I_C. Health (HT)

I_C. Health (HT) of LASI 2017-2019

item label type description
HT001a Question Now I want to ask you about your health. In general, would you say your health is excellent, very good, good, fair, or poor?
HT001b Question [If HT001_a was not asked] Now I want to ask you about your general health. Overall, how is your health in general? Would you say it is very good, good, fair, poor, or very poor?
HT002 Question Has any health professional ever told you that you have Hypertension or high blood pressure ?
HT003 Question Has any health professional ever told you that you have Diabetes or high blood sugar ?
HT004 Question Has any health professional ever told you that you have Cancer or a malignant tumor ?
HT005 Question Has any health professional ever told you that you have Chronic lung disease such as asthma ,chronic obstructive pulmonary disease/Chronic bronchitis or other chronic lung problems ?
HT006 Question Has any health professional ever told you that you have Chronic heart diseases such as Coronary heart disease (heart attack or Myocardial Infarction), congestive heart failure, or other chronic heart problems ?
HT007 Question Has any health professional ever told you that you have Stroke ?
HT008 Question Has any health professional ever told you that you have Arthritis or rheumatism, Osteoporosis or other bone/joint diseases ?
HT009 Question Has any health professional ever told you that you have Any neurological, or psychiatric problems such as depression , Alzheimers/Dementia, unipolar/bipolar disorders, convulsions, Parkinsons etc. ?
HT010 Question Has any health professional ever told you that you have High cholesterol?
HT002a Question [Ask only if HT002=1] Who first diagnosed you with high blood pressure or hypertension?
HT002b Question [Ask only if HT002=1] When were you first diagnosed with high blood pressure or hypertension? Year _____ [Hard check: HT002b_year > current year] OR Age ______ [Hard check: HT002b_age > Rs current age]
HT002c Question [Ask only if HT002=1] In order to control your blood pressure or hypertension, are you currently taking any medication?
HT002d Question [Ask only if HT002=1] In order to control your blood pressure, are you under salt or other diet restrictions?
HT003a Question [Ask only if HT003=1] Who first diagnosed you with diabetes or high blood sugar?
HT003b Question [Ask only if HT003=1] When were you first diagnosed with diabetes or high blood sugar? Year _____ [Hard check: HT003b_year is > current year] OR Age ______ [Hard check: HT003b_age is > Rs current age]
HT003c Question [Ask only if HT003=1] In order to treat or control your diabetes or high blood sugar, are you currently taking medications that you swallow?
HT003d Question [Ask only if HT003=1] Are you currently using insulin shots/injections?
HT003e Question [Ask only if HT003=1] In order to control your diabetes, are you following a special diet?
HT004a Question [Ask only if HT004=1] Who first diagnosed you with cancer?
HT004b Question [Ask only if HT004=1] When were you first diagnosed with cancer? Year _____[Hard check: HT004b_year is > current year] OR Age ______ [Hard check: HT004b_age is > Rs current age]
HT004c Question [Ask only if HT004=1] Have you been diagnosed with more than one type of cancer?
HT004d Question [Ask only if HT004=1] first diagnosed organ/body part: ____[CAPI will provide drop down list for single answer]
HT004e Question [Ask only if HT004c=1] all other organs/body parts: ____ [CAPI will provide drop down list] [Multiple answers are allowed]
HT004f Question [Ask only if HT004=1] During the last two years, what type of treatments have you received for cancer? [Multiple answers are allowed] [Hard check: if response is None, freeze all other option categories]
HT004g Question [Ask if HT004f != fand HT004c=1] for which cancer(s) have you received the treatment? [Multiple answers allowed]
HT005a Question [Ask only if HT005=1] Who first diagnosed you with chronic lung disease?
HT005b Question [Ask only if HT005=1] When were you first diagnosed with a chronic lung disease such as asthma, chronic obstructive pulmonary disease/chronic bronchitis or other chronic lung problems? Year_____ [Hard check: HT005b_year is > current year] OR Age ______ [Hard check:HT005b_age>Rs current age ]
HT005c Question [Ask only if HT005=1] Are you receiving physical or respiratory therapy, or any other treatment for your lung disease?
HT005d Question [Ask only if HT005=1] Which type of chronic lung disease do you have? [Multiple answers are allowed]
HT006a Question [Ask only if HT006=1] Have you ever had a heart attack?
HT006b Question [Ask only if HT006a=1] When did you first have a heart attack? Year _____ [Hard check: HT006b_year >current year] OR Age ______ [Hard check:HT006b_age > Rs current age]
HT006c Question [Ask only if HT006a=1] Was this the time when you were first diagnosed with a heart disease?
HT006d Question [Ask only if HT006c=2] When were you first diagnosed with a heart disease? Year _____ [Hard check: HT006d_year is > current year] OR Age ______ [Hard check: HT006d_age is> Rs current age]
HT006e Question [Ask only if HT006=1] Who first diagnosed you with heart disease?
