the deceased during his/her illness in the period leading to death?
Person1
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Health services used by the deceased during his/her illness in the period leading to death?
Person1
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Health services used by the deceased during his/her illness in the period leading to death?
Person1
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Health services used by the deceased during his/her illness in the period leading to death?
Person1
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Health services used by the deceased during his/her illness in the period leading to death?
Person1
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Health services used by the deceased during his/her illness in the period leading to death?
Person1
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Q0985: Services used - Person 1
Health services used by the deceased during his/her illness in the period leading to death?
Person1
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Health services used by the deceased during his/her illness in the period leading to death?
Person2
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Health services used by the deceased during his/her illness in the period leading to death?
Person2
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Health services used by the deceased during his/her illness in the period leading to death?
Person2
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Health services used by the deceased during his/her illness in the period leading to death?
Person2
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Health services used by the deceased during his/her illness in the period leading to death?
Person2
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Health services used by the deceased during his/her illness in the period leading to death?
Person2
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Health services used by the deceased during his/her illness in the period leading to death?
Person2
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Health services used by the deceased during his/her illness in the period leading to death?
Person2
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Health services used by the deceased during his/her illness in the period leading to death?
Person2
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Health services used by the deceased during his/her illness in the period leading to death?
Person2
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Health services used by the deceased during his/her illness in the period leading to death?
Person2
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Health services used by the deceased during his/her illness in the period leading to death?
Person2
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Health services used by the deceased during his/her illness in the period leading to death?
Person2
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Health services used by the deceased during his/her illness in the period leading to death?
Person2
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Health services used by the deceased during his/her illness in the period leading to death?
Person2
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Health services used by the deceased during his/her illness in the period leading to death?
Person2
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Health services used by the deceased during his/her illness in the period leading to death?
Person2
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Q0985: Services used - Person 2
Health services used by the deceased during his/her illness in the period leading to death?
Person2
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Health services used by the deceased during his/her illness in the period leading to death?
Person3
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Health services used by the deceased during his/her illness in the period leading to death?
Person3
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Health services used by the deceased during his/her illness in the period leading to death?
Person3
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Health services used by the deceased during his/her illness in the period leading to death?
Person3
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Health services used by the deceased during his/her illness in the period leading to death?
Person3
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Health services used by the deceased during his/her illness in the period leading to death?
Person3
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Health services used by the deceased during his/her illness in the period leading to death?
Person3
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Health services used by the deceased during his/her illness in the period leading to death?
Person3
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Health services used by the deceased during his/her illness in the period leading to death?
Person3
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Health services used by the deceased during his/her illness in the period leading to death?
Person3
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Health services used by the deceased during his/her illness in the period leading to death?
Person3
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Health services used by the deceased during his/her illness in the period leading to death?
Person3
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Health services used by the deceased during his/her illness in the period leading to death?
Person3
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Health services used by the deceased during his/her illness in the period leading to death?
Person3
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Health services used by the deceased during his/her illness in the period leading to death?
Person3
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Health services used by the deceased during his/her illness in the period leading to death?
Person3
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Health services used by the deceased during his/her illness in the period leading to death?
Person3
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Q0985: Services used - Person 3
Health services used by the deceased during his/her illness in the period leading to death?
Person3
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Health services used by the deceased during his/her illness in the period leading to death?
Person4
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Health services used by the deceased during his/her illness in the period leading to death?
Person4
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Health services used by the deceased during his/her illness in the period leading to death?
Person4
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Health services used by the deceased during his/her illness in the period leading to death?
Person4
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Health services used by the deceased during his/her illness in the period leading to death?
Person4
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Health services used by the deceased during his/her illness in the period leading to death?
Person4
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Health services used by the deceased during his/her illness in the period leading to death?
Person4
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Health services used by the deceased during his/her illness in the period leading to death?
Person4
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Health services used by the deceased during his/her illness in the period leading to death?
Person4
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Health services used by the deceased during his/her illness in the period leading to death?
Person4
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Health services used by the deceased during his/her illness in the period leading to death?
Person4
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Health services used by the deceased during his/her illness in the period leading to death?
Person4
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Health services used by the deceased during his/her illness in the period leading to death?
Person4
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Health services used by the deceased during his/her illness in the period leading to death?
Person4
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Health services used by the deceased during his/her illness in the period leading to death?
Person4
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Health services used by the deceased during his/her illness in the period leading to death?
Person4
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Health services used by the deceased during his/her illness in the period leading to death?
Person4
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Q0985: Services used - Person 4
Health services used by the deceased during his/her illness in the period leading to death?
Person4
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0909a: Person Number (deceased)
Q0909a: Person Number (deceased)
Q0909a: Person Number (deceased)
Q0909a: Person Number (deceased)
Q0909a: Person Number (deceased)
Person (HH member) number of deceased (from SAGE HH roster) Person1
Q0909a: Person Number (deceased)
Q0909a: Person Number (deceased)
Q0909a: Person Number (deceased)
Q0909a: Person Number (deceased)
Q0909a: Person Number (deceased)
Person (HH member) number of deceased (from SAGE HH roster) Person2
Q0909a: Person Number (deceased)
Q0909a: Person Number (deceased)
Q0909a: Person Number (deceased)
Q0909a: Person Number (deceased)
Q0909a: Person Number (deceased)
Person (HH member) number of deceased (from SAGE HH roster) Person3
Q0909a: Person Number (deceased)
Q0909a: Person Number (deceased)
Q0909a: Person Number (deceased)
Q0909a: Person Number (deceased)
Q0909a: Person Number (deceased)
Person (HH member) number of deceased (from SAGE HH roster) Person4
Q0909b: Row Number from WHS
Q0909b: Row Number from WHS
Q0909b: Row Number from WHS
Q0909b: Row Number from WHS
Q0909b: Row Number from WHS
Row number for deceased household member from WHS.
(use '98' for N/A)
Person1
Q0909b: Row Number from WHS
Q0909b: Row Number from WHS
Q0909b: Row Number from WHS
Q0909b: Row Number from WHS
Q0909b: Row Number from WHS
Row number for deceased household member from WHS.
(use '98' for N/A)
Person2
Q0909b: Row Number from WHS
Q0909b: Row Number from WHS
Q0909b: Row Number from WHS
Q0909b: Row Number from WHS
Q0909b: Row Number from WHS
Row number for deceased household member from WHS.
(use '98' for N/A)
Person3
Q0909b: Row Number from WHS
Q0909b: Row Number from WHS
Q0909b: Row Number from WHS
Q0909b: Row Number from WHS
Q0909b: Row Number from WHS
Row number for deceased household member from WHS.
(use '98' for N/A)
Person4
Q0910: Relationship of informant
Q0910: Relationship of informant
Q0910: Relationship of informant
Q0910: Relationship of informant
Q0910: Relationship of informant
What is your relationship to the deceased?
Person1
1= Parent (father/mother)
2= Spouse
3= Sibling (brother/sister)
4= Child
5= Other relative
6= No relation
Q0910: Relationship of informant
Q0910: Relationship of informant
Q0910: Relationship of informant
Q0910: Relationship of informant
Q0910: Relationship of informant
What is your relationship to the deceased?
Person2
1= Parent (father/mother)
2= Spouse
3= Sibling (brother/sister)
4= Child
5= Other relative
6= No relation
Q0910: Relationship of informant
Q0910: Relationship of informant
Q0910: Relationship of informant
Q0910: Relationship of informant
Q0910: Relationship of informant
What is your relationship to the deceased?
Person3
1= Parent (father/mother)
2= Spouse
3= Sibling (brother/sister)
4= Child
5= Other relative
6= No relation
Q0910: Relationship of informant
Q0910: Relationship of informant
Q0910: Relationship of informant
Q0910: Relationship of informant
Q0910: Relationship of informant
What is your relationship to the deceased?
Person4
1= Parent (father/mother)
2= Spouse
3= Sibling (brother/sister)
4= Child
5= Other relative
6= No relation
Q0911: Lived with deceased?
Q0911: Lived with deceased?
Q0911: Lived with deceased?
Q0911: Lived with deceased?
Q0911: Lived with deceased?
Did you live with the deceased in the period leading to death?Person1
1=Yes; 2=No
Q0911: Lived with deceased?
Q0911: Lived with deceased?
Q0911: Lived with deceased?
Q0911: Lived with deceased?
Q0911: Lived with deceased?
Did you live with the deceased in the period leading to death?Person2
1=Yes; 2=No
Q0911: Lived with deceased?
Q0911: Lived with deceased?
Q0911: Lived with deceased?
Q0911: Lived with deceased?
Q0911: Lived with deceased?
Did you live with the deceased in the period leading to death?Person3
1=Yes; 2=No
Q0911: Lived with deceased?
Q0911: Lived with deceased?
Q0911: Lived with deceased?
Q0911: Lived with deceased?
Q0911: Lived with deceased?
Did you live with the deceased in the period leading to death?Person4
1=Yes; 2=No
Q0912: Last name of deceased
Q0912: Last name of deceased
Q0912: Last name of deceased
Q0912: Last name of deceased
Q0912: Last name of deceased
What was the full name of the deceased?
Person1
Q0912: Last name of deceased
Q0912: Last name of deceased
Q0912: Last name of deceased
Q0912: Last name of deceased
Q0912: Last name of deceased
What was the full name of the deceased?
Person2
Q0912: Last name of deceased
Q0912: Last name of deceased
Q0912: Last name of deceased
Q0912: Last name of deceased
Q0912: Last name of deceased
What was the full name of the deceased?
Person3
Q0912: Last name of deceased
Q0912: Last name of deceased
Q0912: Last name of deceased
Q0912: Last name of deceased
Q0912: Last name of deceased
What was the full name of the deceased?
Person4
Q0912: First name of deceased
Q0912: First name of deceased
Q0912: First name of deceased
Q0912: First name of deceased
Q0912: First name of deceased
What was the full name of the deceased?
Person1
Q0912: First name of deceased
Q0912: First name of deceased
Q0912: First name of deceased
Q0912: First name of deceased
Q0912: First name of deceased
What was the full name of the deceased?
Person2
Q0912: First name of deceased
Q0912: First name of deceased
Q0912: First name of deceased
Q0912: First name of deceased
Q0912: First name of deceased
What was the full name of the deceased?
Person3
Q0912: First name of deceased
Q0912: First name of deceased
Q0912: First name of deceased
Q0912: First name of deceased
Q0912: First name of deceased
What was the full name of the deceased?
Person4
Q0913: Sex of deceased
Q0913: Sex of deceased
Q0913: Sex of deceased
Q0913: Sex of deceased
Q0913: Sex of deceased
What was the sex of the deceased?
Person1
1=Male; 2=Female
Q0913: Sex of deceased
Q0913: Sex of deceased
Q0913: Sex of deceased
Q0913: Sex of deceased
Q0913: Sex of deceased
What was the sex of the deceased?
Person2
1=Male; 2=Female
Q0913: Sex of deceased
Q0913: Sex of deceased
Q0913: Sex of deceased
Q0913: Sex of deceased
Q0913: Sex of deceased
What was the sex of the deceased?
Person3
1=Male; 2=Female
Q0913: Sex of deceased
Q0913: Sex of deceased
Q0913: Sex of deceased
Q0913: Sex of deceased
Q0913: Sex of deceased
What was the sex of the deceased?
Person4
1=Male; 2=Female
Q0914d: Day of birth
Q0914d: Day of birth
Q0914d: Day of birth
Q0914d: Day of birth
Q0914d: Day of birth
Date of Birth of the deceased?
Person1
DD/MM/YY (-8 for DK)
Q0914d: Day of birth
Q0914d: Day of birth
Q0914d: Day of birth
Q0914d: Day of birth
Q0914d: Day of birth
Date of Birth of the deceased?
Person2
DD/MM/YY (-8 for DK)
Q0914d: Day of birth
Q0914d: Day of birth
Q0914d: Day of birth
Q0914d: Day of birth
Q0914d: Day of birth
Date of Birth of the deceased?
Person3
DD/MM/YY (-8 for DK)
Q0914d: Day of birth
Q0914d: Day of birth
Q0914d: Day of birth
Q0914d: Day of birth
Q0914d: Day of birth
Date of Birth of the deceased?
Person4
DD/MM/YY (-8 for DK)
Q0914m: Month of birth
Q0914m: Month of birth
Q0914m: Month of birth
Q0914m: Month of birth
Q0914m: Month of birth
Date of Birth of the deceased?
Person1
DD/MM/YY (-8 for DK)
Q0914m: Month of birth
Q0914m: Month of birth
Q0914m: Month of birth
Q0914m: Month of birth
Q0914m: Month of birth
Date of Birth of the deceased?
Person2
DD/MM/YY (-8 for DK)
Q0914m: Month of birth
Q0914m: Month of birth
Q0914m: Month of birth
Q0914m: Month of birth
Q0914m: Month of birth
Date of Birth of the deceased?
Person3
DD/MM/YY (-8 for DK)
Q0914m: Month of birth
Q0914m: Month of birth
Q0914m: Month of birth
Q0914m: Month of birth
Q0914m: Month of birth
Date of Birth of the deceased?
Person4
DD/MM/YY (-8 for DK)
Q0914y: Year of birth
Q0914y: Year of birth
Q0914y: Year of birth
Q0914y: Year of birth
Q0914y: Year of birth
Date of Birth of the deceased?
Person1
DD/MM/YY (-8 for DK)
Q0914y: Year of birth
Q0914y: Year of birth
Q0914y: Year of birth
Q0914y: Year of birth
Q0914y: Year of birth
Date of Birth of the deceased?
Person2
DD/MM/YY (-8 for DK)
Q0914y: Year of birth
Q0914y: Year of birth
Q0914y: Year of birth
Q0914y: Year of birth
Q0914y: Year of birth
Date of Birth of the deceased?
Person3
DD/MM/YY (-8 for DK)
Q0914y: Year of birth
Q0914y: Year of birth
Q0914y: Year of birth
Q0914y: Year of birth
Q0914y: Year of birth
Date of Birth of the deceased?
Person4
DD/MM/YY (-8 for DK)
Q0915: Marital status of deceased
Q0915: Marital status of deceased
Q0915: Marital status of deceased
Q0915: Marital status of deceased
Q0915: Marital status of deceased
What was the deceased's marital status at time of death?
Person1
1= never married (and not cohabiting)
2= married
3=separated
4=divorced
5=widowed
6=cohabiting
8=don't know
Q0915: Marital status of deceased
Q0915: Marital status of deceased
Q0915: Marital status of deceased
Q0915: Marital status of deceased
Q0915: Marital status of deceased
What was the deceased's marital status at time of death?
Person2
1= never married (and not cohabiting)
2= married
3=separated
4=divorced
5=widowed
6=cohabiting
8=don't know
Q0915: Marital status of deceased
Q0915: Marital status of deceased
Q0915: Marital status of deceased
Q0915: Marital status of deceased
Q0915: Marital status of deceased
What was the deceased's marital status at time of death?
Person3
1= never married (and not cohabiting)
2= married
3=separated
4=divorced
5=widowed
6=cohabiting
8=don't know
Q0915: Marital status of deceased
Q0915: Marital status of deceased
Q0915: Marital status of deceased
Q0915: Marital status of deceased
Q0915: Marital status of deceased
What was the deceased's marital status at time of death?
Person4
1= never married (and not cohabiting)
2= married
3=separated
4=divorced
5=widowed
6=cohabiting
8=don't know
Q0916: Education of deceased
Q0916: Education of deceased
Q0916: Education of deceased
Q0916: Education of deceased
Q0916: Education of deceased
What was the deceased's marital status at time of death?
Person1
1= never married (and not cohabiting)
2= married
3=separated
4=divorced
5=widowed
6=cohabiting
8=don't know
Q0916: Education of deceased
Q0916: Education of deceased
Q0916: Education of deceased
Q0916: Education of deceased
Q0916: Education of deceased
What was the deceased's marital status at time of death?
Person2
1= never married (and not cohabiting)
2= married
3=separated
4=divorced
5=widowed
6=cohabiting
8=don't know
Q0916: Education of deceased
Q0916: Education of deceased
Q0916: Education of deceased
Q0916: Education of deceased
Q0916: Education of deceased
What was the deceased's marital status at time of death?
Person3
1= never married (and not cohabiting)
2= married
3=separated
4=divorced
5=widowed
6=cohabiting
8=don't know
Q0916: Education of deceased
Q0916: Education of deceased
Q0916: Education of deceased
Q0916: Education of deceased
Q0916: Education of deceased
What was the deceased's marital status at time of death?
Person4
1= never married (and not cohabiting)
2= married
3=separated
4=divorced
5=widowed
6=cohabiting
8=don't know
Q0917: Occupation
Q0917: Occupation
Q0917: Occupation
Q0917: Occupation
Q0917: Occupation
What was her/his main occupation?
Person1
INTERVIEWER: Use same technique as in the individual questionnaire.
Q0917: Occupation
Q0917: Occupation
Q0917: Occupation
Q0917: Occupation
Q0917: Occupation
What was her/his main occupation?
Person2
INTERVIEWER: Use same technique as in the individual questionnaire.
Q0917: Occupation
Q0917: Occupation
Q0917: Occupation
Q0917: Occupation
Q0917: Occupation
What was her/his main occupation?
Person3
INTERVIEWER: Use same technique as in the individual questionnaire.
Q0917: Occupation
Q0917: Occupation
Q0917: Occupation
Q0917: Occupation
Q0917: Occupation
What was her/his main occupation?
Person4
INTERVIEWER: Use same technique as in the individual questionnaire.
Q0918: Place of death
Q0918: Place of death
Q0918: Place of death
Q0918: Place of death
Q0918: Place of death
What was her/his place of death? (Where did s/he die?)
Person1
1=Home;
2=Health facility;
7=Other
Q0918: Place of death
Q0918: Place of death
Q0918: Place of death
Q0918: Place of death
Q0918: Place of death
What was her/his place of death? (Where did s/he die?)
Person2
1=Home;
2=Health facility;
7=Other
Q0918: Place of death
Q0918: Place of death
Q0918: Place of death
Q0918: Place of death
Q0918: Place of death
What was her/his place of death? (Where did s/he die?)
Person3
1=Home;
2=Health facility;
7=Other
Q0918: Place of death
Q0918: Place of death
Q0918: Place of death
Q0918: Place of death
Q0918: Place of death
What was her/his place of death? (Where did s/he die?)
Person4
1=Home;
2=Health facility;
7=Other
Q0919d: Day of death
Q0919d: Day of death
Q0919d: Day of death
Q0919d: Day of death
Q0919d: Day of death
What was the date of death?
Person1
DD/MM/YY
(use' -8' for DK)
Q0919d: Day of death
Q0919d: Day of death
Q0919d: Day of death
Q0919d: Day of death
Q0919d: Day of death
What was the date of death?
Person2
DD/MM/YY
(use' -8' for DK)
Q0919d: Day of death
Q0919d: Day of death
Q0919d: Day of death
Q0919d: Day of death
Q0919d: Day of death
What was the date of death?
Person3
DD/MM/YY
(use' -8' for DK)
Q0919d: Day of death
Q0919d: Day of death
Q0919d: Day of death
Q0919d: Day of death
Q0919d: Day of death
What was the date of death?
Person4
DD/MM/YY
(use' -8' for DK)
Q0919m: Month of death
Q0919m: Month of death
Q0919m: Month of death
Q0919m: Month of death
Q0919m: Month of death
What was the date of death?
Person1
DD/MM/YY
(use' -8' for DK)
Q0919m: Month of death
Q0919m: Month of death
Q0919m: Month of death
Q0919m: Month of death
Q0919m: Month of death
What was the date of death?
Person2
DD/MM/YY
(use' -8' for DK)
Q0919m: Month of death
Q0919m: Month of death
Q0919m: Month of death
Q0919m: Month of death
Q0919m: Month of death
What was the date of death?
Person3
DD/MM/YY
(use' -8' for DK)
Q0919m: Month of death
Q0919m: Month of death
Q0919m: Month of death
Q0919m: Month of death
Q0919m: Month of death
What was the date of death?
Person4
DD/MM/YY
(use' -8' for DK)
Q0919y: Year of death
Q0919y: Year of death
Q0919y: Year of death
Q0919y: Year of death
Q0919y: Year of death
What was the date of death?
Person1
DD/MM/YY
(use' -8' for DK)
Q0919y: Year of death
Q0919y: Year of death
Q0919y: Year of death
Q0919y: Year of death
Q0919y: Year of death
What was the date of death?
Person2
DD/MM/YY
(use' -8' for DK)
Q0919y: Year of death
Q0919y: Year of death
Q0919y: Year of death
Q0919y: Year of death
Q0919y: Year of death
What was the date of death?
Person3
DD/MM/YY
(use' -8' for DK)
Q0919y: Year of death
Q0919y: Year of death
Q0919y: Year of death
Q0919y: Year of death
Q0919y: Year of death
What was the date of death?
Person4
DD/MM/YY
(use' -8' for DK)
Q0930: Fever?
Q0930: Fever?
Q0930: Fever?
Q0930: Fever?
Q0930: Fever?
Did s/he have fever?
Person1
1=Yes; 2=No; 8=Don't know
Q0930: Fever?
Q0930: Fever?
Q0930: Fever?
Q0930: Fever?
Q0930: Fever?
Did s/he have fever?
Person2
1=Yes; 2=No; 8=Don't know
Q0930: Fever?
Q0930: Fever?
Q0930: Fever?
Q0930: Fever?
Q0930: Fever?
Did s/he have fever?
Person3
1=Yes; 2=No; 8=Don't know
Q0930: Fever?
Q0930: Fever?
Q0930: Fever?
Q0930: Fever?
Q0930: Fever?
Did s/he have fever?
Person4
1=Yes; 2=No; 8=Don't know
Q0930a: How long (months)?
Q0930a: How long (months)?
Q0930a: How long (months)?
Q0930a: How long (months)?
Q0930a: How long (months)?
a. How long? Months (MM)
Person1
Interviewer: if less than 1 month enter “00” and go to b.
Q0930a: How long (months)?
Q0930a: How long (months)?
Q0930a: How long (months)?
Q0930a: How long (months)?
Q0930a: How long (months)?
a. How long? Months (MM)
Person2
Interviewer: if less than 1 month enter “00” and go to b.
Q0930a: How long (months)?
Q0930a: How long (months)?
Q0930a: How long (months)?
Q0930a: How long (months)?
Q0930a: How long (months)?
a. How long? Months (MM)
Person3
Interviewer: if less than 1 month enter “00” and go to b.
Q0930a: How long (months)?
Q0930a: How long (months)?
Q0930a: How long (months)?
Q0930a: How long (months)?
Q0930a: How long (months)?
a. How long? Months (MM)
Person4
Interviewer: if less than 1 month enter “00” and go to b.
Q0930b: How long (days)?
Q0930b: How long (days)?
Q0930b: How long (days)?
Q0930b: How long (days)?
Q0930b: How long (days)?
Days (DD) Person1
Q0930b: How long (days)?
Q0930b: How long (days)?
Q0930b: How long (days)?
Q0930b: How long (days)?
Q0930b: How long (days)?
Days (DD) Person2
Q0930b: How long (days)?
Q0930b: How long (days)?
Q0930b: How long (days)?
Q0930b: How long (days)?
Q0930b: How long (days)?
Days (DD) Person3
Q0930b: How long (days)?
Q0930b: How long (days)?
Q0930b: How long (days)?
Q0930b: How long (days)?
Q0930b: How long (days)?
Days (DD) Person4
Q0931: Fever was...
Q0931: Fever was...
Q0931: Fever was...
Q0931: Fever was...
Q0931: Fever was...
Was the fever…? Person1
1=continuous;
2=on and off;
8=Don't know
Q0931: Fever was...
Q0931: Fever was...
Q0931: Fever was...
Q0931: Fever was...
Q0931: Fever was...
Was the fever…? Person2
1=continuous;
2=on and off;
8=Don't know
Q0931: Fever was...
Q0931: Fever was...
Q0931: Fever was...
Q0931: Fever was...
Q0931: Fever was...
Was the fever…? Person3
1=continuous;
2=on and off;
8=Don't know
Q0931: Fever was...
Q0931: Fever was...
Q0931: Fever was...
Q0931: Fever was...
Q0931: Fever was...
Was the fever…? Person4
1=continuous;
2=on and off;
8=Don't know
Q0932: Breathless?
Q0932: Breathless?
Q0932: Breathless?
Q0932: Breathless?
Q0932: Breathless?
Was s/he breathless on light work? Person1
1=Yes; 2=No; 8=Don't know
Q0932: Breathless?
Q0932: Breathless?
Q0932: Breathless?
Q0932: Breathless?
Q0932: Breathless?
Was s/he breathless on light work? Person2
1=Yes; 2=No; 8=Don't know
Q0932: Breathless?
Q0932: Breathless?
Q0932: Breathless?
Q0932: Breathless?
Q0932: Breathless?
Was s/he breathless on light work? Person3
1=Yes; 2=No; 8=Don't know
Q0932: Breathless?
Q0932: Breathless?
Q0932: Breathless?
Q0932: Breathless?
Q0932: Breathless?
Was s/he breathless on light work? Person4
1=Yes; 2=No; 8=Don't know
Q0933: Breathless (lying down)?
Q0933: Breathless (lying down)?
Q0933: Breathless (lying down)?
Q0933: Breathless (lying down)?
Q0933: Breathless (lying down)?
Was s/he breathless when lying flat - interfering with sleep? Person1
1=Yes; 2=No; 8=Don't know
Q0933: Breathless (lying down)?
Q0933: Breathless (lying down)?
Q0933: Breathless (lying down)?
Q0933: Breathless (lying down)?
Q0933: Breathless (lying down)?
Was s/he breathless when lying flat - interfering with sleep? Person2
1=Yes; 2=No; 8=Don't know
Q0933: Breathless (lying down)?
Q0933: Breathless (lying down)?
Q0933: Breathless (lying down)?
Q0933: Breathless (lying down)?
Q0933: Breathless (lying down)?
Was s/he breathless when lying flat - interfering with sleep? Person3
1=Yes; 2=No; 8=Don't know
Q0933: Breathless (lying down)?
Q0933: Breathless (lying down)?
Q0933: Breathless (lying down)?
Q0933: Breathless (lying down)?
Q0933: Breathless (lying down)?
Was s/he breathless when lying flat - interfering with sleep? Person4
1=Yes; 2=No; 8=Don't know
Q0934: Palpitations?
Q0934: Palpitations?
Q0934: Palpitations?
Q0934: Palpitations?
Q0934: Palpitations?
Did s/he have palpitations? Person1
1=Yes; 2=No; 8=Don't know
Q0934: Palpitations?
Q0934: Palpitations?
Q0934: Palpitations?
Q0934: Palpitations?
Q0934: Palpitations?
Did s/he have palpitations? Person2
1=Yes; 2=No; 8=Don't know
Q0934: Palpitations?
Q0934: Palpitations?
Q0934: Palpitations?
Q0934: Palpitations?
Q0934: Palpitations?
Did s/he have palpitations? Person3
1=Yes; 2=No; 8=Don't know
Q0934: Palpitations?
Q0934: Palpitations?
Q0934: Palpitations?
Q0934: Palpitations?
Q0934: Palpitations?
Did s/he have palpitations? Person4
1=Yes; 2=No; 8=Don't know
Q0935: Wheezing?
Q0935: Wheezing?
Q0935: Wheezing?
Q0935: Wheezing?
Q0935: Wheezing?
Did s/he have wheezing? Person1
1=Yes; 2=No; 8=Don't know
Q0935: Wheezing?
Q0935: Wheezing?
Q0935: Wheezing?
Q0935: Wheezing?
Q0935: Wheezing?
Did s/he have wheezing? Person2
1=Yes; 2=No; 8=Don't know
Q0935: Wheezing?
Q0935: Wheezing?
Q0935: Wheezing?
Q0935: Wheezing?
Q0935: Wheezing?
Did s/he have wheezing? Person3
1=Yes; 2=No; 8=Don't know
Q0935: Wheezing?
Q0935: Wheezing?
Q0935: Wheezing?
Q0935: Wheezing?
Q0935: Wheezing?
Did s/he have wheezing? Person4
1=Yes; 2=No; 8=Don't know
Q0936: Cough?
Q0936: Cough?
Q0936: Cough?
Q0936: Cough?
Q0936: Cough?
Did s/he have a cough?
Person1
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0937
Q0936: Cough?
Q0936: Cough?
Q0936: Cough?
Q0936: Cough?
Q0936: Cough?
Did s/he have a cough?
Person2
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0937
Q0936: Cough?
Q0936: Cough?
Q0936: Cough?
Q0936: Cough?
Q0936: Cough?
Did s/he have a cough?
Person3
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0937
Q0936: Cough?
Q0936: Cough?
Q0936: Cough?
Q0936: Cough?
Q0936: Cough?
Did s/he have a cough?
Person3
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0937
Q0936a: Cough was...
Q0936a: Cough was...
Q0936a: Cough was...
Q0936a: Cough was...
Q0936a: Cough was...
Q0936a. If yes, was the cough…?
Person1
1=dry; 2=productive; 3=with blood; 8=Don't know
Q0936a: Cough was...
Q0936a: Cough was...
Q0936a: Cough was...
Q0936a: Cough was...
Q0936a: Cough was...
Q0936a. If yes, was the cough…?
Person2
1=dry; 2=productive; 3=with blood; 8=Don't know
Q0936a: Cough was...
Q0936a: Cough was...
Q0936a: Cough was...
Q0936a: Cough was...
Q0936a: Cough was...
Q0936a. If yes, was the cough…?
Person3
1=dry; 2=productive; 3=with blood; 8=Don't know
Q0936a: Cough was...
Q0936a: Cough was...
Q0936a: Cough was...
Q0936a: Cough was...
Q0936a: Cough was...
Q0936a. If yes, was the cough…?
Person4
1=dry; 2=productive; 3=with blood; 8=Don't know
Q0937: Chest pain?
Q0937: Chest pain?
Q0937: Chest pain?
Q0937: Chest pain?
Q0937: Chest pain?
Did s/he have chest pain?
Person1
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0938
Q0937: Chest pain?
Q0937: Chest pain?
Q0937: Chest pain?
Q0937: Chest pain?
Q0937: Chest pain?
Did s/he have chest pain?
Person2
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0938
Q0937: Chest pain?
Q0937: Chest pain?
Q0937: Chest pain?
Q0937: Chest pain?
Q0937: Chest pain?
Did s/he have chest pain?
Person3
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0938
Q0937: Chest pain?
Q0937: Chest pain?
Q0937: Chest pain?
Q0937: Chest pain?
Q0937: Chest pain?
Did s/he have chest pain?
Person4
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0938
Q0937a: How long (months)?
Q0937a: How long (months)?
Q0937a: How long (months)?
Q0937a: How long (months)?
Q0937a: How long (months)?
a. How long? Months (MM)
Person1
Interviewer: if less than 1 month enter “00” and go to b.
Q0937a: How long (months)?
Q0937a: How long (months)?
Q0937a: How long (months)?
Q0937a: How long (months)?
Q0937a: How long (months)?
a. How long? Months (MM)
Person2
Interviewer: if less than 1 month enter “00” and go to b.
Q0937a: How long (months)?
Q0937a: How long (months)?
Q0937a: How long (months)?
Q0937a: How long (months)?
Q0937a: How long (months)?
a. How long? Months (MM)
Person3
Interviewer: if less than 1 month enter “00” and go to b.
Q0937a: How long (months)?
Q0937a: How long (months)?
Q0937a: How long (months)?
Q0937a: How long (months)?
Q0937a: How long (months)?
a. How long? Months (MM)
Person4
Interviewer: if less than 1 month enter “00” and go to b.
Q0937b: How long (days)?
Q0937b: How long (days)?
Q0937b: How long (days)?
Q0937b: How long (days)?
Q0937b: How long (days)?
b. Days (DD)
Person1
Q0937b: How long (days)?
Q0937b: How long (days)?
Q0937b: How long (days)?
Q0937b: How long (days)?
Q0937b: How long (days)?
b. Days (DD)
Person2
Q0937b: How long (days)?
Q0937b: How long (days)?
Q0937b: How long (days)?
Q0937b: How long (days)?
Q0937b: How long (days)?
b. Days (DD)
Person3
Q0937b: How long (days)?
Q0937b: How long (days)?
Q0937b: How long (days)?
Q0937b: How long (days)?
Q0937b: How long (days)?
b. Days (DD)
Person4
Q0937c: Localized?
Q0937c: Localized?
Q0937c: Localized?
Q0937c: Localized?
Q0937c: Localized?
c. Was the pain localized near the sternum (middle of the chest bone)?
Person1
1=Yes; 2=No; 8=Don't know
Q0937c: Localized?
Q0937c: Localized?
Q0937c: Localized?
Q0937c: Localized?
Q0937c: Localized?
c. Was the pain localized near the sternum (middle of the chest bone)?
Person2
1=Yes; 2=No; 8=Don't know
Q0937c: Localized?
Q0937c: Localized?
Q0937c: Localized?
Q0937c: Localized?
Q0937c: Localized?
c. Was the pain localized near the sternum (middle of the chest bone)?
Person3
1=Yes; 2=No; 8=Don't know
Q0937c: Localized?
Q0937c: Localized?
Q0937c: Localized?
Q0937c: Localized?
Q0937c: Localized?
c. Was the pain localized near the sternum (middle of the chest bone)?
Person4
1=Yes; 2=No; 8=Don't know
Q0937d: Pain started...
Q0937d: Pain started...
Q0937d: Pain started...
Q0937d: Pain started...
Q0937d: Pain started...
d. Did the pain start…?Person1
1=suddenly;
2=gradually;
8=Don't know
Q0937d: Pain started...
Q0937d: Pain started...
Q0937d: Pain started...
Q0937d: Pain started...
Q0937d: Pain started...
d. Did the pain start…?Person2
1=suddenly;
2=gradually;
8=Don't know
Q0937d: Pain started...
Q0937d: Pain started...
Q0937d: Pain started...
Q0937d: Pain started...
Q0937d: Pain started...
d. Did the pain start…?Person3
1=suddenly;
2=gradually;
8=Don't know
Q0937d: Pain started...
Q0937d: Pain started...
Q0937d: Pain started...
Q0937d: Pain started...
Q0937d: Pain started...
d. Did the pain start…?Person4
1=suddenly;
2=gradually;
8=Don't know
Q0938: Diarrhoea?
Q0938: Diarrhoea?
Q0938: Diarrhoea?
Q0938: Diarrhoea?
Q0938: Diarrhoea?
Did s/he have diarrhoea?
Person1
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0939
Q0938: Diarrhoea?
Q0938: Diarrhoea?
Q0938: Diarrhoea?
Q0938: Diarrhoea?
Q0938: Diarrhoea?
Did s/he have diarrhoea?
Person2
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0939
Q0938: Diarrhoea?
Q0938: Diarrhoea?
Q0938: Diarrhoea?
Q0938: Diarrhoea?
Q0938: Diarrhoea?
Did s/he have diarrhoea?
Person3
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0939
Q0938: Diarrhoea?
Q0938: Diarrhoea?
Q0938: Diarrhoea?
Q0938: Diarrhoea?
Q0938: Diarrhoea?
Did s/he have diarrhoea?
Person4
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0939
Q0938a: How long (months)?
Q0938a: How long (months)?
Q0938a: How long (months)?
Q0938a: How long (months)?
Q0938a: How long (months)?
a. How long? Months (MM)
Person1
Interviewer: if less than 1 month enter "00" and go to b.
Q0938a: How long (months)?
Q0938a: How long (months)?
Q0938a: How long (months)?
Q0938a: How long (months)?
Q0938a: How long (months)?
a. How long? Months (MM)
Person2
Interviewer: if less than 1 month enter "00" and go to b.
Q0938a: How long (months)?
Q0938a: How long (months)?
Q0938a: How long (months)?
Q0938a: How long (months)?
Q0938a: How long (months)?
a. How long? Months (MM)
Person3
Interviewer: if less than 1 month enter "00" and go to b.
Q0938a: How long (months)?
Q0938a: How long (months)?
Q0938a: How long (months)?
Q0938a: How long (months)?
Q0938a: How long (months)?
a. How long? Months (MM)
Person4
Interviewer: if less than 1 month enter "00" and go to b.
Q0938b: How long (days)?
Q0938b: How long (days)?
Q0938b: How long (days)?
Q0938b: How long (days)?
Q0938b: How long (days)?
Days (DD) Person1
Q0938b: How long (days)?
Q0938b: How long (days)?
Q0938b: How long (days)?
Q0938b: How long (days)?
Q0938b: How long (days)?
Days (DD) Person2
Q0938b: How long (days)?
Q0938b: How long (days)?
Q0938b: How long (days)?
Q0938b: How long (days)?
Q0938b: How long (days)?
Days (DD) Person3
Q0938b: How long (days)?
Q0938b: How long (days)?
Q0938b: How long (days)?
Q0938b: How long (days)?
Q0938b: How long (days)?
Days (DD) Person4
Q0938c: Frequency (daily)
Q0938c: Frequency (daily)
Q0938c: Frequency (daily)
Q0938c: Frequency (daily)
Q0938c: Frequency (daily)
c. If yes, how many times a day?
Person1
Q0938c: Frequency (daily)
Q0938c: Frequency (daily)
Q0938c: Frequency (daily)
Q0938c: Frequency (daily)
Q0938c: Frequency (daily)
c. If yes, how many times a day?
Person2
Q0938c: Frequency (daily)
Q0938c: Frequency (daily)
Q0938c: Frequency (daily)
Q0938c: Frequency (daily)
Q0938c: Frequency (daily)
c. If yes, how many times a day?
Person3
Q0938c: Frequency (daily)
Q0938c: Frequency (daily)
Q0938c: Frequency (daily)
Q0938c: Frequency (daily)
Q0938c: Frequency (daily)
c. If yes, how many times a day?
Person4
Q0938d: Bloody?
Q0938d: Bloody?
Q0938d: Bloody?
Q0938d: Bloody?
Q0938d: Bloody?
d. Did s/he have bloody diarrhoea?
Person1
1=Yes; 2=No; 8=Don't know
Q0938d: Bloody?
Q0938d: Bloody?
Q0938d: Bloody?
Q0938d: Bloody?
Q0938d: Bloody?
d. Did s/he have bloody diarrhoea?
Person2
1=Yes; 2=No; 8=Don't know
Q0938d: Bloody?
Q0938d: Bloody?
Q0938d: Bloody?
Q0938d: Bloody?
Q0938d: Bloody?
d. Did s/he have bloody diarrhoea?
Person3
1=Yes; 2=No; 8=Don't know
Q0938d: Bloody?
Q0938d: Bloody?
Q0938d: Bloody?
Q0938d: Bloody?
Q0938d: Bloody?
d. Did s/he have bloody diarrhoea?
Person4
1=Yes; 2=No; 8=Don't know
Q0939: Poor appetite?
Q0939: Poor appetite?
Q0939: Poor appetite?
Q0939: Poor appetite?
Q0939: Poor appetite?
Did s/he have poor appetite?Person1
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0940
Q0939: Poor appetite?
Q0939: Poor appetite?
Q0939: Poor appetite?
Q0939: Poor appetite?
Q0939: Poor appetite?
Did s/he have poor appetite?Person2
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0940
Q0939: Poor appetite?
Q0939: Poor appetite?
Q0939: Poor appetite?
Q0939: Poor appetite?
Q0939: Poor appetite?
Did s/he have poor appetite?Person3
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0940
Q0939: Poor appetite?
Q0939: Poor appetite?
Q0939: Poor appetite?
Q0939: Poor appetite?
Q0939: Poor appetite?
Did s/he have poor appetite?Person4
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0940
Q0939a: How long (months)?
Q0939a: How long (months)?
Q0939a: How long (months)?
Q0939a: How long (months)?
Q0939a: How long (months)?
a. How long? Months (MM) Person1
Interviewer: if less than 1 month enter “00” and go to b.
Q0939a: How long (months)?
Q0939a: How long (months)?
Q0939a: How long (months)?
Q0939a: How long (months)?
Q0939a: How long (months)?
a. How long? Months (MM) Person2
Interviewer: if less than 1 month enter “00” and go to b.
Q0939a: How long (months)?
Q0939a: How long (months)?
Q0939a: How long (months)?
Q0939a: How long (months)?
Q0939a: How long (months)?
a. How long? Months (MM) Person3
Interviewer: if less than 1 month enter “00” and go to b.
Q0939a: How long (months)?
Q0939a: How long (months)?
Q0939a: How long (months)?
Q0939a: How long (months)?
Q0939a: How long (months)?
a. How long? Months (MM) Person4
Interviewer: if less than 1 month enter “00” and go to b.
Q0939b: How long (days)?
Q0939b: How long (days)?
Q0939b: How long (days)?
Q0939b: How long (days)?
Q0939b: How long (days)?
b. Days (DD) Person1
Q0939b: How long (days)?
Q0939b: How long (days)?
Q0939b: How long (days)?
Q0939b: How long (days)?
Q0939b: How long (days)?
b. Days (DD) Person3
Q0939b: How long (days)?
Q0939b: How long (days)?
Q0939b: How long (days)?
Q0939b: How long (days)?
Q0939b: How long (days)?
b. Days (DD) Person4
Q0940: Pain swallowing?
Q0940: Pain swallowing?
Q0940: Pain swallowing?
Q0940: Pain swallowing?
Q0940: Pain swallowing?
Did s/he complain of pain on swallowing?Person1
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0941
Q0940: Pain swallowing?
Q0940: Pain swallowing?
Q0940: Pain swallowing?
Q0940: Pain swallowing?
Q0940: Pain swallowing?
Did s/he complain of pain on swallowing?Person2
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0941
Q0940: Pain swallowing?
Q0940: Pain swallowing?
Q0940: Pain swallowing?
Q0940: Pain swallowing?
Q0940: Pain swallowing?
Did s/he complain of pain on swallowing?Person3
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0941
Q0940: Pain swallowing?
Q0940: Pain swallowing?
Q0940: Pain swallowing?
Q0940: Pain swallowing?
Q0940: Pain swallowing?
Did s/he complain of pain on swallowing?Person4
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0941
Q0940a: How long (months)?
Q0940a: How long (months)?
Q0940a: How long (months)?
Q0940a: How long (months)?
Q0940a: How long (months)?
a. How long? Months (MM) Person1
Interviewer: if less than 1 month enter “00” and go to b.
Q0940a: How long (months)?
Q0940a: How long (months)?
Q0940a: How long (months)?
Q0940a: How long (months)?
Q0940a: How long (months)?
a. How long? Months (MM) Person2
Interviewer: if less than 1 month enter “00” and go to b.
Q0940a: How long (months)?
Q0940a: How long (months)?
Q0940a: How long (months)?
Q0940a: How long (months)?
Q0940a: How long (months)?
a. How long? Months (MM) Person3
Interviewer: if less than 1 month enter “00” and go to b.
Q0940a: How long (months)?
Q0940a: How long (months)?
Q0940a: How long (months)?
Q0940a: How long (months)?
Q0940a: How long (months)?
a. How long? Months (MM) Person4
Interviewer: if less than 1 month enter “00” and go to b.
Q0940b: How long (days)?
Q0940b: How long (days)?
Q0940b: How long (days)?
Q0940b: How long (days)?
Q0940b: How long (days)?
b. Days (DD) Person1
Q0940b: How long (days)?
Q0940b: How long (days)?
Q0940b: How long (days)?
Q0940b: How long (days)?
Q0940b: How long (days)?
b. Days (DD) Person2
Q0940b: How long (days)?
Q0940b: How long (days)?
Q0940b: How long (days)?
Q0940b: How long (days)?
Q0940b: How long (days)?
b. Days (DD) Person3
Q0940b: How long (days)?
Q0940b: How long (days)?
Q0940b: How long (days)?
Q0940b: How long (days)?
Q0940b: How long (days)?
b. Days (DD) Person4
Q0941: Difficulty swallowing?
Q0941: Difficulty swallowing?
Q0941: Difficulty swallowing?
Q0941: Difficulty swallowing?
Q0941: Difficulty swallowing?
Did s/he have difficulty in swallowing? Person1
1=Yes; 2=No; 8=Don't know
f NO or DK, skip to Q0942
Q0941: Difficulty swallowing?
Q0941: Difficulty swallowing?
Q0941: Difficulty swallowing?
Q0941: Difficulty swallowing?
Q0941: Difficulty swallowing?
Did s/he have difficulty in swallowing? Person2
1=Yes; 2=No; 8=Don't know
f NO or DK, skip to Q0942
Q0941: Difficulty swallowing?
Q0941: Difficulty swallowing?
Q0941: Difficulty swallowing?
Q0941: Difficulty swallowing?
Q0941: Difficulty swallowing?
Did s/he have difficulty in swallowing? Person3
1=Yes; 2=No; 8=Don't know
f NO or DK, skip to Q0942
Q0941: Difficulty swallowing?
Q0941: Difficulty swallowing?
Q0941: Difficulty swallowing?
Q0941: Difficulty swallowing?
Q0941: Difficulty swallowing?
Did s/he have difficulty in swallowing? Person4
1=Yes; 2=No; 8=Don't know
f NO or DK, skip to Q0942
Q0941a: How long (months)?
Q0941a: How long (months)?
Q0941a: How long (months)?
Q0941a: How long (months)?
Q0941a: How long (months)?
a. How long? Months (MM) Person1
Interviewer: if less than 1 month enter “00” and go to b.
Q0941a: How long (months)?
Q0941a: How long (months)?
Q0941a: How long (months)?
Q0941a: How long (months)?
Q0941a: How long (months)?
a. How long? Months (MM) Person2
Interviewer: if less than 1 month enter “00” and go to b.
Q0941a: How long (months)?
Q0941a: How long (months)?
Q0941a: How long (months)?
Q0941a: How long (months)?
Q0941a: How long (months)?
a. How long? Months (MM) Person3
Interviewer: if less than 1 month enter “00” and go to b.
Q0941a: How long (months)?
Q0941a: How long (months)?
Q0941a: How long (months)?
Q0941a: How long (months)?
Q0941a: How long (months)?
a. How long? Months (MM) Person4
Interviewer: if less than 1 month enter “00” and go to b.
Q0941b: How long (days)?
Q0941b: How long (days)?
Q0941b: How long (days)?
Q0941b: How long (days)?
Q0941b: How long (days)?
b. Days (DD) Person1
Q0941b: How long (days)?
Q0941b: How long (days)?
Q0941b: How long (days)?
Q0941b: How long (days)?
Q0941b: How long (days)?
b. Days (DD) Person2
Q0941b: How long (days)?
Q0941b: How long (days)?
Q0941b: How long (days)?
Q0941b: How long (days)?
Q0941b: How long (days)?
b. Days (DD) Person3
Q0941b: How long (days)?
Q0941b: How long (days)?
Q0941b: How long (days)?
Q0941b: How long (days)?
Q0941b: How long (days)?
b. Days (DD) Person4
Q0942: Headache?
Q0942: Headache?
Q0942: Headache?
Q0942: Headache?
Q0942: Headache?
Did s/he have headache?Person1
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0943
Q0942: Headache?
Q0942: Headache?
Q0942: Headache?
Q0942: Headache?
Q0942: Headache?
Did s/he have headache?Person2
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0943
Q0942: Headache?
Q0942: Headache?
Q0942: Headache?
Q0942: Headache?
Q0942: Headache?
Did s/he have headache?Person3
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0943
Q0942: Headache?
Q0942: Headache?
Q0942: Headache?
Q0942: Headache?
Q0942: Headache?
Did s/he have headache?Person4
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0943
Q0942a: How long (months)
Q0942a: How long (months)
Q0942a: How long (months)
Q0942a: How long (months)
Q0942a: How long (months)
a. How long? Months (MM) Person1
Interviewer: if less than 1 month enter “00” and go to b.
Q0942a: How long (months)
Q0942a: How long (months)
Q0942a: How long (months)
Q0942a: How long (months)
Q0942a: How long (months)
a. How long? Months (MM) Person
Interviewer: if less than 1 month enter “00” and go to b.
Q0942a: How long (months)
Q0942a: How long (months)
Q0942a: How long (months)
Q0942a: How long (months)
Q0942a: How long (months)
a. How long? Months (MM) Person3
Interviewer: if less than 1 month enter “00” and go to b.
Q0942a: How long (months)
Q0942a: How long (months)
Q0942a: How long (months)
Q0942a: How long (months)
Q0942a: How long (months)
a. How long? Months (MM) Person4
Interviewer: if less than 1 month enter “00” and go to b.
Q0942b: How long (days)?
Q0942b: How long (days)?
Q0942b: How long (days)?
Q0942b: How long (days)?
Q0942b: How long (days)?
b. Days (DD) Person1
Q0942b: How long (days)?
Q0942b: How long (days)?
Q0942b: How long (days)?
Q0942b: How long (days)?
Q0942b: How long (days)?
b. Days (DD) Person2
Q0942b: How long (days)?
Q0942b: How long (days)?
Q0942b: How long (days)?
Q0942b: How long (days)?
Q0942b: How long (days)?
b. Days (DD) Person3
Q0942b: How long (days)?
Q0942b: How long (days)?
Q0942b: How long (days)?
Q0942b: How long (days)?
Q0942b: How long (days)?
b. Days (DD) Person4
Q0943: Blood in urine?
Q0943: Blood in urine?
Q0943: Blood in urine?
Q0943: Blood in urine?
Q0943: Blood in urine?
Did s/he have blood in urine?Person1
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0944
Q0943: Blood in urine?
Q0943: Blood in urine?
Q0943: Blood in urine?
Q0943: Blood in urine?
Q0943: Blood in urine?
Did s/he have blood in urine?Person2
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0944
Q0943: Blood in urine?
Q0943: Blood in urine?
Q0943: Blood in urine?
Q0943: Blood in urine?
Q0943: Blood in urine?
Did s/he have blood in urine?Person3
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0944
Q0943: Blood in urine?
Q0943: Blood in urine?
Q0943: Blood in urine?
Q0943: Blood in urine?
Q0943: Blood in urine?
Did s/he have blood in urine?Person4
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0944
Q0943a: How long (months)?
Q0943a: How long (months)?
Q0943a: How long (months)?
Q0943a: How long (months)?
Q0943a: How long (months)?
a. How long? Months (MM) Person1
Interviewer: if less than 1 month enter “00” and go to b.
Q0943a: How long (months)?
Q0943a: How long (months)?
Q0943a: How long (months)?
Q0943a: How long (months)?
Q0943a: How long (months)?
a. How long? Months (MM) Person2
Interviewer: if less than 1 month enter “00” and go to b.
Q0943a: How long (months)?
Q0943a: How long (months)?
Q0943a: How long (months)?
Q0943a: How long (months)?
Q0943a: How long (months)?
a. How long? Months (MM) Person3
Interviewer: if less than 1 month enter “00” and go to b.
Q0943a: How long (months)?
Q0943a: How long (months)?
Q0943a: How long (months)?
Q0943a: How long (months)?
Q0943a: How long (months)?
a. How long? Months (MM) Person4
Interviewer: if less than 1 month enter “00” and go to b.
Q0943b: How long (days)?
Q0943b: How long (days)?
Q0943b: How long (days)?
Q0943b: How long (days)?
Q0943b: How long (days)?
b. Days (DD) Person1
Q0943b: How long (days)?
Q0943b: How long (days)?
Q0943b: How long (days)?
Q0943b: How long (days)?
Q0943b: How long (days)?
b. Days (DD) Person2
Q0943b: How long (days)?
Q0943b: How long (days)?
Q0943b: How long (days)?
Q0943b: How long (days)?
Q0943b: How long (days)?
b. Days (DD) Person3
Q0943b: How long (days)?
Q0943b: How long (days)?
Q0943b: How long (days)?
Q0943b: How long (days)?
Q0943b: How long (days)?
b. Days (DD) Person4
Q0944: Pain urinating?
Q0944: Pain urinating?
Q0944: Pain urinating?
Q0944: Pain urinating?
Q0944: Pain urinating?
Did s/he have pain while passing urine?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0945
Q0944: Pain urinating?
Q0944: Pain urinating?
Q0944: Pain urinating?
Q0944: Pain urinating?
Q0944: Pain urinating?
Did s/he have pain while passing urine?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0945
Q0944: Pain urinating?
Q0944: Pain urinating?
Q0944: Pain urinating?
Q0944: Pain urinating?
Q0944: Pain urinating?
Did s/he have pain while passing urine?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0945
Q0944: Pain urinating?
Q0944: Pain urinating?
Q0944: Pain urinating?
Q0944: Pain urinating?
Q0944: Pain urinating?
Did s/he have pain while passing urine?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0945
Q0944a: How long (months)?
Q0944a: How long (months)?
Q0944a: How long (months)?
Q0944a: How long (months)?
Q0944a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b
Q0944a: How long (months)?
Q0944a: How long (months)?
Q0944a: How long (months)?
Q0944a: How long (months)?
Q0944a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b
Q0944a: How long (months)?
Q0944a: How long (months)?
Q0944a: How long (months)?
Q0944a: How long (months)?
Q0944a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b
Q0944a: How long (months)?
Q0944a: How long (months)?
Q0944a: How long (months)?
Q0944a: How long (months)?
Q0944a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b
Q0944b: How long (days)?
Q0944b: How long (days)?
Q0944b: How long (days)?
Q0944b: How long (days)?
Q0944b: How long (days)?
b. Days (DD)
Q0944b: How long (days)?
Q0944b: How long (days)?
Q0944b: How long (days)?
Q0944b: How long (days)?
Q0944b: How long (days)?
b. Days (DD)
Q0944b: How long (days)?
Q0944b: How long (days)?
Q0944b: How long (days)?
Q0944b: How long (days)?
Q0944b: How long (days)?
b. Days (DD)
Q0944b: How long (days)?
Q0944b: How long (days)?
Q0944b: How long (days)?
Q0944b: How long (days)?
Q0944b: How long (days)?
b. Days (DD)
Q0945: Unable to urinate?
Q0945: Unable to urinate?
Q0945: Unable to urinate?
Q0945: Unable to urinate?
Q0945: Unable to urinate?
Was s/he unable to pass urine?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0946
Q0945: Unable to urinate?
Q0945: Unable to urinate?
Q0945: Unable to urinate?
Q0945: Unable to urinate?
Q0945: Unable to urinate?
Was s/he unable to pass urine?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0946
Q0945: Unable to urinate?
Q0945: Unable to urinate?
Q0945: Unable to urinate?
Q0945: Unable to urinate?
Q0945: Unable to urinate?
Was s/he unable to pass urine?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0946
Q0945: Unable to urinate?
Q0945: Unable to urinate?
Q0945: Unable to urinate?
Q0945: Unable to urinate?
Q0945: Unable to urinate?
Was s/he unable to pass urine?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0946
Q0945a: How long (months)?
Q0945a: How long (months)?
Q0945a: How long (months)?
Q0945a: How long (months)?
Q0945a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0945a: How long (months)?
Q0945a: How long (months)?
Q0945a: How long (months)?
Q0945a: How long (months)?
Q0945a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0945a: How long (months)?
Q0945a: How long (months)?
Q0945a: How long (months)?
Q0945a: How long (months)?
Q0945a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0945a: How long (months)?
Q0945a: How long (months)?
Q0945a: How long (months)?
Q0945a: How long (months)?
Q0945a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0945b: How long (days)?
Q0945b: How long (days)?
Q0945b: How long (days)?
Q0945b: How long (days)?
Q0945b: How long (days)?
b. Days (DD)
Q0945b: How long (days)?
Q0945b: How long (days)?
Q0945b: How long (days)?
Q0945b: How long (days)?
Q0945b: How long (days)?
b. Days (DD)
Q0945b: How long (days)?
Q0945b: How long (days)?
Q0945b: How long (days)?
Q0945b: How long (days)?
Q0945b: How long (days)?
b. Days (DD)
Q0945b: How long (days)?
Q0945b: How long (days)?
Q0945b: How long (days)?
Q0945b: How long (days)?
Q0945b: How long (days)?
b. Days (DD)
Q0946: Excessive urination?
Q0946: Excessive urination?
Q0946: Excessive urination?
Q0946: Excessive urination?
Q0946: Excessive urination?
Did s/he have to urinate many times in a day?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0947
Q0946: Excessive urination?
Q0946: Excessive urination?
Q0946: Excessive urination?
Q0946: Excessive urination?
Q0946: Excessive urination?
Did s/he have to urinate many times in a day?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0947
Q0946: Excessive urination?
Q0946: Excessive urination?
Q0946: Excessive urination?
Q0946: Excessive urination?
Q0946: Excessive urination?
Did s/he have to urinate many times in a day?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0947
Q0946: Excessive urination?
Q0946: Excessive urination?
Q0946: Excessive urination?
Q0946: Excessive urination?
Q0946: Excessive urination?
Did s/he have to urinate many times in a day?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0947
Q0946a: How long (months)?
Q0946a: How long (months)?
Q0946a: How long (months)?
Q0946a: How long (months)?
Q0946a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0946a: How long (months)?
Q0946a: How long (months)?
Q0946a: How long (months)?
Q0946a: How long (months)?
Q0946a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0946a: How long (months)?
Q0946a: How long (months)?
Q0946a: How long (months)?
Q0946a: How long (months)?
Q0946a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0946a: How long (months)?
Q0946a: How long (months)?
Q0946a: How long (months)?
Q0946a: How long (months)?
Q0946a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0946b: How long (days)?
Q0946b: How long (days)?
Q0946b: How long (days)?
Q0946b: How long (days)?
Q0946b: How long (days)?
b. Days (DD)
Q0946b: How long (days)?
Q0946b: How long (days)?
Q0946b: How long (days)?
Q0946b: How long (days)?
Q0946b: How long (days)?
b. Days (DD)
Q0946b: How long (days)?
Q0946b: How long (days)?
Q0946b: How long (days)?
Q0946b: How long (days)?
Q0946b: How long (days)?
b. Days (DD)
Q0946b: How long (days)?
Q0946b: How long (days)?
Q0946b: How long (days)?
Q0946b: How long (days)?
Q0946b: How long (days)?
b. Days (DD)
Q0947: Tingling?
Q0947: Tingling?
Q0947: Tingling?
Q0947: Tingling?
Q0947: Tingling?
Did s/he have a sensation of pins and needles in the feet?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0948
Q0947: Tingling?
Q0947: Tingling?
Q0947: Tingling?
Q0947: Tingling?
Q0947: Tingling?
Did s/he have a sensation of pins and needles in the feet?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0948
Q0947: Tingling?
Q0947: Tingling?
Q0947: Tingling?
Q0947: Tingling?
Q0947: Tingling?
Did s/he have a sensation of pins and needles in the feet?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0948
Q0947: Tingling?
Q0947: Tingling?
Q0947: Tingling?
Q0947: Tingling?
Q0947: Tingling?
Did s/he have a sensation of pins and needles in the feet?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0948
Q0947a: How long (months)?
Q0947a: How long (months)?
Q0947a: How long (months)?
Q0947a: How long (months)?
Q0947a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0947a: How long (months)?
Q0947a: How long (months)?
Q0947a: How long (months)?
Q0947a: How long (months)?
Q0947a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0947a: How long (months)?
Q0947a: How long (months)?
Q0947a: How long (months)?
Q0947a: How long (months)?
Q0947a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0947a: How long (months)?
Q0947a: How long (months)?
Q0947a: How long (months)?
Q0947a: How long (months)?
Q0947a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0947b: How long (days)?
Q0947b: How long (days)?
Q0947b: How long (days)?
Q0947b: How long (days)?
Q0947b: How long (days)?
b. Days (DD)
Q0947b: How long (days)?
Q0947b: How long (days)?
Q0947b: How long (days)?
Q0947b: How long (days)?
Q0947b: How long (days)?
b. Days (DD)
Q0947b: How long (days)?
Q0947b: How long (days)?
Q0947b: How long (days)?
Q0947b: How long (days)?
Q0947b: How long (days)?
b. Days (DD)
Q0947b: How long (days)?
Q0947b: How long (days)?
Q0947b: How long (days)?
Q0947b: How long (days)?
Q0947b: How long (days)?
b. Days (DD)
Q0948: Abdominal pain?
Q0948: Abdominal pain?
Q0948: Abdominal pain?
Q0948: Abdominal pain?
Q0948: Abdominal pain?
Did s/he have abdominal pain?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0949
Q0948: Abdominal pain?
Q0948: Abdominal pain?
Q0948: Abdominal pain?
Q0948: Abdominal pain?
Q0948: Abdominal pain?
Did s/he have abdominal pain?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0949
Q0948: Abdominal pain?
Q0948: Abdominal pain?
Q0948: Abdominal pain?
Q0948: Abdominal pain?
Q0948: Abdominal pain?
Did s/he have abdominal pain?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0949
Q0948: Abdominal pain?
Q0948: Abdominal pain?
Q0948: Abdominal pain?
Q0948: Abdominal pain?
Q0948: Abdominal pain?
Did s/he have abdominal pain?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0949
Q0948a: Location
Q0948a: Location
Q0948a: Location
Q0948a: Location
Q0948a: Location
a) If yes, was the pain…?
1=upper;
2=lower;
3=all over abdomen;
8=Don't know
Q0948a: Location
Q0948a: Location
Q0948a: Location
Q0948a: Location
Q0948a: Location
a) If yes, was the pain…?
1=upper;
2=lower;
3=all over abdomen;
8=Don't know
Q0948a: Location
Q0948a: Location
Q0948a: Location
Q0948a: Location
Q0948a: Location
a) If yes, was the pain…?
1=upper;
2=lower;
3=all over abdomen;
8=Don't know
Q0948a: Location
Q0948a: Location
Q0948a: Location
Q0948a: Location
Q0948a: Location
a) If yes, was the pain…?
1=upper;
2=lower;
3=all over abdomen;
8=Don't know
Q0949: Abdominal distension?
Q0949: Abdominal distension?
Q0949: Abdominal distension?
Q0949: Abdominal distension?
Q0949: Abdominal distension?
Did s/he have abdominal distension?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0950
Q0949: Abdominal distension?
Q0949: Abdominal distension?
Q0949: Abdominal distension?
Q0949: Abdominal distension?
Q0949: Abdominal distension?
Did s/he have abdominal distension?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0950
Q0949: Abdominal distension?
Q0949: Abdominal distension?
Q0949: Abdominal distension?
Q0949: Abdominal distension?
Q0949: Abdominal distension?
Did s/he have abdominal distension?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0950
Q0949: Abdominal distension?
Q0949: Abdominal distension?
Q0949: Abdominal distension?
Q0949: Abdominal distension?
Q0949: Abdominal distension?
Did s/he have abdominal distension?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0950
Q0949a: How long (months)?
Q0949a: How long (months)?
Q0949a: How long (months)?
Q0949a: How long (months)?
Q0949a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0949a: How long (months)?
Q0949a: How long (months)?
Q0949a: How long (months)?
Q0949a: How long (months)?
Q0949a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0949a: How long (months)?
Q0949a: How long (months)?
Q0949a: How long (months)?
Q0949a: How long (months)?
Q0949a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0949a: How long (months)?
Q0949a: How long (months)?
Q0949a: How long (months)?
Q0949a: How long (months)?
Q0949a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0949b: How long (days)?
Q0949b: How long (days)?
Q0949b: How long (days)?
Q0949b: How long (days)?
Q0949b: How long (days)?
b. Days (DD)
Q0949b: How long (days)?
Q0949b: How long (days)?
Q0949b: How long (days)?
Q0949b: How long (days)?
Q0949b: How long (days)?
b. Days (DD)
Q0949b: How long (days)?
Q0949b: How long (days)?
Q0949b: How long (days)?
Q0949b: How long (days)?
Q0949b: How long (days)?
b. Days (DD)
Q0949b: How long (days)?
Q0949b: How long (days)?
Q0949b: How long (days)?
Q0949b: How long (days)?
Q0949b: How long (days)?
b. Days (DD)
Q0949c: Started...
Q0949c: Started...
Q0949c: Started...
Q0949c: Started...
Q0949c: Started...
c. Did the distension start…?
1=suddenly within a few days;
2=gradually over the weeks; 8=Don't know
Q0949c: Started...
Q0949c: Started...
Q0949c: Started...
Q0949c: Started...
Q0949c: Started...
c. Did the distension start…?
1=suddenly within a few days;
2=gradually over the weeks; 8=Don't know
Q0949c: Started...
Q0949c: Started...
Q0949c: Started...
Q0949c: Started...
Q0949c: Started...
c. Did the distension start…?
1=suddenly within a few days;
2=gradually over the weeks; 8=Don't know
Q0949c: Started...
Q0949c: Started...
Q0949c: Started...
Q0949c: Started...
Q0949c: Started...
c. Did the distension start…?
1=suddenly within a few days;
2=gradually over the weeks; 8=Don't know
Q0950: Vomited?
Q0950: Vomited?
Q0950: Vomited?
Q0950: Vomited?
Q0950: Vomited?
Did s/he vomit?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0951
Q0950: Vomited?
Q0950: Vomited?
Q0950: Vomited?
Q0950: Vomited?
Q0950: Vomited?
Did s/he vomit?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0951
Q0950: Vomited?
Q0950: Vomited?
Q0950: Vomited?
Q0950: Vomited?
Q0950: Vomited?
Did s/he vomit?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0951
Q0950: Vomited?
Q0950: Vomited?
Q0950: Vomited?
Q0950: Vomited?
Q0950: Vomited?
Did s/he vomit?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0951
Q0950a: How long (months)?
Q0950a: How long (months)?
Q0950a: How long (months)?
Q0950a: How long (months)?
Q0950a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0950a: How long (months)?
Q0950a: How long (months)?
Q0950a: How long (months)?
Q0950a: How long (months)?
Q0950a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0950a: How long (months)?
Q0950a: How long (months)?
Q0950a: How long (months)?
Q0950a: How long (months)?
Q0950a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0950a: How long (months)?
Q0950a: How long (months)?
Q0950a: How long (months)?
Q0950a: How long (months)?
Q0950a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0950b: How long (days)?
Q0950b: How long (days)?
Q0950b: How long (days)?
Q0950b: How long (days)?
Q0950b: How long (days)?
b. Days (DD)
Q0950b: How long (days)?
Q0950b: How long (days)?
Q0950b: How long (days)?
Q0950b: How long (days)?
Q0950b: How long (days)?
b. Days (DD)
Q0950b: How long (days)?
Q0950b: How long (days)?
Q0950b: How long (days)?
Q0950b: How long (days)?
Q0950b: How long (days)?
b. Days (DD)
Q0950b: How long (days)?
Q0950b: How long (days)?
Q0950b: How long (days)?
Q0950b: How long (days)?
Q0950b: How long (days)?
b. Days (DD)
Q0951: Abdominal mass?
Q0951: Abdominal mass?
Q0951: Abdominal mass?
Q0951: Abdominal mass?
Q0951: Abdominal mass?
Did s/he have a mass in the abdomen?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0952
Q0951: Abdominal mass?
Q0951: Abdominal mass?
Q0951: Abdominal mass?
Q0951: Abdominal mass?
Q0951: Abdominal mass?
Did s/he have a mass in the abdomen?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0952
Q0951: Abdominal mass?
Q0951: Abdominal mass?
Q0951: Abdominal mass?
Q0951: Abdominal mass?
Q0951: Abdominal mass?
Did s/he have a mass in the abdomen?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0952
Q0951: Abdominal mass?
Q0951: Abdominal mass?
Q0951: Abdominal mass?
Q0951: Abdominal mass?
Q0951: Abdominal mass?
Did s/he have a mass in the abdomen?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0952
Q0951a: How long (months)?
Q0951a: How long (months)?
Q0951a: How long (months)?
Q0951a: How long (months)?
Q0951a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0951a: How long (months)?
Q0951a: How long (months)?
Q0951a: How long (months)?
Q0951a: How long (months)?
Q0951a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0951a: How long (months)?
Q0951a: How long (months)?
Q0951a: How long (months)?
Q0951a: How long (months)?
Q0951a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0951a: How long (months)?
Q0951a: How long (months)?
Q0951a: How long (months)?
Q0951a: How long (months)?
Q0951a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0951b: How long (days)?
Q0951b: How long (days)?
Q0951b: How long (days)?
Q0951b: How long (days)?
Q0951b: How long (days)?
b. Days (DD)
Q0951b: How long (days)?
Q0951b: How long (days)?
Q0951b: How long (days)?
Q0951b: How long (days)?
Q0951b: How long (days)?
b. Days (DD)
Q0951b: How long (days)?
Q0951b: How long (days)?
Q0951b: How long (days)?
Q0951b: How long (days)?
Q0951b: How long (days)?
b. Days (DD)
Q0951b: How long (days)?
Q0951b: How long (days)?
Q0951b: How long (days)?
Q0951b: How long (days)?
Q0951b: How long (days)?
b. Days (DD)
Q0952: Mental confusion?
Q0952: Mental confusion?
Q0952: Mental confusion?
Q0952: Mental confusion?
Q0952: Mental confusion?
Did s/he become mentally confused?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0953
Q0952: Mental confusion?
Q0952: Mental confusion?
Q0952: Mental confusion?
Q0952: Mental confusion?
Q0952: Mental confusion?
Did s/he become mentally confused?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0953
Q0952: Mental confusion?
Q0952: Mental confusion?
Q0952: Mental confusion?
Q0952: Mental confusion?
Q0952: Mental confusion?
Did s/he become mentally confused?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0953
Q0952: Mental confusion?
Q0952: Mental confusion?
Q0952: Mental confusion?
Q0952: Mental confusion?
Q0952: Mental confusion?
Did s/he become mentally confused?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0953
Q0952a: How long (months)?
Q0952a: How long (months)?
Q0952a: How long (months)?
Q0952a: How long (months)?
Q0952a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0952a: How long (months)?
Q0952a: How long (months)?
Q0952a: How long (months)?
Q0952a: How long (months)?
Q0952a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0952a: How long (months)?
Q0952a: How long (months)?
Q0952a: How long (months)?
Q0952a: How long (months)?
Q0952a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0952a: How long (months)?
Q0952a: How long (months)?
Q0952a: How long (months)?
Q0952a: How long (months)?
Q0952a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0952b: How long (days)?
Q0952b: How long (days)?
Q0952b: How long (days)?
Q0952b: How long (days)?
Q0952b: How long (days)?
b. Days (DD)
Q0952b: How long (days)?
Q0952b: How long (days)?
Q0952b: How long (days)?
Q0952b: How long (days)?
Q0952b: How long (days)?
b. Days (DD)
Q0952b: How long (days)?
Q0952b: How long (days)?
Q0952b: How long (days)?
Q0952b: How long (days)?
Q0952b: How long (days)?
b. Days (DD)
Q0952b: How long (days)?
Q0952b: How long (days)?
Q0952b: How long (days)?
Q0952b: How long (days)?
Q0952b: How long (days)?
b. Days (DD)
Q0953: Unconscious?
Q0953: Unconscious?
Q0953: Unconscious?
Q0953: Unconscious?
Q0953: Unconscious?
Did s/he have loss of consciousness?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0954
Q0953: Unconscious?
Q0953: Unconscious?
Q0953: Unconscious?
Q0953: Unconscious?
Q0953: Unconscious?
Did s/he have loss of consciousness?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0954
Q0953: Unconscious?
Q0953: Unconscious?
Q0953: Unconscious?
Q0953: Unconscious?
Q0953: Unconscious?
Did s/he have loss of consciousness?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0954
Q0953: Unconscious?
Q0953: Unconscious?
Q0953: Unconscious?
Q0953: Unconscious?
Q0953: Unconscious?
Did s/he have loss of consciousness?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0954
Q0953a: How long (months)?
Q0953a: How long (months)?
Q0953a: How long (months)?
Q0953a: How long (months)?
Q0953a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0953a: How long (months)?
Q0953a: How long (months)?
Q0953a: How long (months)?
Q0953a: How long (months)?
Q0953a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0953a: How long (months)?
Q0953a: How long (months)?
Q0953a: How long (months)?
Q0953a: How long (months)?
Q0953a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0953a: How long (months)?
Q0953a: How long (months)?
Q0953a: How long (months)?
Q0953a: How long (months)?
Q0953a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0953b: How long (days)?
Q0953b: How long (days)?
Q0953b: How long (days)?
Q0953b: How long (days)?
Q0953b: How long (days)?
b. Days (DD)
Q0953b: How long (days)?
Q0953b: How long (days)?
Q0953b: How long (days)?
Q0953b: How long (days)?
Q0953b: How long (days)?
b. Days (DD)
Q0953b: How long (days)?
Q0953b: How long (days)?
Q0953b: How long (days)?
Q0953b: How long (days)?
Q0953b: How long (days)?
b. Days (DD)
Q0953b: How long (days)?
Q0953b: How long (days)?
Q0953b: How long (days)?
Q0953b: How long (days)?
Q0953b: How long (days)?
b. Days (DD)
Q0953c: Started...
Q0953c: Started...
Q0953c: Started...
Q0953c: Started...
Q0953c: Started...
c. Did s/he become unconscious…?
1= suddenly;
2= gradually as days went by; 8= Don't know
Q0953c: Started...
Q0953c: Started...
Q0953c: Started...
Q0953c: Started...
Q0953c: Started...
c. Did s/he become unconscious…?
1= suddenly;
2= gradually as days went by; 8= Don't know
Q0953c: Started...
Q0953c: Started...
Q0953c: Started...
Q0953c: Started...
Q0953c: Started...
c. Did s/he become unconscious…?
1= suddenly;
2= gradually as days went by; 8= Don't know
Q0953c: Started...
Q0953c: Started...
Q0953c: Started...
Q0953c: Started...
Q0953c: Started...
c. Did s/he become unconscious…?
1= suddenly;
2= gradually as days went by; 8= Don't know
Q0954: Body paralysis?
Q0954: Body paralysis?
Q0954: Body paralysis?
Q0954: Body paralysis?
Q0954: Body paralysis?
Was s/he paralysed on one side of the body?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0955
Q0954: Body paralysis?
Q0954: Body paralysis?
Q0954: Body paralysis?
Q0954: Body paralysis?
Q0954: Body paralysis?
Was s/he paralysed on one side of the body?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0955
Q0954: Body paralysis?
Q0954: Body paralysis?
Q0954: Body paralysis?
Q0954: Body paralysis?
Q0954: Body paralysis?
Was s/he paralysed on one side of the body?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0955
Q0954: Body paralysis?
Q0954: Body paralysis?
Q0954: Body paralysis?
Q0954: Body paralysis?
Q0954: Body paralysis?
Was s/he paralysed on one side of the body?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0955
Q0954a: How long (months)?
Q0954a: How long (months)?
Q0954a: How long (months)?
Q0954a: How long (months)?
Q0954a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0954a: How long (months)?
Q0954a: How long (months)?
Q0954a: How long (months)?
Q0954a: How long (months)?
Q0954a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0954a: How long (months)?
Q0954a: How long (months)?
Q0954a: How long (months)?
Q0954a: How long (months)?
Q0954a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0954a: How long (months)?
Q0954a: How long (months)?
Q0954a: How long (months)?
Q0954a: How long (months)?
Q0954a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0954b: How long (days)?
Q0954b: How long (days)?
Q0954b: How long (days)?
Q0954b: How long (days)?
Q0954b: How long (days)?
b. Days (DD)
Q0954b: How long (days)?
Q0954b: How long (days)?
Q0954b: How long (days)?
Q0954b: How long (days)?
Q0954b: How long (days)?
b. Days (DD)
Q0954b: How long (days)?
Q0954b: How long (days)?
Q0954b: How long (days)?
Q0954b: How long (days)?
Q0954b: How long (days)?
b. Days (DD)
Q0954b: How long (days)?
Q0954b: How long (days)?
Q0954b: How long (days)?
Q0954b: How long (days)?
Q0954b: How long (days)?
b. Days (DD)
Q0955: Leg paralysis?
Q0955: Leg paralysis?
Q0955: Leg paralysis?
Q0955: Leg paralysis?
Q0955: Leg paralysis?
Did s/he have paralysis of both legs?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0956
Q0955: Leg paralysis?
Q0955: Leg paralysis?
Q0955: Leg paralysis?
Q0955: Leg paralysis?
Q0955: Leg paralysis?
Did s/he have paralysis of both legs?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0956
Q0955: Leg paralysis?
Q0955: Leg paralysis?
Q0955: Leg paralysis?
Q0955: Leg paralysis?
Q0955: Leg paralysis?
Did s/he have paralysis of both legs?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0956
Q0955: Leg paralysis?
Q0955: Leg paralysis?
Q0955: Leg paralysis?
Q0955: Leg paralysis?
Q0955: Leg paralysis?
Did s/he have paralysis of both legs?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0956
Q0955a: How long (months)?
Q0955a: How long (months)?
Q0955a: How long (months)?
Q0955a: How long (months)?
Q0955a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0955a: How long (months)?
Q0955a: How long (months)?
Q0955a: How long (months)?
Q0955a: How long (months)?
Q0955a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0955a: How long (months)?
Q0955a: How long (months)?
Q0955a: How long (months)?
Q0955a: How long (months)?
Q0955a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0955a: How long (months)?
Q0955a: How long (months)?
Q0955a: How long (months)?
Q0955a: How long (months)?
Q0955a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0955b: How long (days)?
Q0955b: How long (days)?
Q0955b: How long (days)?
Q0955b: How long (days)?
Q0955b: How long (days)?
b. Days (DD)
Q0955b: How long (days)?
Q0955b: How long (days)?
Q0955b: How long (days)?
Q0955b: How long (days)?
Q0955b: How long (days)?
b. Days (DD)
Q0955b: How long (days)?
Q0955b: How long (days)?
Q0955b: How long (days)?
Q0955b: How long (days)?
Q0955b: How long (days)?
b. Days (DD)
Q0955b: How long (days)?
Q0955b: How long (days)?
Q0955b: How long (days)?
Q0955b: How long (days)?
Q0955b: How long (days)?
b. Days (DD)
Q0956: Body stiffness?
Q0956: Body stiffness?
Q0956: Body stiffness?
Q0956: Body stiffness?
Q0956: Body stiffness?
Did s/he develop stiffness of the whole body?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0957
Q0956: Body stiffness?
Q0956: Body stiffness?
Q0956: Body stiffness?
Q0956: Body stiffness?
Q0956: Body stiffness?
Did s/he develop stiffness of the whole body?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0957
Q0956: Body stiffness?
Q0956: Body stiffness?
Q0956: Body stiffness?
Q0956: Body stiffness?
Q0956: Body stiffness?
Did s/he develop stiffness of the whole body?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0957
Q0956: Body stiffness?
Q0956: Body stiffness?
Q0956: Body stiffness?
Q0956: Body stiffness?
Q0956: Body stiffness?
Did s/he develop stiffness of the whole body?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0957
Q0956a: How long (months)?
Q0956a: How long (months)?
Q0956a: How long (months)?
Q0956a: How long (months)?
Q0956a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0956a: How long (months)?
Q0956a: How long (months)?
Q0956a: How long (months)?
Q0956a: How long (months)?
Q0956a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0956a: How long (months)?
Q0956a: How long (months)?
Q0956a: How long (months)?
Q0956a: How long (months)?
Q0956a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0956a: How long (months)?
Q0956a: How long (months)?
Q0956a: How long (months)?
Q0956a: How long (months)?
Q0956a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0956b: How long (days)?
Q0956b: How long (days)?
Q0956b: How long (days)?
Q0956b: How long (days)?
Q0956b: How long (days)?
b. Days (DD)
Q0956b: How long (days)?
Q0956b: How long (days)?
Q0956b: How long (days)?
Q0956b: How long (days)?
Q0956b: How long (days)?
b. Days (DD)
Q0956b: How long (days)?
Q0956b: How long (days)?
Q0956b: How long (days)?
Q0956b: How long (days)?
Q0956b: How long (days)?
b. Days (DD)
Q0956b: How long (days)?
Q0956b: How long (days)?
Q0956b: How long (days)?
Q0956b: How long (days)?
Q0956b: How long (days)?
b. Days (DD)
Q0957: Neck pain?
Q0957: Neck pain?
Q0957: Neck pain?
Q0957: Neck pain?
Q0957: Neck pain?
Did s/he have neck pain?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0958
Q0957: Neck pain?
Q0957: Neck pain?
Q0957: Neck pain?
Q0957: Neck pain?
Q0957: Neck pain?
Did s/he have neck pain?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0958
Q0957: Neck pain?
Q0957: Neck pain?
Q0957: Neck pain?
Q0957: Neck pain?
Q0957: Neck pain?
Did s/he have neck pain?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0958
Q0957: Neck pain?
Q0957: Neck pain?
Q0957: Neck pain?
Q0957: Neck pain?
Q0957: Neck pain?
Did s/he have neck pain?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0958
Q0957a: How long (months)?
Q0957a: How long (months)?
Q0957a: How long (months)?
Q0957a: How long (months)?
Q0957a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0957a: How long (months)?
Q0957a: How long (months)?
Q0957a: How long (months)?
Q0957a: How long (months)?
Q0957a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0957a: How long (months)?
Q0957a: How long (months)?
Q0957a: How long (months)?
Q0957a: How long (months)?
Q0957a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0957a: How long (months)?
Q0957a: How long (months)?
Q0957a: How long (months)?
Q0957a: How long (months)?
Q0957a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0957b: How long (weeks)?
Q0957b: How long (weeks)?
Q0957b: How long (weeks)?
Q0957b: How long (weeks)?
Q0957b: How long (weeks)?
b. Days (DD)
Q0957b: How long (weeks)?
Q0957b: How long (weeks)?
Q0957b: How long (weeks)?
Q0957b: How long (weeks)?
Q0957b: How long (weeks)?
b. Days (DD)
Q0957b: How long (weeks)?
Q0957b: How long (weeks)?
Q0957b: How long (weeks)?
Q0957b: How long (weeks)?
Q0957b: How long (weeks)?
b. Days (DD)
Q0957b: How long (weeks)?
Q0957b: How long (weeks)?
Q0957b: How long (weeks)?
Q0957b: How long (weeks)?
Q0957b: How long (weeks)?
b. Days (DD)
Q0958: Fits?
Q0958: Fits?
Q0958: Fits?
Q0958: Fits?
Q0958: Fits?
Did s/he have fits?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0959
Q0958: Fits?
Q0958: Fits?
Q0958: Fits?
Q0958: Fits?
Q0958: Fits?
Did s/he have fits?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0959
Q0958: Fits?
Q0958: Fits?
Q0958: Fits?
Q0958: Fits?
Q0958: Fits?
Did s/he have fits?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0959
Q0958: Fits?
Q0958: Fits?
Q0958: Fits?
Q0958: Fits?
Q0958: Fits?
Did s/he have fits?
1=Yes; 2=No; 8=Don't know
If NO or DK, skip to Q0959
Q0958a: How long (months)
Q0958a: How long (months)
Q0958a: How long (months)
Q0958a: How long (months)
Q0958a: How long (months)
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0958a: How long (months)
Q0958a: How long (months)
Q0958a: How long (months)
Q0958a: How long (months)
Q0958a: How long (months)
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0958a: How long (months)
Q0958a: How long (months)
Q0958a: How long (months)
Q0958a: How long (months)
Q0958a: How long (months)
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0958a: How long (months)
Q0958a: How long (months)
Q0958a: How long (months)
Q0958a: How long (months)
Q0958a: How long (months)
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0958b: How long (days)
Q0958b: How long (days)
Q0958b: How long (days)
Q0958b: How long (days)
Q0958b: How long (days)
b. Days (DD)
Q0958b: How long (days)
Q0958b: How long (days)
Q0958b: How long (days)
Q0958b: How long (days)
Q0958b: How long (days)
b. Days (DD)
Q0958b: How long (days)
Q0958b: How long (days)
Q0958b: How long (days)
Q0958b: How long (days)
Q0958b: How long (days)
b. Days (DD)
Q0958b: How long (days)
Q0958b: How long (days)
Q0958b: How long (days)
Q0958b: How long (days)
Q0958b: How long (days)
b. Days (DD)
Q0958c: Number per day
Q0958c: Number per day
Q0958c: Number per day
Q0958c: Number per day
Q0958c: Number per day
. When it was severe, how many times did s/he have fits in a day?
Q0958c: Number per day
Q0958c: Number per day
Q0958c: Number per day
Q0958c: Number per day
Q0958c: Number per day
. When it was severe, how many times did s/he have fits in a day?
Q0958c: Number per day
Q0958c: Number per day
Q0958c: Number per day
Q0958c: Number per day
Q0958c: Number per day
. When it was severe, how many times did s/he have fits in a day?
Q0958c: Number per day
Q0958c: Number per day
Q0958c: Number per day
Q0958c: Number per day
Q0958c: Number per day
. When it was severe, how many times did s/he have fits in a day?
Q0959: Ulcer/swelling in breasts?
Q0959: Ulcer/swelling in breasts?
Q0959: Ulcer/swelling in breasts?
Q0959: Ulcer/swelling in breasts?
Q0959: Ulcer/swelling in breasts?
Did she have an ulcer or swelling in the breasts?
1=Yes; 2=No
If NO or DK, skip to Q0960
Q0959: Ulcer/swelling in breasts?
Q0959: Ulcer/swelling in breasts?
Q0959: Ulcer/swelling in breasts?
Q0959: Ulcer/swelling in breasts?
Q0959: Ulcer/swelling in breasts?
Did she have an ulcer or swelling in the breasts?
1=Yes; 2=No
If NO or DK, skip to Q0960
Q0959: Ulcer/swelling in breasts?
Q0959: Ulcer/swelling in breasts?
Q0959: Ulcer/swelling in breasts?
Q0959: Ulcer/swelling in breasts?
Q0959: Ulcer/swelling in breasts?
Did she have an ulcer or swelling in the breasts?
1=Yes; 2=No
If NO or DK, skip to Q0960
Q0959: Ulcer/swelling in breasts?
Q0959: Ulcer/swelling in breasts?
Q0959: Ulcer/swelling in breasts?
Q0959: Ulcer/swelling in breasts?
Q0959: Ulcer/swelling in breasts?
Did she have an ulcer or swelling in the breasts?
1=Yes; 2=No
If NO or DK, skip to Q0960
Q0959a: How long (months)?
Q0959a: How long (months)?
Q0959a: How long (months)?
Q0959a: How long (months)?
Q0959a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0959a: How long (months)?
Q0959a: How long (months)?
Q0959a: How long (months)?
Q0959a: How long (months)?
Q0959a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0959a: How long (months)?
Q0959a: How long (months)?
Q0959a: How long (months)?
Q0959a: How long (months)?
Q0959a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0959a: How long (months)?
Q0959a: How long (months)?
Q0959a: How long (months)?
Q0959a: How long (months)?
Q0959a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0959b: How long (days)?
Q0959b: How long (days)?
Q0959b: How long (days)?
Q0959b: How long (days)?
Q0959b: How long (days)?
b. Days (DD)
Q0959b: How long (days)?
Q0959b: How long (days)?
Q0959b: How long (days)?
Q0959b: How long (days)?
Q0959b: How long (days)?
b. Days (DD)
Q0959b: How long (days)?
Q0959b: How long (days)?
Q0959b: How long (days)?
Q0959b: How long (days)?
Q0959b: How long (days)?
b. Days (DD)
Q0959b: How long (days)?
Q0959b: How long (days)?
Q0959b: How long (days)?
Q0959b: How long (days)?
Q0959b: How long (days)?
b. Days (DD)
Q0960: Excessive menstrual bleeding?
Q0960: Excessive menstrual bleeding?
Q0960: Excessive menstrual bleeding?
Q0960: Excessive menstrual bleeding?
Q0960: Excessive menstrual bleeding?
Did she have excessive vaginal bleeding during her menstrual period?
1=Yes; 2=No; 8=Don't know
If NO, skip to Q0961
Q0960: Excessive menstrual bleeding?
Q0960: Excessive menstrual bleeding?
Q0960: Excessive menstrual bleeding?
Q0960: Excessive menstrual bleeding?
Q0960: Excessive menstrual bleeding?
Did she have excessive vaginal bleeding during her menstrual period?
1=Yes; 2=No; 8=Don't know
If NO, skip to Q0961
Q0960: Excessive menstrual bleeding?
Q0960: Excessive menstrual bleeding?
Q0960: Excessive menstrual bleeding?
Q0960: Excessive menstrual bleeding?
Q0960: Excessive menstrual bleeding?
Did she have excessive vaginal bleeding during her menstrual period?
1=Yes; 2=No; 8=Don't know
If NO, skip to Q0961
Q0960: Excessive menstrual bleeding?
Q0960: Excessive menstrual bleeding?
Q0960: Excessive menstrual bleeding?
Q0960: Excessive menstrual bleeding?
Q0960: Excessive menstrual bleeding?
Did she have excessive vaginal bleeding during her menstrual period?
1=Yes; 2=No; 8=Don't know
If NO, skip to Q0961
Q0960a: How long (months)?
Q0960a: How long (months)?
Q0960a: How long (months)?
Q0960a: How long (months)?
Q0960a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0960a: How long (months)?
Q0960a: How long (months)?
Q0960a: How long (months)?
Q0960a: How long (months)?
Q0960a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0960a: How long (months)?
Q0960a: How long (months)?
Q0960a: How long (months)?
Q0960a: How long (months)?
Q0960a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0960a: How long (months)?
Q0960a: How long (months)?
Q0960a: How long (months)?
Q0960a: How long (months)?
Q0960a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0960b: How long (days)?
Q0960b: How long (days)?
Q0960b: How long (days)?
Q0960b: How long (days)?
Q0960b: How long (days)?
b. Days (DD)
Q0960b: How long (days)?
Q0960b: How long (days)?
Q0960b: How long (days)?
Q0960b: How long (days)?
Q0960b: How long (days)?
b. Days (DD)
Q0960b: How long (days)?
Q0960b: How long (days)?
Q0960b: How long (days)?
Q0960b: How long (days)?
Q0960b: How long (days)?
b. Days (DD)
Q0960b: How long (days)?
Q0960b: How long (days)?
Q0960b: How long (days)?
Q0960b: How long (days)?
Q0960b: How long (days)?
b. Days (DD)
Q0961: Non-menstrual bleeding?
Q0961: Non-menstrual bleeding?
Q0961: Non-menstrual bleeding?
Q0961: Non-menstrual bleeding?
Q0961: Non-menstrual bleeding?
Did she have vaginal bleeding when she was not in her menstrual period?
1=Yes; 2=No; 8=DK
If NO, skip to Q0962
Q0961: Non-menstrual bleeding?
Q0961: Non-menstrual bleeding?
Q0961: Non-menstrual bleeding?
Q0961: Non-menstrual bleeding?
Q0961: Non-menstrual bleeding?
Did she have vaginal bleeding when she was not in her menstrual period?
1=Yes; 2=No; 8=DK
If NO, skip to Q0962
Q0961: Non-menstrual bleeding?
Q0961: Non-menstrual bleeding?
Q0961: Non-menstrual bleeding?
Q0961: Non-menstrual bleeding?
Q0961: Non-menstrual bleeding?
Did she have vaginal bleeding when she was not in her menstrual period?
1=Yes; 2=No; 8=DK
If NO, skip to Q0962
Q0961: Non-menstrual bleeding?
Q0961: Non-menstrual bleeding?
Q0961: Non-menstrual bleeding?
Q0961: Non-menstrual bleeding?
Q0961: Non-menstrual bleeding?
Did she have vaginal bleeding when she was not in her menstrual period?
1=Yes; 2=No; 8=DK
If NO, skip to Q0962
Q0961a: How long (months)?
Q0961a: How long (months)?
Q0961a: How long (months)?
Q0961a: How long (months)?
Q0961a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0961a: How long (months)?
Q0961a: How long (months)?
Q0961a: How long (months)?
Q0961a: How long (months)?
Q0961a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0961a: How long (months)?
Q0961a: How long (months)?
Q0961a: How long (months)?
Q0961a: How long (months)?
Q0961a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0961a: How long (months)?
Q0961a: How long (months)?
Q0961a: How long (months)?
Q0961a: How long (months)?
Q0961a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0961b: How long (days)?
Q0961b: How long (days)?
Q0961b: How long (days)?
Q0961b: How long (days)?
Q0961b: How long (days)?
b. Days (DD)
Q0961b: How long (days)?
Q0961b: How long (days)?
Q0961b: How long (days)?
Q0961b: How long (days)?
Q0961b: How long (days)?
b. Days (DD)
Q0961b: How long (days)?
Q0961b: How long (days)?
Q0961b: How long (days)?
Q0961b: How long (days)?
Q0961b: How long (days)?
b. Days (DD)
Q0961b: How long (days)?
Q0961b: How long (days)?
Q0961b: How long (days)?
Q0961b: How long (days)?
Q0961b: How long (days)?
b. Days (DD)
Q0961c: Persisted until death?
Q0961c: Persisted until death?
Q0961c: Persisted until death?
Q0961c: Persisted until death?
Q0961c: Persisted until death?
c. Did the bleeding persist until death?
1=Yes; 2=No; 8=DK
Q0961c: Persisted until death?
Q0961c: Persisted until death?
Q0961c: Persisted until death?
Q0961c: Persisted until death?
Q0961c: Persisted until death?
c. Did the bleeding persist until death?
1=Yes; 2=No; 8=DK
Q0961c: Persisted until death?
Q0961c: Persisted until death?
Q0961c: Persisted until death?
Q0961c: Persisted until death?
Q0961c: Persisted until death?
c. Did the bleeding persist until death?
1=Yes; 2=No; 8=DK
Q0961c: Persisted until death?
Q0961c: Persisted until death?
Q0961c: Persisted until death?
Q0961c: Persisted until death?
Q0961c: Persisted until death?
c. Did the bleeding persist until death?
1=Yes; 2=No; 8=DK
Q0962: Vaginal discharge?
Q0962: Vaginal discharge?
Q0962: Vaginal discharge?
Q0962: Vaginal discharge?
Q0962: Vaginal discharge?
Did she have abnormal vaginal discharge?
1=Yes; 2=No; 8=DK
If NO or DK, skip to Q0963
Q0962: Vaginal discharge?
Q0962: Vaginal discharge?
Q0962: Vaginal discharge?
Q0962: Vaginal discharge?
Q0962: Vaginal discharge?
Did she have abnormal vaginal discharge?
1=Yes; 2=No; 8=DK
If NO or DK, skip to Q0963
Q0962: Vaginal discharge?
Q0962: Vaginal discharge?
Q0962: Vaginal discharge?
Q0962: Vaginal discharge?
Q0962: Vaginal discharge?
Did she have abnormal vaginal discharge?
1=Yes; 2=No; 8=DK
If NO or DK, skip to Q0963
Q0962: Vaginal discharge?
Q0962: Vaginal discharge?
Q0962: Vaginal discharge?
Q0962: Vaginal discharge?
Q0962: Vaginal discharge?
Did she have abnormal vaginal discharge?
1=Yes; 2=No; 8=DK
If NO or DK, skip to Q0963
Q0962a: How long (months)?
Q0962a: How long (months)?
Q0962a: How long (months)?
Q0962a: How long (months)?
Q0962a: How long (months)?
a. How long? Months (MM)
Q0962a: How long (months)?
Q0962a: How long (months)?
Q0962a: How long (months)?
Q0962a: How long (months)?
Q0962a: How long (months)?
a. How long? Months (MM)
Q0962a: How long (months)?
Q0962a: How long (months)?
Q0962a: How long (months)?
Q0962a: How long (months)?
Q0962a: How long (months)?
a. How long? Months (MM)
Q0962a: How long (months)?
Q0962a: How long (months)?
Q0962a: How long (months)?
Q0962a: How long (months)?
Q0962a: How long (months)?
a. How long? Months (MM)
Q0962b: How long (days)?
Q0962b: How long (days)?
Q0962b: How long (days)?
Q0962b: How long (days)?
Q0962b: How long (days)?
b. Days (DD)
Q0962b: How long (days)?
Q0962b: How long (days)?
Q0962b: How long (days)?
Q0962b: How long (days)?
Q0962b: How long (days)?
b. Days (DD)
Q0962b: How long (days)?
Q0962b: How long (days)?
Q0962b: How long (days)?
Q0962b: How long (days)?
Q0962b: How long (days)?
b. Days (DD)
Q0962b: How long (days)?
Q0962b: How long (days)?
Q0962b: How long (days)?
Q0962b: How long (days)?
Q0962b: How long (days)?
b. Days (DD)
Q0963: Pregnant?
Q0963: Pregnant?
Q0963: Pregnant?
Q0963: Pregnant?
Q0963: Pregnant?
Was she pregnant?
1=Yes; 2=No; 8=DK
If NO or DK, skip to Q0964
Q0963: Pregnant?
Q0963: Pregnant?
Q0963: Pregnant?
Q0963: Pregnant?
Q0963: Pregnant?
Was she pregnant?
1=Yes; 2=No; 8=DK
If NO or DK, skip to Q0964
Q0963: Pregnant?
Q0963: Pregnant?
Q0963: Pregnant?
Q0963: Pregnant?
Q0963: Pregnant?
Was she pregnant?
1=Yes; 2=No; 8=DK
If NO or DK, skip to Q0964
Q0963: Pregnant?
Q0963: Pregnant?
Q0963: Pregnant?
Q0963: Pregnant?
Q0963: Pregnant?
Was she pregnant?
1=Yes; 2=No; 8=DK
If NO or DK, skip to Q0964
Q0963a: How long (months)?
Q0963a: How long (months)?
Q0963a: How long (months)?
Q0963a: How long (months)?
Q0963a: How long (months)?
a. If yes, how many months pregnant was she?
Months
Q0963a: How long (months)?
Q0963a: How long (months)?
Q0963a: How long (months)?
Q0963a: How long (months)?
Q0963a: How long (months)?
a. If yes, how many months pregnant was she?
Months
Q0963a: How long (months)?
Q0963a: How long (months)?
Q0963a: How long (months)?
Q0963a: How long (months)?
Q0963a: How long (months)?
a. If yes, how many months pregnant was she?
Months
Q0963a: How long (months)?
Q0963a: How long (months)?
Q0963a: How long (months)?
Q0963a: How long (months)?
Q0963a: How long (months)?
a. If yes, how many months pregnant was she?
Months
Q0964: Recent birth?
Q0964: Recent birth?
Q0964: Recent birth?
Q0964: Recent birth?
Q0964: Recent birth?
Did she give birth recently?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0965
Q0964: Recent birth?
Q0964: Recent birth?
Q0964: Recent birth?
Q0964: Recent birth?
Q0964: Recent birth?
Did she give birth recently?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0965
Q0964: Recent birth?
Q0964: Recent birth?
Q0964: Recent birth?
Q0964: Recent birth?
Q0964: Recent birth?
Did she give birth recently?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0965
Q0964: Recent birth?
Q0964: Recent birth?
Q0964: Recent birth?
Q0964: Recent birth?
Q0964: Recent birth?
Did she give birth recently?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0965
Q0964a: Days before death?
Q0964a: Days before death?
Q0964a: Days before death?
Q0964a: Days before death?
Q0964a: Days before death?
a. If yes, how many days before death?
Q0964a: Days before death?
Q0964a: Days before death?
Q0964a: Days before death?
Q0964a: Days before death?
Q0964a: Days before death?
a. If yes, how many days before death?
Q0964a: Days before death?
Q0964a: Days before death?
Q0964a: Days before death?
Q0964a: Days before death?
Q0964a: Days before death?
a. If yes, how many days before death?
Q0964a: Days before death?
Q0964a: Days before death?
Q0964a: Days before death?
Q0964a: Days before death?
Q0964a: Days before death?
a. If yes, how many days before death?
Q0964b: Excessive bleeding?
Q0964b: Excessive bleeding?
Q0964b: Excessive bleeding?
Q0964b: Excessive bleeding?
Q0964b: Excessive bleeding?
b. Did she have excessive bleeding in the beginning of labour pains?
1=Yes; 2=No; 8=Don't know
Q0964b: Excessive bleeding?
Q0964b: Excessive bleeding?
Q0964b: Excessive bleeding?
Q0964b: Excessive bleeding?
Q0964b: Excessive bleeding?
b. Did she have excessive bleeding in the beginning of labour pains?
1=Yes; 2=No; 8=Don't know
Q0964b: Excessive bleeding?
Q0964b: Excessive bleeding?
Q0964b: Excessive bleeding?
Q0964b: Excessive bleeding?
Q0964b: Excessive bleeding?
b. Did she have excessive bleeding in the beginning of labour pains?
1=Yes; 2=No; 8=Don't know
Q0964b: Excessive bleeding?
Q0964b: Excessive bleeding?
Q0964b: Excessive bleeding?
Q0964b: Excessive bleeding?
Q0964b: Excessive bleeding?
b. Did she have excessive bleeding in the beginning of labour pains?
1=Yes; 2=No; 8=Don't know
Q0964c: Bleeding during labor?
Q0964c: Bleeding during labor?
Q0964c: Bleeding during labor?
Q0964c: Bleeding during labor?
Q0964c: Bleeding during labor?
c. Did she have excessive bleeding during labour (before delivering the baby)?
1=Yes; 2=No; 8=Don't know
Q0964c: Bleeding during labor?
Q0964c: Bleeding during labor?
Q0964c: Bleeding during labor?
Q0964c: Bleeding during labor?
Q0964c: Bleeding during labor?
c. Did she have excessive bleeding during labour (before delivering the baby)?
1=Yes; 2=No; 8=Don't know
Q0964c: Bleeding during labor?
Q0964c: Bleeding during labor?
Q0964c: Bleeding during labor?
Q0964c: Bleeding during labor?
Q0964c: Bleeding during labor?
c. Did she have excessive bleeding during labour (before delivering the baby)?
1=Yes; 2=No; 8=Don't know
Q0964c: Bleeding during labor?
Q0964c: Bleeding during labor?
Q0964c: Bleeding during labor?
Q0964c: Bleeding during labor?
Q0964c: Bleeding during labor?
c. Did she have excessive bleeding during labour (before delivering the baby)?
1=Yes; 2=No; 8=Don't know
Q0964d: Difficulty delivering?
Q0964d: Difficulty delivering?
Q0964d: Difficulty delivering?
Q0964d: Difficulty delivering?
Q0964d: Difficulty delivering?
d. Did she have difficulty in delivering the baby?
1=Yes; 2=No; 8=DK
Q0964d: Difficulty delivering?
Q0964d: Difficulty delivering?
Q0964d: Difficulty delivering?
Q0964d: Difficulty delivering?
Q0964d: Difficulty delivering?
d. Did she have difficulty in delivering the baby?
1=Yes; 2=No; 8=DK
Q0964d: Difficulty delivering?
Q0964d: Difficulty delivering?
Q0964d: Difficulty delivering?
Q0964d: Difficulty delivering?
Q0964d: Difficulty delivering?
d. Did she have difficulty in delivering the baby?
1=Yes; 2=No; 8=DK
Q0964d: Difficulty delivering?
Q0964d: Difficulty delivering?
Q0964d: Difficulty delivering?
Q0964d: Difficulty delivering?
Q0964d: Difficulty delivering?
d. Did she have difficulty in delivering the baby?
1=Yes; 2=No; 8=DK
Q0964e: Difficult placenta?
Q0964e: Difficult placenta?
Q0964e: Difficult placenta?
Q0964e: Difficult placenta?
Q0964e: Difficult placenta?
e. Did she have difficulty in delivering the placenta?
1=Yes; 2=No; 8=DK
Q0964e: Difficult placenta?
Q0964e: Difficult placenta?
Q0964e: Difficult placenta?
Q0964e: Difficult placenta?
Q0964e: Difficult placenta?
e. Did she have difficulty in delivering the placenta?
1=Yes; 2=No; 8=DK
Q0964e: Difficult placenta?
Q0964e: Difficult placenta?
Q0964e: Difficult placenta?
Q0964e: Difficult placenta?
Q0964e: Difficult placenta?
e. Did she have difficulty in delivering the placenta?
1=Yes; 2=No; 8=DK
Q0964e: Difficult placenta?
Q0964e: Difficult placenta?
Q0964e: Difficult placenta?
Q0964e: Difficult placenta?
Q0964e: Difficult placenta?
e. Did she have difficulty in delivering the placenta?
1=Yes; 2=No; 8=DK
Q0964f: Prolonged labor?
Q0964f: Prolonged labor?
Q0964f: Prolonged labor?
Q0964f: Prolonged labor?
Q0964f: Prolonged labor?
f. Did she have a prolonged labour?
1=Yes; 2=No; 8=DK
Q0964f: Prolonged labor?
Q0964f: Prolonged labor?
Q0964f: Prolonged labor?
Q0964f: Prolonged labor?
Q0964f: Prolonged labor?
f. Did she have a prolonged labour?
1=Yes; 2=No; 8=DK
Q0964f: Prolonged labor?
Q0964f: Prolonged labor?
Q0964f: Prolonged labor?
Q0964f: Prolonged labor?
Q0964f: Prolonged labor?
f. Did she have a prolonged labour?
1=Yes; 2=No; 8=DK
Q0964f: Prolonged labor?
Q0964f: Prolonged labor?
Q0964f: Prolonged labor?
Q0964f: Prolonged labor?
Q0964f: Prolonged labor?
f. Did she have a prolonged labour?
1=Yes; 2=No; 8=DK
Q0964g: Caesarian?
Q0964g: Caesarian?
Q0964g: Caesarian?
Q0964g: Caesarian?
Q0964g: Caesarian?
g. Did she have a caesarian operation for delivery?
1=Yes; 2=No; 8=DK
Q0964g: Caesarian?
Q0964g: Caesarian?
Q0964g: Caesarian?
Q0964g: Caesarian?
Q0964g: Caesarian?
g. Did she have a caesarian operation for delivery?
1=Yes; 2=No; 8=DK
Q0964g: Caesarian?
Q0964g: Caesarian?
Q0964g: Caesarian?
Q0964g: Caesarian?
Q0964g: Caesarian?
g. Did she have a caesarian operation for delivery?
1=Yes; 2=No; 8=DK
Q0964g: Caesarian?
Q0964g: Caesarian?
Q0964g: Caesarian?
Q0964g: Caesarian?
Q0964g: Caesarian?
g. Did she have a caesarian operation for delivery?
1=Yes; 2=No; 8=DK
Q0964h: Forceps/vacuum?
Q0964h: Forceps/vacuum?
Q0964h: Forceps/vacuum?
Q0964h: Forceps/vacuum?
Q0964h: Forceps/vacuum?
h. Did she have a forceps or vacuum delivery?
1=Yes; 2=No; 8=DK
Q0964h: Forceps/vacuum?
Q0964h: Forceps/vacuum?
Q0964h: Forceps/vacuum?
Q0964h: Forceps/vacuum?
Q0964h: Forceps/vacuum?
h. Did she have a forceps or vacuum delivery?
1=Yes; 2=No; 8=DK
Q0964h: Forceps/vacuum?
Q0964h: Forceps/vacuum?
Q0964h: Forceps/vacuum?
Q0964h: Forceps/vacuum?
Q0964h: Forceps/vacuum?
h. Did she have a forceps or vacuum delivery?
1=Yes; 2=No; 8=DK
Q0964h: Forceps/vacuum?
Q0964h: Forceps/vacuum?
Q0964h: Forceps/vacuum?
Q0964h: Forceps/vacuum?
Q0964h: Forceps/vacuum?
h. Did she have a forceps or vacuum delivery?
1=Yes; 2=No; 8=DK
Q0964i: Post-delivery bleeding?
Q0964i: Post-delivery bleeding?
Q0964i: Post-delivery bleeding?
Q0964i: Post-delivery bleeding?
Q0964i: Post-delivery bleeding?
i. Did she have too much bleeding after delivering the baby?
1=Yes; 2=No; 8=DK
Q0964i: Post-delivery bleeding?
Q0964i: Post-delivery bleeding?
Q0964i: Post-delivery bleeding?
Q0964i: Post-delivery bleeding?
Q0964i: Post-delivery bleeding?
i. Did she have too much bleeding after delivering the baby?
1=Yes; 2=No; 8=DK
Q0964i: Post-delivery bleeding?
Q0964i: Post-delivery bleeding?
Q0964i: Post-delivery bleeding?
Q0964i: Post-delivery bleeding?
Q0964i: Post-delivery bleeding?
i. Did she have too much bleeding after delivering the baby?
1=Yes; 2=No; 8=DK
Q0964i: Post-delivery bleeding?
Q0964i: Post-delivery bleeding?
Q0964i: Post-delivery bleeding?
Q0964i: Post-delivery bleeding?
Q0964i: Post-delivery bleeding?
i. Did she have too much bleeding after delivering the baby?
1=Yes; 2=No; 8=DK
Q0964j: Baby is...
Q0964j: Baby is...
Q0964j: Baby is...
Q0964j: Baby is...
Q0964j: Baby is...
j. How is the baby?
1=alive;
2=born dead;
3=died within 7 days of birth;
4=died after 7 days of birth; 5= twins, one died
Q0964j: Baby is...
Q0964j: Baby is...
Q0964j: Baby is...
Q0964j: Baby is...
Q0964j: Baby is...
j. How is the baby?
1=alive;
2=born dead;
3=died within 7 days of birth;
4=died after 7 days of birth; 5= twins, one died
Q0964j: Baby is...
Q0964j: Baby is...
Q0964j: Baby is...
Q0964j: Baby is...
Q0964j: Baby is...
j. How is the baby?
1=alive;
2=born dead;
3=died within 7 days of birth;
4=died after 7 days of birth; 5= twins, one died
Q0964j: Baby is...
Q0964j: Baby is...
Q0964j: Baby is...
Q0964j: Baby is...
Q0964j: Baby is...
j. How is the baby?
1=alive;
2=born dead;
3=died within 7 days of birth;
4=died after 7 days of birth; 5= twins, one died
Q0965: Recent abortion?
Q0965: Recent abortion?
Q0965: Recent abortion?
Q0965: Recent abortion?
Q0965: Recent abortion?
Did she have an abortion recently?
1=Yes; 2=No; 8=DK
If NO or DK, skip to Q0966
Q0965: Recent abortion?
Q0965: Recent abortion?
Q0965: Recent abortion?
Q0965: Recent abortion?
Q0965: Recent abortion?
Did she have an abortion recently?
1=Yes; 2=No; 8=DK
If NO or DK, skip to Q0966
Q0965: Recent abortion?
Q0965: Recent abortion?
Q0965: Recent abortion?
Q0965: Recent abortion?
Q0965: Recent abortion?
Did she have an abortion recently?
1=Yes; 2=No; 8=DK
If NO or DK, skip to Q0966
Q0965: Recent abortion?
Q0965: Recent abortion?
Q0965: Recent abortion?
Q0965: Recent abortion?
Q0965: Recent abortion?
Did she have an abortion recently?
1=Yes; 2=No; 8=DK
If NO or DK, skip to Q0966
Q0965a: Days before death?
Q0965a: Days before death?
Q0965a: Days before death?
Q0965a: Days before death?
Q0965a: Days before death?
a) If yes, how many days before death?
Q0965a: Days before death?
Q0965a: Days before death?
Q0965a: Days before death?
Q0965a: Days before death?
Q0965a: Days before death?
a) If yes, how many days before death?
Q0965a: Days before death?
Q0965a: Days before death?
Q0965a: Days before death?
Q0965a: Days before death?
Q0965a: Days before death?
a) If yes, how many days before death?
Q0965a: Days before death?
Q0965a: Days before death?
Q0965a: Days before death?
Q0965a: Days before death?
Q0965a: Days before death?
a) If yes, how many days before death?
Q0966: Ankle swelling?
Q0966: Ankle swelling?
Q0966: Ankle swelling?
Q0966: Ankle swelling?
Q0966: Ankle swelling?
Did s/he have ankle swelling?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0967
Q0966: Ankle swelling?
Q0966: Ankle swelling?
Q0966: Ankle swelling?
Q0966: Ankle swelling?
Q0966: Ankle swelling?
Did s/he have ankle swelling?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0967
Q0966: Ankle swelling?
Q0966: Ankle swelling?
Q0966: Ankle swelling?
Q0966: Ankle swelling?
Q0966: Ankle swelling?
Did s/he have ankle swelling?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0967
Q0966: Ankle swelling?
Q0966: Ankle swelling?
Q0966: Ankle swelling?
Q0966: Ankle swelling?
Q0966: Ankle swelling?
Did s/he have ankle swelling?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0967
Q0966a: How long (months)?
Q0966a: How long (months)?
Q0966a: How long (months)?
Q0966a: How long (months)?
Q0966a: How long (months)?
a. How long? Months (MM)
If NO or DK, skip to Q0967
Interviewer: if less than 1 month enter “00” & go to b.
Q0966a: How long (months)?
Q0966a: How long (months)?
Q0966a: How long (months)?
Q0966a: How long (months)?
Q0966a: How long (months)?
a. How long? Months (MM)
If NO or DK, skip to Q0967
Interviewer: if less than 1 month enter “00” & go to b.
Q0966a: How long (months)?
Q0966a: How long (months)?
Q0966a: How long (months)?
Q0966a: How long (months)?
Q0966a: How long (months)?
a. How long? Months (MM)
If NO or DK, skip to Q0967
Interviewer: if less than 1 month enter “00” & go to b.
Q0966a: How long (months)?
Q0966a: How long (months)?
Q0966a: How long (months)?
Q0966a: How long (months)?
Q0966a: How long (months)?
a. How long? Months (MM)
If NO or DK, skip to Q0967
Interviewer: if less than 1 month enter “00” & go to b.
Q0966b: How long (days)?
Q0966b: How long (days)?
Q0966b: How long (days)?
Q0966b: How long (days)?
Q0966b: How long (days)?
b. Days (DD)
Q0966b: How long (days)?
Q0966b: How long (days)?
Q0966b: How long (days)?
Q0966b: How long (days)?
Q0966b: How long (days)?
b. Days (DD)
Q0966b: How long (days)?
Q0966b: How long (days)?
Q0966b: How long (days)?
Q0966b: How long (days)?
Q0966b: How long (days)?
b. Days (DD)
Q0966b: How long (days)?
Q0966b: How long (days)?
Q0966b: How long (days)?
Q0966b: How long (days)?
Q0966b: How long (days)?
b. Days (DD)
Q0967: Swelling joints?
Q0967: Swelling joints?
Q0967: Swelling joints?
Q0967: Swelling joints?
Q0967: Swelling joints?
Did s/he have swelling of the joints?
1=Yes; 2=No; 8= Don't know
If NO or DK, skip to Q0968
Q0967: Swelling joints?
Q0967: Swelling joints?
Q0967: Swelling joints?
Q0967: Swelling joints?
Q0967: Swelling joints?
Did s/he have swelling of the joints?
1=Yes; 2=No; 8= Don't know
If NO or DK, skip to Q0968
Q0967: Swelling joints?
Q0967: Swelling joints?
Q0967: Swelling joints?
Q0967: Swelling joints?
Q0967: Swelling joints?
Did s/he have swelling of the joints?
1=Yes; 2=No; 8= Don't know
If NO or DK, skip to Q0968
Q0967: Swelling joints?
Q0967: Swelling joints?
Q0967: Swelling joints?
Q0967: Swelling joints?
Q0967: Swelling joints?
Did s/he have swelling of the joints?
1=Yes; 2=No; 8= Don't know
If NO or DK, skip to Q0968
Q0967a: How long (months)?
Q0967a: How long (months)?
Q0967a: How long (months)?
Q0967a: How long (months)?
Q0967a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter "00" & go to b.
Q0967a: How long (months)?
Q0967a: How long (months)?
Q0967a: How long (months)?
Q0967a: How long (months)?
Q0967a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter "00" & go to b.
Q0967a: How long (months)?
Q0967a: How long (months)?
Q0967a: How long (months)?
Q0967a: How long (months)?
Q0967a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter "00" & go to b.
Q0967a: How long (months)?
Q0967a: How long (months)?
Q0967a: How long (months)?
Q0967a: How long (months)?
Q0967a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter "00" & go to b.
Q0967b: How long (days)?
Q0967b: How long (days)?
Q0967b: How long (days)?
Q0967b: How long (days)?
Q0967b: How long (days)?
b. Days (DD)
Q0967b: How long (days)?
Q0967b: How long (days)?
Q0967b: How long (days)?
Q0967b: How long (days)?
Q0967b: How long (days)?
b. Days (DD)
Q0967b: How long (days)?
Q0967b: How long (days)?
Q0967b: How long (days)?
Q0967b: How long (days)?
Q0967b: How long (days)?
b. Days (DD)
Q0967b: How long (days)?
Q0967b: How long (days)?
Q0967b: How long (days)?
Q0967b: How long (days)?
Q0967b: How long (days)?
b. Days (DD)
Q0968: Weight loss?
Q0968: Weight loss?
Q0968: Weight loss?
Q0968: Weight loss?
Q0968: Weight loss?
Did s/he have weight loss?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0969
Q0968: Weight loss?
Q0968: Weight loss?
Q0968: Weight loss?
Q0968: Weight loss?
Q0968: Weight loss?
Did s/he have weight loss?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0969
Q0968: Weight loss?
Q0968: Weight loss?
Q0968: Weight loss?
Q0968: Weight loss?
Q0968: Weight loss?
Did s/he have weight loss?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0969
Q0968: Weight loss?
Q0968: Weight loss?
Q0968: Weight loss?
Q0968: Weight loss?
Q0968: Weight loss?
Did s/he have weight loss?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0969
Q0968a: How long (months)?
Q0968a: How long (months)?
Q0968a: How long (months)?
Q0968a: How long (months)?
Q0968a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b
Q0968a: How long (months)?
Q0968a: How long (months)?
Q0968a: How long (months)?
Q0968a: How long (months)?
Q0968a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b
Q0968a: How long (months)?
Q0968a: How long (months)?
Q0968a: How long (months)?
Q0968a: How long (months)?
Q0968a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b
Q0968a: How long (months)?
Q0968a: How long (months)?
Q0968a: How long (months)?
Q0968a: How long (months)?
Q0968a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b
Q0968b: How long (days)?
Q0968b: How long (days)?
Q0968b: How long (days)?
Q0968b: How long (days)?
Q0968b: How long (days)?
b. Days (DD)
Q0968b: How long (days)?
Q0968b: How long (days)?
Q0968b: How long (days)?
Q0968b: How long (days)?
Q0968b: How long (days)?
b. Days (DD)
Q0968b: How long (days)?
Q0968b: How long (days)?
Q0968b: How long (days)?
Q0968b: How long (days)?
Q0968b: How long (days)?
b. Days (DD)
Q0968b: How long (days)?
Q0968b: How long (days)?
Q0968b: How long (days)?
Q0968b: How long (days)?
Q0968b: How long (days)?
b. Days (DD)
Q0969: Mouth sores?
Q0969: Mouth sores?
Q0969: Mouth sores?
Q0969: Mouth sores?
Q0969: Mouth sores?
Did s/he have mouth sores?
1=Yes; 2=No; 8= Don't know
If NO or DK, skip to Q0970
Q0969: Mouth sores?
Q0969: Mouth sores?
Q0969: Mouth sores?
Q0969: Mouth sores?
Q0969: Mouth sores?
Did s/he have mouth sores?
1=Yes; 2=No; 8= Don't know
If NO or DK, skip to Q0970
Q0969: Mouth sores?
Q0969: Mouth sores?
Q0969: Mouth sores?
Q0969: Mouth sores?
Q0969: Mouth sores?
Did s/he have mouth sores?
1=Yes; 2=No; 8= Don't know
If NO or DK, skip to Q0970
Q0969: Mouth sores?
Q0969: Mouth sores?
Q0969: Mouth sores?
Q0969: Mouth sores?
Q0969: Mouth sores?
Did s/he have mouth sores?
1=Yes; 2=No; 8= Don't know
If NO or DK, skip to Q0970
Q0969a: How long (months)?
Q0969a: How long (months)?
Q0969a: How long (months)?
Q0969a: How long (months)?
Q0969a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0969a: How long (months)?
Q0969a: How long (months)?
Q0969a: How long (months)?
Q0969a: How long (months)?
Q0969a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0969a: How long (months)?
Q0969a: How long (months)?
Q0969a: How long (months)?
Q0969a: How long (months)?
Q0969a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0969a: How long (months)?
Q0969a: How long (months)?
Q0969a: How long (months)?
Q0969a: How long (months)?
Q0969a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0969b: How long (days)?
Q0969b: How long (days)?
Q0969b: How long (days)?
Q0969b: How long (days)?
Q0969b: How long (days)?
b. Days (DD)
Q0969b: How long (days)?
Q0969b: How long (days)?
Q0969b: How long (days)?
Q0969b: How long (days)?
Q0969b: How long (days)?
b. Days (DD)
Q0969b: How long (days)?
Q0969b: How long (days)?
Q0969b: How long (days)?
Q0969b: How long (days)?
Q0969b: How long (days)?
b. Days (DD)
Q0969b: How long (days)?
Q0969b: How long (days)?
Q0969b: How long (days)?
Q0969b: How long (days)?
Q0969b: How long (days)?
b. Days (DD)
Q0970: Pallid?
Q0970: Pallid?
Q0970: Pallid?
Q0970: Pallid?
Q0970: Pallid?
Did s/he look pale?
1=Yes; 2=No; 8= Don't know
If NO or DK, skip to Q0971
Q0970: Pallid?
Q0970: Pallid?
Q0970: Pallid?
Q0970: Pallid?
Q0970: Pallid?
Did s/he look pale?
1=Yes; 2=No; 8= Don't know
If NO or DK, skip to Q0971
Q0970: Pallid?
Q0970: Pallid?
Q0970: Pallid?
Q0970: Pallid?
Q0970: Pallid?
Did s/he look pale?
1=Yes; 2=No; 8= Don't know
If NO or DK, skip to Q0971
Q0970: Pallid?
Q0970: Pallid?
Q0970: Pallid?
Q0970: Pallid?
Q0970: Pallid?
Did s/he look pale?
1=Yes; 2=No; 8= Don't know
If NO or DK, skip to Q0971
Q0970a: How long (months)?
Q0970a: How long (months)?
Q0970a: How long (months)?
Q0970a: How long (months)?
Q0970a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b
Q0970a: How long (months)?
Q0970a: How long (months)?
Q0970a: How long (months)?
Q0970a: How long (months)?
Q0970a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b
Q0970a: How long (months)?
Q0970a: How long (months)?
Q0970a: How long (months)?
Q0970a: How long (months)?
Q0970a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b
Q0970a: How long (months)?
Q0970a: How long (months)?
Q0970a: How long (months)?
Q0970a: How long (months)?
Q0970a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b
Q0970b: How long (days)?
Q0970b: How long (days)?
Q0970b: How long (days)?
Q0970b: How long (days)?
Q0970b: How long (days)?
b. Days (DD)
Q0970b: How long (days)?
Q0970b: How long (days)?
Q0970b: How long (days)?
Q0970b: How long (days)?
Q0970b: How long (days)?
b. Days (DD)
Q0970b: How long (days)?
Q0970b: How long (days)?
Q0970b: How long (days)?
Q0970b: How long (days)?
Q0970b: How long (days)?
b. Days (DD)
Q0970b: How long (days)?
Q0970b: How long (days)?
Q0970b: How long (days)?
Q0970b: How long (days)?
Q0970b: How long (days)?
b. Days (DD)
Q0971: Darkened lips?
Q0971: Darkened lips?
Q0971: Darkened lips?
Q0971: Darkened lips?
Q0971: Darkened lips?
Did her/his lips grow darker in colour?
1=Yes; 2=No; 8= Don't know
If NO or DK, skip to Q0972
Q0971: Darkened lips?
Q0971: Darkened lips?
Q0971: Darkened lips?
Q0971: Darkened lips?
Q0971: Darkened lips?
Did her/his lips grow darker in colour?
1=Yes; 2=No; 8= Don't know
If NO or DK, skip to Q0972
Q0971: Darkened lips?
Q0971: Darkened lips?
Q0971: Darkened lips?
Q0971: Darkened lips?
Q0971: Darkened lips?
Did her/his lips grow darker in colour?
1=Yes; 2=No; 8= Don't know
If NO or DK, skip to Q0972
Q0971: Darkened lips?
Q0971: Darkened lips?
Q0971: Darkened lips?
Q0971: Darkened lips?
Q0971: Darkened lips?
Did her/his lips grow darker in colour?
1=Yes; 2=No; 8= Don't know
If NO or DK, skip to Q0972
Q0971a: How long (months)?
Q0971a: How long (months)?
Q0971a: How long (months)?
Q0971a: How long (months)?
Q0971a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0971a: How long (months)?
Q0971a: How long (months)?
Q0971a: How long (months)?
Q0971a: How long (months)?
Q0971a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0971a: How long (months)?
Q0971a: How long (months)?
Q0971a: How long (months)?
Q0971a: How long (months)?
Q0971a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0971a: How long (months)?
Q0971a: How long (months)?
Q0971a: How long (months)?
Q0971a: How long (months)?
Q0971a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0971b: How long (days)?
Q0971b: How long (days)?
Q0971b: How long (days)?
Q0971b: How long (days)?
Q0971b: How long (days)?
b. Days (DD)
Q0971b: How long (days)?
Q0971b: How long (days)?
Q0971b: How long (days)?
Q0971b: How long (days)?
Q0971b: How long (days)?
b. Days (DD)
Q0971b: How long (days)?
Q0971b: How long (days)?
Q0971b: How long (days)?
Q0971b: How long (days)?
Q0971b: How long (days)?
b. Days (DD)
Q0971b: How long (days)?
Q0971b: How long (days)?
Q0971b: How long (days)?
Q0971b: How long (days)?
Q0971b: How long (days)?
b. Days (DD)
Q0972: Skin disease?
Q0972: Skin disease?
Q0972: Skin disease?
Q0972: Skin disease?
Q0972: Skin disease?
Did s/he have any skin disease?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0973
Q0972: Skin disease?
Q0972: Skin disease?
Q0972: Skin disease?
Q0972: Skin disease?
Q0972: Skin disease?
Did s/he have any skin disease?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0973
Q0972: Skin disease?
Q0972: Skin disease?
Q0972: Skin disease?
Q0972: Skin disease?
Q0972: Skin disease?
Did s/he have any skin disease?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0973
Q0972: Skin disease?
Q0972: Skin disease?
Q0972: Skin disease?
Q0972: Skin disease?
Q0972: Skin disease?
Did s/he have any skin disease?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0973
Q0972a: How long (months)?
Q0972a: How long (months)?
Q0972a: How long (months)?
Q0972a: How long (months)?
Q0972a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0972a: How long (months)?
Q0972a: How long (months)?
Q0972a: How long (months)?
Q0972a: How long (months)?
Q0972a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0972a: How long (months)?
Q0972a: How long (months)?
Q0972a: How long (months)?
Q0972a: How long (months)?
Q0972a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0972a: How long (months)?
Q0972a: How long (months)?
Q0972a: How long (months)?
Q0972a: How long (months)?
Q0972a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0972b: How long (days)?
Q0972b: How long (days)?
Q0972b: How long (days)?
Q0972b: How long (days)?
Q0972b: How long (days)?
b. Days (DD)
Q0972b: How long (days)?
Q0972b: How long (days)?
Q0972b: How long (days)?
Q0972b: How long (days)?
Q0972b: How long (days)?
b. Days (DD)
Q0972b: How long (days)?
Q0972b: How long (days)?
Q0972b: How long (days)?
Q0972b: How long (days)?
Q0972b: How long (days)?
b. Days (DD)
Q0972b: How long (days)?
Q0972b: How long (days)?
Q0972b: How long (days)?
Q0972b: How long (days)?
Q0972b: How long (days)?
b. Days (DD)
Q0973: Puffy face?
Q0973: Puffy face?
Q0973: Puffy face?
Q0973: Puffy face?
Q0973: Puffy face?
Did s/he have puffiness of the face?
1=Yes; 2=No; 8= DK
f NO or DK, skip to Q0974
Q0973: Puffy face?
Q0973: Puffy face?
Q0973: Puffy face?
Q0973: Puffy face?
Q0973: Puffy face?
Did s/he have puffiness of the face?
1=Yes; 2=No; 8= DK
f NO or DK, skip to Q0974
Q0973: Puffy face?
Q0973: Puffy face?
Q0973: Puffy face?
Q0973: Puffy face?
Q0973: Puffy face?
Did s/he have puffiness of the face?
1=Yes; 2=No; 8= DK
f NO or DK, skip to Q0974
Q0973: Puffy face?
Q0973: Puffy face?
Q0973: Puffy face?
Q0973: Puffy face?
Q0973: Puffy face?
Did s/he have puffiness of the face?
1=Yes; 2=No; 8= DK
f NO or DK, skip to Q0974
Q0973a: How long (months)?
Q0973a: How long (months)?
Q0973a: How long (months)?
Q0973a: How long (months)?
Q0973a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0973a: How long (months)?
Q0973a: How long (months)?
Q0973a: How long (months)?
Q0973a: How long (months)?
Q0973a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0973a: How long (months)?
Q0973a: How long (months)?
Q0973a: How long (months)?
Q0973a: How long (months)?
Q0973a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0973a: How long (months)?
Q0973a: How long (months)?
Q0973a: How long (months)?
Q0973a: How long (months)?
Q0973a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0973b: How long (days)?
Q0973b: How long (days)?
Q0973b: How long (days)?
Q0973b: How long (days)?
Q0973b: How long (days)?
b. Days (DD)
Q0973b: How long (days)?
Q0973b: How long (days)?
Q0973b: How long (days)?
Q0973b: How long (days)?
Q0973b: How long (days)?
b. Days (DD)
Q0973b: How long (days)?
Q0973b: How long (days)?
Q0973b: How long (days)?
Q0973b: How long (days)?
Q0973b: How long (days)?
b. Days (DD)
Q0973b: How long (days)?
Q0973b: How long (days)?
Q0973b: How long (days)?
Q0973b: How long (days)?
Q0973b: How long (days)?
b. Days (DD)
Q0975: Yellow eyes?
Q0975: Yellow eyes?
Q0975: Yellow eyes?
Q0975: Yellow eyes?
Q0975: Yellow eyes?
Did the eye colour change to yellow (jaundice)?
1=Yes; 2=No; 8= DK
f NO or DK , skip to Q0976
Q0975: Yellow eyes?
Q0975: Yellow eyes?
Q0975: Yellow eyes?
Q0975: Yellow eyes?
Q0975: Yellow eyes?
Did the eye colour change to yellow (jaundice)?
1=Yes; 2=No; 8= DK
f NO or DK , skip to Q0976
Q0975: Yellow eyes?
Q0975: Yellow eyes?
Q0975: Yellow eyes?
Q0975: Yellow eyes?
Q0975: Yellow eyes?
Did the eye colour change to yellow (jaundice)?
1=Yes; 2=No; 8= DK
f NO or DK , skip to Q0976
Q0975: Yellow eyes?
Q0975: Yellow eyes?
Q0975: Yellow eyes?
Q0975: Yellow eyes?
Q0975: Yellow eyes?
Did the eye colour change to yellow (jaundice)?
1=Yes; 2=No; 8= DK
f NO or DK , skip to Q0976
Q0975a: How long (months)?
Q0975a: How long (months)?
Q0975a: How long (months)?
Q0975a: How long (months)?
Q0975a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0975a: How long (months)?
Q0975a: How long (months)?
Q0975a: How long (months)?
Q0975a: How long (months)?
Q0975a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0975a: How long (months)?
Q0975a: How long (months)?
Q0975a: How long (months)?
Q0975a: How long (months)?
Q0975a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0975a: How long (months)?
Q0975a: How long (months)?
Q0975a: How long (months)?
Q0975a: How long (months)?
Q0975a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0975b: How long (days)?
Q0975b: How long (days)?
Q0975b: How long (days)?
Q0975b: How long (days)?
Q0975b: How long (days)?
b. Days (DD)
Q0975b: How long (days)?
Q0975b: How long (days)?
Q0975b: How long (days)?
Q0975b: How long (days)?
Q0975b: How long (days)?
b. Days (DD)
Q0975b: How long (days)?
Q0975b: How long (days)?
Q0975b: How long (days)?
Q0975b: How long (days)?
Q0975b: How long (days)?
b. Days (DD)
Q0975b: How long (days)?
Q0975b: How long (days)?
Q0975b: How long (days)?
Q0975b: How long (days)?
Q0975b: How long (days)?
b. Days (DD)
Q0976: Road accident?
Q0976: Road accident?
Q0976: Road accident?
Q0976: Road accident?
Q0976: Road accident?
Was s/he injured in a road accident?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0977
Q0976: Road accident?
Q0976: Road accident?
Q0976: Road accident?
Q0976: Road accident?
Q0976: Road accident?
Was s/he injured in a road accident?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0977
Q0976: Road accident?
Q0976: Road accident?
Q0976: Road accident?
Q0976: Road accident?
Q0976: Road accident?
Was s/he injured in a road accident?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0977
Q0976: Road accident?
Q0976: Road accident?
Q0976: Road accident?
Q0976: Road accident?
Q0976: Road accident?
Was s/he injured in a road accident?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0977
Q0976a: How long (months)?
Q0976a: How long (months)?
Q0976a: How long (months)?
Q0976a: How long (months)?
Q0976a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0976a: How long (months)?
Q0976a: How long (months)?
Q0976a: How long (months)?
Q0976a: How long (months)?
Q0976a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0976a: How long (months)?
Q0976a: How long (months)?
Q0976a: How long (months)?
Q0976a: How long (months)?
Q0976a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0976a: How long (months)?
Q0976a: How long (months)?
Q0976a: How long (months)?
Q0976a: How long (months)?
Q0976a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0976b: How long (days)?
Q0976b: How long (days)?
Q0976b: How long (days)?
Q0976b: How long (days)?
Q0976b: How long (days)?
b. Days (DD)
Q0976b: How long (days)?
Q0976b: How long (days)?
Q0976b: How long (days)?
Q0976b: How long (days)?
Q0976b: How long (days)?
b. Days (DD)
Q0976b: How long (days)?
Q0976b: How long (days)?
Q0976b: How long (days)?
Q0976b: How long (days)?
Q0976b: How long (days)?
b. Days (DD)
Q0976b: How long (days)?
Q0976b: How long (days)?
Q0976b: How long (days)?
Q0976b: How long (days)?
Q0976b: How long (days)?
b. Days (DD)
Q0977: Other accidental injury?
Q0977: Other accidental injury?
Q0977: Other accidental injury?
Q0977: Other accidental injury?
Q0977: Other accidental injury?
Did s/he suffer any other accidental injuries recently before death?
1=Yes; 2=No; 8= DK
if NO or DK, skip to Q0978
Q0977: Other accidental injury?
Q0977: Other accidental injury?
Q0977: Other accidental injury?
Q0977: Other accidental injury?
Q0977: Other accidental injury?
Did s/he suffer any other accidental injuries recently before death?
1=Yes; 2=No; 8= DK
if NO or DK, skip to Q0978
Q0977: Other accidental injury?
Q0977: Other accidental injury?
Q0977: Other accidental injury?
Q0977: Other accidental injury?
Q0977: Other accidental injury?
Did s/he suffer any other accidental injuries recently before death?
1=Yes; 2=No; 8= DK
if NO or DK, skip to Q0978
Q0977: Other accidental injury?
Q0977: Other accidental injury?
Q0977: Other accidental injury?
Q0977: Other accidental injury?
Q0977: Other accidental injury?
Did s/he suffer any other accidental injuries recently before death?
1=Yes; 2=No; 8= DK
if NO or DK, skip to Q0978
Q0977a: How long (months)?
Q0977a: How long (months)?
Q0977a: How long (months)?
Q0977a: How long (months)?
Q0977a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0977a: How long (months)?
Q0977a: How long (months)?
Q0977a: How long (months)?
Q0977a: How long (months)?
Q0977a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0977a: How long (months)?
Q0977a: How long (months)?
Q0977a: How long (months)?
Q0977a: How long (months)?
Q0977a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0977a: How long (months)?
Q0977a: How long (months)?
Q0977a: How long (months)?
Q0977a: How long (months)?
Q0977a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0977b: How long (days)?
Q0977b: How long (days)?
Q0977b: How long (days)?
Q0977b: How long (days)?
Q0977b: How long (days)?
b. Days (DD)
Q0977b: How long (days)?
Q0977b: How long (days)?
Q0977b: How long (days)?
Q0977b: How long (days)?
Q0977b: How long (days)?
b. Days (DD)
Q0977b: How long (days)?
Q0977b: How long (days)?
Q0977b: How long (days)?
Q0977b: How long (days)?
Q0977b: How long (days)?
b. Days (DD)
Q0977b: How long (days)?
Q0977b: How long (days)?
Q0977b: How long (days)?
Q0977b: How long (days)?
Q0977b: How long (days)?
b. Days (DD)
Q0978: Intentional injury?
Q0978: Intentional injury?
Q0978: Intentional injury?
Q0978: Intentional injury?
Q0978: Intentional injury?
Was s/he injured intentionally by someone?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0979
Q0978: Intentional injury?
Q0978: Intentional injury?
Q0978: Intentional injury?
Q0978: Intentional injury?
Q0978: Intentional injury?
Was s/he injured intentionally by someone?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0979
Q0978: Intentional injury?
Q0978: Intentional injury?
Q0978: Intentional injury?
Q0978: Intentional injury?
Q0978: Intentional injury?
Was s/he injured intentionally by someone?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0979
Q0978: Intentional injury?
Q0978: Intentional injury?
Q0978: Intentional injury?
Q0978: Intentional injury?
Q0978: Intentional injury?
Was s/he injured intentionally by someone?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0979
Q0978a: How long (months)?
Q0978a: How long (months)?
Q0978a: How long (months)?
Q0978a: How long (months)?
Q0978a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b
Q0978a: How long (months)?
Q0978a: How long (months)?
Q0978a: How long (months)?
Q0978a: How long (months)?
Q0978a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b
Q0978a: How long (months)?
Q0978a: How long (months)?
Q0978a: How long (months)?
Q0978a: How long (months)?
Q0978a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b
Q0978a: How long (months)?
Q0978a: How long (months)?
Q0978a: How long (months)?
Q0978a: How long (months)?
Q0978a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b
Q0978b: How long (days)?
Q0978b: How long (days)?
Q0978b: How long (days)?
Q0978b: How long (days)?
Q0978b: How long (days)?
b. Days (DD)
Q0978b: How long (days)?
Q0978b: How long (days)?
Q0978b: How long (days)?
Q0978b: How long (days)?
Q0978b: How long (days)?
b. Days (DD)
Q0978b: How long (days)?
Q0978b: How long (days)?
Q0978b: How long (days)?
Q0978b: How long (days)?
Q0978b: How long (days)?
b. Days (DD)
Q0978b: How long (days)?
Q0978b: How long (days)?
Q0978b: How long (days)?
Q0978b: How long (days)?
Q0978b: How long (days)?
b. Days (DD)
Q0979: Dog bite?
Q0979: Dog bite?
Q0979: Dog bite?
Q0979: Dog bite?
Q0979: Dog bite?
Did a dog bite her/him?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0980
Q0979: Dog bite?
Q0979: Dog bite?
Q0979: Dog bite?
Q0979: Dog bite?
Q0979: Dog bite?
Did a dog bite her/him?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0980
Q0979: Dog bite?
Q0979: Dog bite?
Q0979: Dog bite?
Q0979: Dog bite?
Q0979: Dog bite?
Did a dog bite her/him?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0980
Q0979: Dog bite?
Q0979: Dog bite?
Q0979: Dog bite?
Q0979: Dog bite?
Q0979: Dog bite?
Did a dog bite her/him?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0980
Q0979a: How long (months)?
Q0979a: How long (months)?
Q0979a: How long (months)?
Q0979a: How long (months)?
Q0979a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0979a: How long (months)?
Q0979a: How long (months)?
Q0979a: How long (months)?
Q0979a: How long (months)?
Q0979a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0979a: How long (months)?
Q0979a: How long (months)?
Q0979a: How long (months)?
Q0979a: How long (months)?
Q0979a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0979a: How long (months)?
Q0979a: How long (months)?
Q0979a: How long (months)?
Q0979a: How long (months)?
Q0979a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0979b: How long (days)?
Q0979b: How long (days)?
Q0979b: How long (days)?
Q0979b: How long (days)?
Q0979b: How long (days)?
b. Days (DD)
Q0979b: How long (days)?
Q0979b: How long (days)?
Q0979b: How long (days)?
Q0979b: How long (days)?
Q0979b: How long (days)?
b. Days (DD)
Q0979b: How long (days)?
Q0979b: How long (days)?
Q0979b: How long (days)?
Q0979b: How long (days)?
Q0979b: How long (days)?
b. Days (DD)
Q0979b: How long (days)?
Q0979b: How long (days)?
Q0979b: How long (days)?
Q0979b: How long (days)?
Q0979b: How long (days)?
b. Days (DD)
Q0980: Other animal/insect bite?
Q0980: Other animal/insect bite?
Q0980: Other animal/insect bite?
Q0980: Other animal/insect bite?
Q0980: Other animal/insect bite?
Did any other animal or insect bite her/him?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0981
Q0980: Other animal/insect bite?
Q0980: Other animal/insect bite?
Q0980: Other animal/insect bite?
Q0980: Other animal/insect bite?
Q0980: Other animal/insect bite?
Did any other animal or insect bite her/him?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0981
Q0980: Other animal/insect bite?
Q0980: Other animal/insect bite?
Q0980: Other animal/insect bite?
Q0980: Other animal/insect bite?
Q0980: Other animal/insect bite?
Did any other animal or insect bite her/him?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0981
Q0980: Other animal/insect bite?
Q0980: Other animal/insect bite?
Q0980: Other animal/insect bite?
Q0980: Other animal/insect bite?
Q0980: Other animal/insect bite?
Did any other animal or insect bite her/him?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0981
Q0980a: How long (months)?
Q0980a: How long (months)?
Q0980a: How long (months)?
Q0980a: How long (months)?
Q0980a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0980a: How long (months)?
Q0980a: How long (months)?
Q0980a: How long (months)?
Q0980a: How long (months)?
Q0980a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0980a: How long (months)?
Q0980a: How long (months)?
Q0980a: How long (months)?
Q0980a: How long (months)?
Q0980a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0980a: How long (months)?
Q0980a: How long (months)?
Q0980a: How long (months)?
Q0980a: How long (months)?
Q0980a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” & go to b.
Q0980b: How long (days)?
Q0980b: How long (days)?
Q0980b: How long (days)?
Q0980b: How long (days)?
Q0980b: How long (days)?
b. Days (DD)
Q0980b: How long (days)?
Q0980b: How long (days)?
Q0980b: How long (days)?
Q0980b: How long (days)?
Q0980b: How long (days)?
b. Days (DD)
Q0980b: How long (days)?
Q0980b: How long (days)?
Q0980b: How long (days)?
Q0980b: How long (days)?
Q0980b: How long (days)?
b. Days (DD)
Q0980b: How long (days)?
Q0980b: How long (days)?
Q0980b: How long (days)?
Q0980b: How long (days)?
Q0980b: How long (days)?
b. Days (DD)
Q0981: Accidental poisoning?
Q0981: Accidental poisoning?
Q0981: Accidental poisoning?
Q0981: Accidental poisoning?
Q0981: Accidental poisoning?
Did s/he encounter any accidental poisoning (including alcohol poisoning)?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0982
Q0981: Accidental poisoning?
Q0981: Accidental poisoning?
Q0981: Accidental poisoning?
Q0981: Accidental poisoning?
Q0981: Accidental poisoning?
Did s/he encounter any accidental poisoning (including alcohol poisoning)?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0982
Q0981: Accidental poisoning?
Q0981: Accidental poisoning?
Q0981: Accidental poisoning?
Q0981: Accidental poisoning?
Q0981: Accidental poisoning?
Did s/he encounter any accidental poisoning (including alcohol poisoning)?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0982
Q0981: Accidental poisoning?
Q0981: Accidental poisoning?
Q0981: Accidental poisoning?
Q0981: Accidental poisoning?
Q0981: Accidental poisoning?
Did s/he encounter any accidental poisoning (including alcohol poisoning)?
1=Yes; 2=No; 8= DK
If NO or DK, skip to Q0982
Q0981a: How long (months)?
Q0981a: How long (months)?
Q0981a: How long (months)?
Q0981a: How long (months)?
Q0981a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0981a: How long (months)?
Q0981a: How long (months)?
Q0981a: How long (months)?
Q0981a: How long (months)?
Q0981a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0981a: How long (months)?
Q0981a: How long (months)?
Q0981a: How long (months)?
Q0981a: How long (months)?
Q0981a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0981a: How long (months)?
Q0981a: How long (months)?
Q0981a: How long (months)?
Q0981a: How long (months)?
Q0981a: How long (months)?
a. How long? Months (MM)
Interviewer: if less than 1 month enter “00” and go to b.
Q0981b: How long (days)?
Q0981b: How long (days)?
Q0981b: How long (days)?
Q0981b: How long (days)?
Q0981b: How long (days)?
b. Days (DD)
Q0981b: How long (days)?
Q0981b: How long (days)?
Q0981b: How long (days)?
Q0981b: How long (days)?
Q0981b: How long (days)?
b. Days (DD)
Q0981b: How long (days)?
Q0981b: How long (days)?
Q0981b: How long (days)?
Q0981b: How long (days)?
Q0981b: How long (days)?
b. Days (DD)
Q0981b: How long (days)?
Q0981b: How long (days)?
Q0981b: How long (days)?
Q0981b: How long (days)?
Q0981b: How long (days)?
b. Days (DD)
Q0982: Suicide?
Q0982: Suicide?
Q0982: Suicide?
Q0982: Suicide?
Q0982: Suicide?
Did s/he commit suicide?
1=Yes; 2=No; 8=DK
Q0982: Suicide?
Q0982: Suicide?
Q0982: Suicide?
Q0982: Suicide?
Q0982: Suicide?
Did s/he commit suicide?
1=Yes; 2=No; 8=DK
Q0982: Suicide?
Q0982: Suicide?
Q0982: Suicide?
Q0982: Suicide?
Q0982: Suicide?
Did s/he commit suicide?
1=Yes; 2=No; 8=DK
Q0982: Suicide?
Q0982: Suicide?
Q0982: Suicide?
Q0982: Suicide?
Q0982: Suicide?
Did s/he commit suicide?
1=Yes; 2=No; 8=DK
Q0984: Health care services used?
Q0984: Health care services used?
Q0984: Health care services used?
Q0984: Health care services used?
Q0984: Health care services used?
Did the deceased use health care services before death?
1=yes; 2=no; 8=DK
If NO or DK, skip to Q0986
Q0984: Health care services used?
Q0984: Health care services used?
Q0984: Health care services used?
Q0984: Health care services used?
Q0984: Health care services used?
Did the deceased use health care services before death?
1=yes; 2=no; 8=DK
If NO or DK, skip to Q0986
Q0984: Health care services used?
Q0984: Health care services used?
Q0984: Health care services used?
Q0984: Health care services used?
Q0984: Health care services used?
Did the deceased use health care services before death?
1=yes; 2=no; 8=DK
If NO or DK, skip to Q0986
Q0984: Health care services used?
Q0984: Health care services used?
Q0984: Health care services used?
Q0984: Health care services used?
Q0984: Health care services used?
Did the deceased use health care services before death?
1=yes; 2=no; 8=DK
If NO or DK, skip to Q0986
Q0985a: Medicine?
Q0985a: Medicine?
Q0985a: Medicine?
Q0985a: Medicine?
Q0985a: Medicine?
Health services used by the deceased during his/her illness in the period leading to death?
Did s/he get medicine here? 1=yes; 2=no; 8=DK
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985a: Medicine?
Q0985a: Medicine?
Q0985a: Medicine?
Q0985a: Medicine?
Q0985a: Medicine?
Health services used by the deceased during his/her illness in the period leading to death?
Did s/he get medicine here? 1=yes; 2=no; 8=DK
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985a: Medicine?
Q0985a: Medicine?
Q0985a: Medicine?
Q0985a: Medicine?
Q0985a: Medicine?
Health services used by the deceased during his/her illness in the period leading to death?
Did s/he get medicine here? 1=yes; 2=no; 8=DK
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985a: Medicine?
Q0985a: Medicine?
Q0985a: Medicine?
Q0985a: Medicine?
Q0985a: Medicine?
Health services used by the deceased during his/her illness in the period leading to death?
Did s/he get medicine here? 1=yes; 2=no; 8=DK
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985b: Traditional medicine?
Q0985b: Traditional medicine?
Q0985b: Traditional medicine?
Q0985b: Traditional medicine?
Q0985b: Traditional medicine?
Health services used by the deceased during his/her illness in the period leading to death?
Was s/he given traditional medicine?
1=yes; 2=no; 8=DK
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985b: Traditional medicine?
Q0985b: Traditional medicine?
Q0985b: Traditional medicine?
Q0985b: Traditional medicine?
Q0985b: Traditional medicine?
Health services used by the deceased during his/her illness in the period leading to death?
Was s/he given traditional medicine?
1=yes; 2=no; 8=DK
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985b: Traditional medicine?
Q0985b: Traditional medicine?
Q0985b: Traditional medicine?
Q0985b: Traditional medicine?
Q0985b: Traditional medicine?
Health services used by the deceased during his/her illness in the period leading to death?
Was s/he given traditional medicine?
1=yes; 2=no; 8=DK
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985b: Traditional medicine?
Q0985b: Traditional medicine?
Q0985b: Traditional medicine?
Q0985b: Traditional medicine?
Q0985b: Traditional medicine?
Health services used by the deceased during his/her illness in the period leading to death?
Was s/he given traditional medicine?
1=yes; 2=no; 8=DK
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985c: Modern medicine?
Q0985c: Modern medicine?
Q0985c: Modern medicine?
Q0985c: Modern medicine?
Q0985c: Modern medicine?
Health services used by the deceased during his/her illness in the period leading to death?
Was s/he given modern medicine?
1=yes; 2=no; 8=DK
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985c: Modern medicine?
Q0985c: Modern medicine?
Q0985c: Modern medicine?
Q0985c: Modern medicine?
Q0985c: Modern medicine?
Health services used by the deceased during his/her illness in the period leading to death?
Was s/he given modern medicine?
1=yes; 2=no; 8=DK
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985c: Modern medicine?
Q0985c: Modern medicine?
Q0985c: Modern medicine?
Q0985c: Modern medicine?
Q0985c: Modern medicine?
Health services used by the deceased during his/her illness in the period leading to death?
Was s/he given modern medicine?
1=yes; 2=no; 8=DK
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985c: Modern medicine?
Q0985c: Modern medicine?
Q0985c: Modern medicine?
Q0985c: Modern medicine?
Q0985c: Modern medicine?
Health services used by the deceased during his/her illness in the period leading to death?
Was s/he given modern medicine?
1=yes; 2=no; 8=DK
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985d: Medicine from family?
Q0985d: Medicine from family?
Q0985d: Medicine from family?
Q0985d: Medicine from family?
Q0985d: Medicine from family?
Health services used by the deceased during his/her illness in the period leading to death?
Was s/he given medicine from family?
1=yes; 2=no; 8=DK
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985d: Medicine from family?
Q0985d: Medicine from family?
Q0985d: Medicine from family?
Q0985d: Medicine from family?
Q0985d: Medicine from family?
Health services used by the deceased during his/her illness in the period leading to death?
Was s/he given medicine from family?
1=yes; 2=no; 8=DK
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985d: Medicine from family?
Q0985d: Medicine from family?
Q0985d: Medicine from family?
Q0985d: Medicine from family?
Q0985d: Medicine from family?
Health services used by the deceased during his/her illness in the period leading to death?
Was s/he given medicine from family?
1=yes; 2=no; 8=DK
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985d: Medicine from family?
Q0985d: Medicine from family?
Q0985d: Medicine from family?
Q0985d: Medicine from family?
Q0985d: Medicine from family?
Health services used by the deceased during his/her illness in the period leading to death?
Was s/he given medicine from family?
1=yes; 2=no; 8=DK
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985e: Gov't health facility?
Q0985e: Gov't health facility?
Q0985e: Gov't health facility?
Q0985e: Gov't health facility?
Q0985e: Gov't health facility?
Health services used by the deceased during his/her illness in the period leading to death?
Was she given medicine from any government health facility?
1=yes; 2=no; 8=DK
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985e: Gov't health facility?
Q0985e: Gov't health facility?
Q0985e: Gov't health facility?
Q0985e: Gov't health facility?
Q0985e: Gov't health facility?
Health services used by the deceased during his/her illness in the period leading to death?
Was she given medicine from any government health facility?
1=yes; 2=no; 8=DK
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985e: Gov't health facility?
Q0985e: Gov't health facility?
Q0985e: Gov't health facility?
Q0985e: Gov't health facility?
Q0985e: Gov't health facility?
Health services used by the deceased during his/her illness in the period leading to death?
Was she given medicine from any government health facility?
1=yes; 2=no; 8=DK
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0985e: Gov't health facility?
Q0985e: Gov't health facility?
Q0985e: Gov't health facility?
Q0985e: Gov't health facility?
Q0985e: Gov't health facility?
Health services used by the deceased during his/her illness in the period leading to death?
Was she given medicine from any government health facility?
1=yes; 2=no; 8=DK
1=Private doctor抯 office
2=Private clinic or health care facility
3=Private hospital
4=Public clinic or health care facility
5=Public hospital
6=Charity or church run clinic
7=Charity or church run hospital
8=Home visit
9=Public dispensary
10=Private dispensary
11=Medical doctor (including gynecologist, psychiatrist, etc.)
12=Nurse/midwife
13=Dentist
14=Physiotherapist, chiropractor
15=Traditional healer/medicine practitioner (use local name)
16=Pharmacist, druggist
17=Home health/village health care worker
88=DON'T KNOW
INTERVIEWER: Refer to the list below and circle all that are relevant.
Q0986: Used tobacco?
Q0986: Used tobacco?
Q0986: Used tobacco?
Q0986: Used tobacco?
Q0986: Used tobacco?
Now we would like to ask a few questions about habits and behaviours, particularly about any use of tobacco or alcohol.
Had the deceased smoked, snuffed or chewed more than 100 cigarettes or 100 grams of tobacco in his/her whole life?
1=yes; 2=no; 8=DK
If NO or DK, skip to Q0990
Q0986: Used tobacco?
Q0986: Used tobacco?
Q0986: Used tobacco?
Q0986: Used tobacco?
Q0986: Used tobacco?
Now we would like to ask a few questions about habits and behaviours, particularly about any use of tobacco or alcohol.
Had the deceased smoked, snuffed or chewed more than 100 cigarettes or 100 grams of tobacco in his/her whole life?
1=yes; 2=no; 8=DK
If NO or DK, skip to Q0990
Q0986: Used tobacco?
Q0986: Used tobacco?
Q0986: Used tobacco?
Q0986: Used tobacco?
Q0986: Used tobacco?
Now we would like to ask a few questions about habits and behaviours, particularly about any use of tobacco or alcohol.
Had the deceased smoked, snuffed or chewed more than 100 cigarettes or 100 grams of tobacco in his/her whole life?
1=yes; 2=no; 8=DK
If NO or DK, skip to Q0990
Q0986: Used tobacco?
Q0986: Used tobacco?
Q0986: Used tobacco?
Q0986: Used tobacco?
Q0986: Used tobacco?
Now we would like to ask a few questions about habits and behaviours, particularly about any use of tobacco or alcohol.
Had the deceased smoked, snuffed or chewed more than 100 cigarettes or 100 grams of tobacco in his/her whole life?
1=yes; 2=no; 8=DK
If NO or DK, skip to Q0990
Q0987: Month prior?
Q0987: Month prior?
Q0987: Month prior?
Q0987: Month prior?
Q0987: Month prior?
Did the deceased smoke, snuff or chew during one month before death?
1=yes; 2=no; 8=DK
Q0987: Month prior?
Q0987: Month prior?
Q0987: Month prior?
Q0987: Month prior?
Q0987: Month prior?
Did the deceased smoke, snuff or chew during one month before death?
1=yes; 2=no; 8=DK
Q0987: Month prior?
Q0987: Month prior?
Q0987: Month prior?
Q0987: Month prior?
Q0987: Month prior?
Did the deceased smoke, snuff or chew during one month before death?
1=yes; 2=no; 8=DK
Q0987: Month prior?
Q0987: Month prior?
Q0987: Month prior?
Q0987: Month prior?
Q0987: Month prior?
Did the deceased smoke, snuff or chew during one month before death?
1=yes; 2=no; 8=DK
Q0988: When stopped?
Q0988: When stopped?
Q0988: When stopped?
Q0988: When stopped?
Q0988: When stopped?
If no, how long had the deceased stopped smoking, snuffing or chewing before death?
1=1 month
2=2 to 6 months;
3=7 to 11 months;
4= 1 to 5 years;
5= more than 5 years;
8=DK
Q0988: When stopped?
Q0988: When stopped?
Q0988: When stopped?
Q0988: When stopped?
Q0988: When stopped?
If no, how long had the deceased stopped smoking, snuffing or chewing before death?
1=1 month
2=2 to 6 months;
3=7 to 11 months;
4= 1 to 5 years;
5= more than 5 years;
8=DK
Q0988: When stopped?
Q0988: When stopped?
Q0988: When stopped?
Q0988: When stopped?
Q0988: When stopped?
If no, how long had the deceased stopped smoking, snuffing or chewing before death?
1=1 month
2=2 to 6 months;
3=7 to 11 months;
4= 1 to 5 years;
5= more than 5 years;
8=DK
Q0988: When stopped?
Q0988: When stopped?
Q0988: When stopped?
Q0988: When stopped?
Q0988: When stopped?
If no, how long had the deceased stopped smoking, snuffing or chewing before death?
1=1 month
2=2 to 6 months;
3=7 to 11 months;
4= 1 to 5 years;
5= more than 5 years;
8=DK
A0989: Daily consumption
A0989: Daily consumption
A0989: Daily consumption
A0989: Daily consumption
A0989: Daily consumption
When the deceased smoked, snuffed or chewed, how many cigarettes or how many grams of tobacco did he smoke/snuff/chew per day on average?
A0989: Daily consumption
A0989: Daily consumption
A0989: Daily consumption
A0989: Daily consumption
A0989: Daily consumption
When the deceased smoked, snuffed or chewed, how many cigarettes or how many grams of tobacco did he smoke/snuff/chew per day on average?
A0989: Daily consumption
A0989: Daily consumption
A0989: Daily consumption
A0989: Daily consumption
A0989: Daily consumption
When the deceased smoked, snuffed or chewed, how many cigarettes or how many grams of tobacco did he smoke/snuff/chew per day on average?
A0989: Daily consumption
A0989: Daily consumption
A0989: Daily consumption
A0989: Daily consumption
A0989: Daily consumption
When the deceased smoked, snuffed or chewed, how many cigarettes or how many grams of tobacco did he smoke/snuff/chew per day on average?
A0989: Daily consumption (g)
A0989: Daily consumption (g)
A0989: Daily consumption (g)
A0989: Daily consumption (g)
A0989: Daily consumption (g)
A0989: Daily consumption (g)
A0989: Daily consumption (g)
A0989: Daily consumption (g)
A0989: Daily consumption (g)
A0989: Daily consumption (g)
A0989: Daily consumption (g)
A0989: Daily consumption (g)
A0989: Daily consumption (g)
A0989: Daily consumption (g)
A0989: Daily consumption (g)
A0989: Daily consumption (g)
A0989: Daily consumption (g)
A0989: Daily consumption (g)
A0989: Daily consumption (g)
A0989: Daily consumption (g)
Q0990: Used alcohol?
Q0990: Used alcohol?
Q0990: Used alcohol?
Q0990: Used alcohol?
Q0990: Used alcohol?
Did the deceased drink alcohol?
1=yes; 2=no= 8=DK
If NO or DK, skip to Q0993
Q0990: Used alcohol?
Q0990: Used alcohol?
Q0990: Used alcohol?
Q0990: Used alcohol?
Q0990: Used alcohol?
Did the deceased drink alcohol?
1=yes; 2=no= 8=DK
If NO or DK, skip to Q0993
Q0990: Used alcohol?
Q0990: Used alcohol?
Q0990: Used alcohol?
Q0990: Used alcohol?
Q0990: Used alcohol?
Did the deceased drink alcohol?
1=yes; 2=no= 8=DK
If NO or DK, skip to Q0993
Q0990: Used alcohol?
Q0990: Used alcohol?
Q0990: Used alcohol?
Q0990: Used alcohol?
Q0990: Used alcohol?
Did the deceased drink alcohol?
1=yes; 2=no= 8=DK
If NO or DK, skip to Q0993
Q0991: Month prior?
Q0991: Month prior?
Q0991: Month prior?
Q0991: Month prior?
Q0991: Month prior?
Did the deceased drink alcohol within the month before death?
1=yes; 2=no; 8=DK
Q0991: Month prior?
Q0991: Month prior?
Q0991: Month prior?
Q0991: Month prior?
Q0991: Month prior?
Did the deceased drink alcohol within the month before death?
1=yes; 2=no; 8=DK
Q0991: Month prior?
Q0991: Month prior?
Q0991: Month prior?
Q0991: Month prior?
Q0991: Month prior?
Did the deceased drink alcohol within the month before death?
1=yes; 2=no; 8=DK
Q0991: Month prior?
Q0991: Month prior?
Q0991: Month prior?
Q0991: Month prior?
Q0991: Month prior?
Did the deceased drink alcohol within the month before death?
1=yes; 2=no; 8=DK
Q0992: Frequency
Q0992: Frequency
Q0992: Frequency
Q0992: Frequency
Q0992: Frequency
How often did the deceased usually drink?
1= every day
2= nearly every day
3= 4 to 5 times per week
4= once a week
5= 2 to 3 times per month
6= once a month
7=4 to 5 times per year
8= DK
Q0992: Frequency
Q0992: Frequency
Q0992: Frequency
Q0992: Frequency
Q0992: Frequency
How often did the deceased usually drink?
1= every day
2= nearly every day
3= 4 to 5 times per week
4= once a week
5= 2 to 3 times per month
6= once a month
7=4 to 5 times per year
8= DK
Q0992: Frequency
Q0992: Frequency
Q0992: Frequency
Q0992: Frequency
Q0992: Frequency
How often did the deceased usually drink?
1= every day
2= nearly every day
3= 4 to 5 times per week
4= once a week
5= 2 to 3 times per month
6= once a month
7=4 to 5 times per year
8= DK
Q0992: Frequency
Q0992: Frequency
Q0992: Frequency
Q0992: Frequency
Q0992: Frequency
How often did the deceased usually drink?
1= every day
2= nearly every day
3= 4 to 5 times per week
4= once a week
5= 2 to 3 times per month
6= once a month
7=4 to 5 times per year
8= DK
Q0993: Death certificate?
Q0993: Death certificate?
Q0993: Death certificate?
Q0993: Death certificate?
Q0993: Death certificate?
Now we would like to ask you a few more questions about the cause of death of this person [name]. These specifics will be the last questions we ask.
Was a death certificate issued for this person?
1=yes; 2=no; 3= N/A;
8=DK
If NO, NA or DK, skip to Q0994
Q0993: Death certificate?
Q0993: Death certificate?
Q0993: Death certificate?
Q0993: Death certificate?
Q0993: Death certificate?
Now we would like to ask you a few more questions about the cause of death of this person [name]. These specifics will be the last questions we ask.
Was a death certificate issued for this person?
1=yes; 2=no; 3= N/A;
8=DK
If NO, NA or DK, skip to Q0994
Q0993: Death certificate?
Q0993: Death certificate?
Q0993: Death certificate?
Q0993: Death certificate?
Q0993: Death certificate?
Now we would like to ask you a few more questions about the cause of death of this person [name]. These specifics will be the last questions we ask.
Was a death certificate issued for this person?
1=yes; 2=no; 3= N/A;
8=DK
If NO, NA or DK, skip to Q0994
Q0993: Death certificate?
Q0993: Death certificate?
Q0993: Death certificate?
Q0993: Death certificate?
Q0993: Death certificate?
Now we would like to ask you a few more questions about the cause of death of this person [name]. These specifics will be the last questions we ask.
Was a death certificate issued for this person?
1=yes; 2=no; 3= N/A;
8=DK
If NO, NA or DK, skip to Q0994
Q0993a: death certificate details?
Q0993a: death certificate details?
Q0993a: death certificate details?
Q0993a: death certificate details?
Q0993a: death certificate details?
. What was the cause of death listed on the death certificate?
Q0993a: death certificate details?
Q0993a: death certificate details?
Q0993a: death certificate details?
Q0993a: death certificate details?
Q0993a: death certificate details?
. What was the cause of death listed on the death certificate?
Q0993a: death certificate details?
Q0993a: death certificate details?
Q0993a: death certificate details?
Q0993a: death certificate details?
Q0993a: death certificate details?
. What was the cause of death listed on the death certificate?
Q0993a: death certificate details?
Q0993a: death certificate details?
Q0993a: death certificate details?
Q0993a: death certificate details?
Q0993a: death certificate details?
. What was the cause of death listed on the death certificate?
Q0994: Burial permit?
Q0994: Burial permit?
Q0994: Burial permit?
Q0994: Burial permit?
Q0994: Burial permit?
Was a burial permit issued for this person?
1=yes; 2=no; 3=N/A;
8=don't know
If NO, NA or DK, skip to Q0995
Q0994: Burial permit?
Q0994: Burial permit?
Q0994: Burial permit?
Q0994: Burial permit?
Q0994: Burial permit?
Was a burial permit issued for this person?
1=yes; 2=no; 3=N/A;
8=don't know
If NO, NA or DK, skip to Q0995
Q0994: Burial permit?
Q0994: Burial permit?
Q0994: Burial permit?
Q0994: Burial permit?
Q0994: Burial permit?
Was a burial permit issued for this person?
1=yes; 2=no; 3=N/A;
8=don't know
If NO, NA or DK, skip to Q0995
Q0994: Burial permit?
Q0994: Burial permit?
Q0994: Burial permit?
Q0994: Burial permit?
Q0994: Burial permit?
Was a burial permit issued for this person?
1=yes; 2=no; 3=N/A;
8=don't know
If NO, NA or DK, skip to Q0995
Q0994a: permit details?
Q0994a: permit details?
Q0994a: permit details?
Q0994a: permit details?
Q0994a: permit details?
a. What was the cause of death listed on the burial permit?
Q0994a: permit details?
Q0994a: permit details?
Q0994a: permit details?
Q0994a: permit details?
Q0994a: permit details?
a. What was the cause of death listed on the burial permit?
Q0994a: permit details?
Q0994a: permit details?
Q0994a: permit details?
Q0994a: permit details?
Q0994a: permit details?
a. What was the cause of death listed on the burial permit?
Q0994a: permit details?
Q0994a: permit details?
Q0994a: permit details?
Q0994a: permit details?
Q0994a: permit details?
a. What was the cause of death listed on the burial permit?
Q0995: Autopsy?
Q0995: Autopsy?
Q0995: Autopsy?
Q0995: Autopsy?
Q0995: Autopsy?
Was an autopsy/post mortem performed?
1=yes; 2=no; 8=don't know
If NO or DK, skip to Q0996
Q0995: Autopsy?
Q0995: Autopsy?
Q0995: Autopsy?
Q0995: Autopsy?
Q0995: Autopsy?
Was an autopsy/post mortem performed?
1=yes; 2=no; 8=don't know
If NO or DK, skip to Q0996
Q0995: Autopsy?
Q0995: Autopsy?
Q0995: Autopsy?
Q0995: Autopsy?
Q0995: Autopsy?
Was an autopsy/post mortem performed?
1=yes; 2=no; 8=don't know
If NO or DK, skip to Q0996
Q0995: Autopsy?
Q0995: Autopsy?
Q0995: Autopsy?
Q0995: Autopsy?
Q0995: Autopsy?
Was an autopsy/post mortem performed?
1=yes; 2=no; 8=don't know
If NO or DK, skip to Q0996
Q0995a: Autopsy details
Q0995a: Autopsy details
Q0995a: Autopsy details
Q0995a: Autopsy details
Q0995a: Autopsy details
a. What was the cause of death listed on the autopsy/post mortem report? (What were the post-mortem results?)
Q0995a: Autopsy details
Q0995a: Autopsy details
Q0995a: Autopsy details
Q0995a: Autopsy details
Q0995a: Autopsy details
a. What was the cause of death listed on the autopsy/post mortem report? (What were the post-mortem results?)
Q0995a: Autopsy details
Q0995a: Autopsy details
Q0995a: Autopsy details
Q0995a: Autopsy details
Q0995a: Autopsy details
a. What was the cause of death listed on the autopsy/post mortem report? (What were the post-mortem results?)
Q0995a: Autopsy details
Q0995a: Autopsy details
Q0995a: Autopsy details
Q0995a: Autopsy details
Q0995a: Autopsy details
a. What was the cause of death listed on the autopsy/post mortem report? (What were the post-mortem results?)
Q0996a: MCH/ANC card?
Q0996a: MCH/ANC card?
Q0996a: MCH/ANC card?
Q0996a: MCH/ANC card?
Q0996a: MCH/ANC card?
a. Did the deceased have an MCH/ANC card?
1=yes; 2=no; 3=NA; 8=don't know
Q0996a: MCH/ANC card?
Q0996a: MCH/ANC card?
Q0996a: MCH/ANC card?
Q0996a: MCH/ANC card?
Q0996a: MCH/ANC card?
a. Did the deceased have an MCH/ANC card?
1=yes; 2=no; 3=NA; 8=don't know
Q0996a: MCH/ANC card?
Q0996a: MCH/ANC card?
Q0996a: MCH/ANC card?
Q0996a: MCH/ANC card?
Q0996a: MCH/ANC card?
a. Did the deceased have an MCH/ANC card?
1=yes; 2=no; 3=NA; 8=don't know
Q0996a: MCH/ANC card?
Q0996a: MCH/ANC card?
Q0996a: MCH/ANC card?
Q0996a: MCH/ANC card?
Q0996a: MCH/ANC card?
a. Did the deceased have an MCH/ANC card?
1=yes; 2=no; 3=NA; 8=don't know
Q0996b: Hospital prescription?
Q0996b: Hospital prescription?
Q0996b: Hospital prescription?
Q0996b: Hospital prescription?
Q0996b: Hospital prescription?
b. Did the deceased have a hospital prescription form?
1=yes; 2=no; 8=don't know
Q0996b: Hospital prescription?
Q0996b: Hospital prescription?
Q0996b: Hospital prescription?
Q0996b: Hospital prescription?
Q0996b: Hospital prescription?
b. Did the deceased have a hospital prescription form?
1=yes; 2=no; 8=don't know
Q0996b: Hospital prescription?
Q0996b: Hospital prescription?
Q0996b: Hospital prescription?
Q0996b: Hospital prescription?
Q0996b: Hospital prescription?
b. Did the deceased have a hospital prescription form?
1=yes; 2=no; 8=don't know
Q0996b: Hospital prescription?
Q0996b: Hospital prescription?
Q0996b: Hospital prescription?
Q0996b: Hospital prescription?
Q0996b: Hospital prescription?
b. Did the deceased have a hospital prescription form?
1=yes; 2=no; 8=don't know
Q0996c: Treatment cards?
Q0996c: Treatment cards?
Q0996c: Treatment cards?
Q0996c: Treatment cards?
Q0996c: Treatment cards?
c. Did the deceased have a treatment cards?
1=yes; 2=no; 8=don't know
Q0996c: Treatment cards?
Q0996c: Treatment cards?
Q0996c: Treatment cards?
Q0996c: Treatment cards?
Q0996c: Treatment cards?
c. Did the deceased have a treatment cards?
1=yes; 2=no; 8=don't know
Q0996c: Treatment cards?
Q0996c: Treatment cards?
Q0996c: Treatment cards?
Q0996c: Treatment cards?
Q0996c: Treatment cards?
c. Did the deceased have a treatment cards?
1=yes; 2=no; 8=don't know
Q0996c: Treatment cards?
Q0996c: Treatment cards?
Q0996c: Treatment cards?
Q0996c: Treatment cards?
Q0996c: Treatment cards?
c. Did the deceased have a treatment cards?
1=yes; 2=no; 8=don't know
Q0996d: Hospital discharge form?
Q0996d: Hospital discharge form?
Q0996d: Hospital discharge form?
Q0996d: Hospital discharge form?
Q0996d: Hospital discharge form?
d. Did the deceased have a hospital discharge form?
1=yes; 2=no; 8=don't know
If NO, skip to Q0996f
Q0996d: Hospital discharge form?
Q0996d: Hospital discharge form?
Q0996d: Hospital discharge form?
Q0996d: Hospital discharge form?
Q0996d: Hospital discharge form?
d. Did the deceased have a hospital discharge form?
1=yes; 2=no; 8=don't know
If NO, skip to Q0996f
Q0996d: Hospital discharge form?
Q0996d: Hospital discharge form?
Q0996d: Hospital discharge form?
Q0996d: Hospital discharge form?
Q0996d: Hospital discharge form?
d. Did the deceased have a hospital discharge form?
1=yes; 2=no; 8=don't know
If NO, skip to Q0996f
Q0996d: Hospital discharge form?
Q0996d: Hospital discharge form?
Q0996d: Hospital discharge form?
Q0996d: Hospital discharge form?
Q0996d: Hospital discharge form?
d. Did the deceased have a hospital discharge form?
1=yes; 2=no; 8=don't know
If NO, skip to Q0996f
Q0996f: Other hospital documents?
Q0996f: Other hospital documents?
Q0996f: Other hospital documents?
Q0996f: Other hospital documents?
Q0996f: Other hospital documents?
f. Did the deceased have any other hospital documents?
1=yes; 2=no; 8=don't know
Q0996f: Other hospital documents?
Q0996f: Other hospital documents?
Q0996f: Other hospital documents?
Q0996f: Other hospital documents?
Q0996f: Other hospital documents?
f. Did the deceased have any other hospital documents?
1=yes; 2=no; 8=don't know
Q0996f: Other hospital documents?
Q0996f: Other hospital documents?
Q0996f: Other hospital documents?
Q0996f: Other hospital documents?
Q0996f: Other hospital documents?
f. Did the deceased have any other hospital documents?
1=yes; 2=no; 8=don't know
Q0996f: Other hospital documents?
Q0996f: Other hospital documents?
Q0996f: Other hospital documents?
Q0996f: Other hospital documents?
Q0996f: Other hospital documents?
f. Did the deceased have any other hospital documents?
1=yes; 2=no; 8=don't know
Q0996g: Laboratory results?
Q0996g: Laboratory results?
Q0996g: Laboratory results?
Q0996g: Laboratory results?
Q0996g: Laboratory results?
g. Did the deceased have any laboratory or cytology results?
1=yes; 2=no; 8=don't know
Q0996g: Laboratory results?
Q0996g: Laboratory results?
Q0996g: Laboratory results?
Q0996g: Laboratory results?
Q0996g: Laboratory results?
g. Did the deceased have any laboratory or cytology results?
1=yes; 2=no; 8=don't know
Q0996g: Laboratory results?
Q0996g: Laboratory results?
Q0996g: Laboratory results?
Q0996g: Laboratory results?
Q0996g: Laboratory results?
g. Did the deceased have any laboratory or cytology results?
1=yes; 2=no; 8=don't know
Q0996g: Laboratory results?
Q0996g: Laboratory results?
Q0996g: Laboratory results?
Q0996g: Laboratory results?
Q0996g: Laboratory results?
g. Did the deceased have any laboratory or cytology results?
1=yes; 2=no; 8=don't know
Q0997: Informed of cause of death?
Q0997: Informed of cause of death?
Q0997: Informed of cause of death?
Q0997: Informed of cause of death?
Q0997: Informed of cause of death?
Did a health care worker tell you the cause of death?
1=yes; 2=no; 8=don't know
If NO or DK, Skip to next person or skip to next section
Q0997: Informed of cause of death?
Q0997: Informed of cause of death?
Q0997: Informed of cause of death?
Q0997: Informed of cause of death?
Q0997: Informed of cause of death?
Did a health care worker tell you the cause of death?
1=yes; 2=no; 8=don't know
If NO or DK, Skip to next person or skip to next section
Q0997: Informed of cause of death?
Q0997: Informed of cause of death?
Q0997: Informed of cause of death?
Q0997: Informed of cause of death?
Q0997: Informed of cause of death?
Did a health care worker tell you the cause of death?
1=yes; 2=no; 8=don't know
If NO or DK, Skip to next person or skip to next section
Q0997: Informed of cause of death?
Q0997: Informed of cause of death?
Q0997: Informed of cause of death?
Q0997: Informed of cause of death?
Q0997: Informed of cause of death?
Did a health care worker tell you the cause of death?
1=yes; 2=no; 8=don't know
If NO or DK, Skip to next person or skip to next section
Q0997a: What is the cause of death
Q0997a: What is the cause of death
Q0997a: What is the cause of death
Q0997a: What is the cause of death
Q0997a: What is the cause of death
a. What did the health care worker tell you was the cause of death?
Q0997a: What is the cause of death
Q0997a: What is the cause of death
Q0997a: What is the cause of death
Q0997a: What is the cause of death
Q0997a: What is the cause of death
a. What did the health care worker tell you was the cause of death?
Q0997a: What is the cause of death
Q0997a: What is the cause of death
Q0997a: What is the cause of death
Q0997a: What is the cause of death
Q0997a: What is the cause of death
a. What did the health care worker tell you was the cause of death?
Q0997a: What is the cause of death
Q0997a: What is the cause of death
Q0997a: What is the cause of death
Q0997a: What is the cause of death
Q0997a: What is the cause of death
a. What did the health care worker tell you was the cause of death?