HT006f Question [Ask if HT006 =1] What kind of heart related conditions have you been diagnosed with? a. Rheumatic heart disease b. Congenital / Structural Disorders c. Conduction Disorders / Cardiac arrhythmias d. Congestive heart failure e. Other heart conditions please specify
HT006g Question [Ask only if current age of respondent- (minus) respondents age in HT006b > 2] In the last two years, have you had a heart attack?
HT006h Question [Ask only if HT006=1] Are you currently taking any medication for your heart disease?
HT007a Question [Ask only if HT007=1] Who first diagnosed you with a stroke?
HT007b Question [Ask only if HT007=1] When were you first diagnosed with a stroke? Year _____ [Hard check: HT007b_year > current year] OR Age ______ [Hard check: HT007b_age > Rs current age]
HT007c Question [Ask only if HT007=1] Are you currently taking any medications because of your stroke or its complications?
HT007d Question [Ask only if HT007=1] Are you receiving physical or occupational therapy because of your stroke or its complications?
HT007e Question [Ask only if HT007=1] Have you had any subsequent stroke after the first diagnosed stroke you just told me about?
HT007f Question [Ask only if HT007e=1] In the last two years, have you consulted a doctor in connection with this most recent stroke?
HT007g Question [Ask only if HT007=1] Do you still have any remaining problems because of your stroke(s), such as difficulty in moving or speaking?
HT007h. Question Weakness in your arms and legs, or decreased ability to move or use them?
HT007i. Question Difficulty in speaking or swallowing?
HT007j. Question Difficulty with your vision?
HT007k. Question Difficulty in thinking or finding the right words to say?
HT008a Question [Ask only if HT008=1] Have you ever been diagnosed with the following bone/joint diseases/problems? [Multiple answers are allowed]? a. Arthritis b. Rheumatism c. Osteoporosis d. Other, please specify______
HT008b Question [Ask if HT008a= a or b] Who first diagnosed you with arthritis or rheumatism?
HT008c Question [Ask if HT008a=a or b] When were you first diagnosed with arthritis or rheumatism? Year _____ [Hard check: HT008c_year> current year] OR Age ______ [Hard check: HT008c_age > Rs current age]
HT008d Question [Ask only if HT008a=c]Who first diagnosed you with osteoporosis?
HT008e Question [Ask only if HT008a=c]When you were first diagnosed with osteoporosis? Year _____ [Hard check: HT008e year> current year] OR ______ Age [Hard check: HT008e_age > Rs current age]
HT008f Question [Ask only if HT008=1] Are you currently taking any medication or receiving other treatments for your arthritis, rheumatism or osteoporosis?
HT009a Question [Ask only if HT009=1] Which type of neurological or psychiatric problem(s) have you been diagnosed with [Multiple answers are allowed]?
HT009b Question [Ask only ifHT009=1] Who first diagnosed you with your neurological, or psychiatric problems or conditions?
HT009c Question [Ask only if HT009=1] When were you first diagnosed with this problem? _____Year [Hard check: HT009c_year > current year] OR ______ Age [Hard check: HT009b_age > Rs current age]
HT009d Question [Ask only if HT009=1] Are you currently taking any psychiatric or psychological treatment or therapy for your condition?
HT009e Question [Ask only if HT009=1] Are you currently taking tranquilizers, antidepressants, or other types of medication for neurological or psychiatric problem (s)?
HT010a Question [Ask only if HT010=1] Who first diagnosed you with high cholesterol?
HT010b Question [Ask only if HT010=1] When were you first diagnosed with high cholesterol? Year _____ [Hard check: HT0010b_year > current year] OR Age ______ [Hard check:HT0010b_age > Rs current age]
HT010c Question [Ask only if HT010=1] Do you regularly take medications to help lower your cholesterol?
HT010d Question [Ask ALL respondents] In the past 2 years, have you had a blood test for cholesterol?
HT011 Question Now I would like to ask about other chronic conditions. Have you ever been diagnosed with any of the following chronic conditions or diseases? [Multiple answers are allowed]
HT012 Question Have you ever been diagnosed with any of the following urogenital conditions or diseases? [Multiple answers are allowed] [Instruction for CAPI : Freeze all other option if HT012 = e]
HT013 Question [Ask only if HT012=a] In last two years, have you been on dialysis?
HT014 Question Do you ever pass urine while sneezing, coughing, laughing or lifting heavy objects?
HT015 Question Now I have some questions about your eyesight. Have you ever been diagnosed with any eye or vision problem or condition, including ordinary nearsightedness or farsightedness?
HT016 Question [Ask only if HT015 =1] Were you diagnosed with an eye or vision problem or condition in one or both eyes?
HT017 Question [Ask only if HT015=1] With which problem or condition were you diagnosed? [Multiple answers are allowed]
HT018 Question [Ask only if HT015=1] Have you ever undergone any treatment or corrective surgery for an eye problem or condition?
HT019 Question How good is your eyesight for seeing things at a distance, like recognizing a person across the street (or 20 meters away) whether or not you wear glasses, contacts, or corrective lenses?
HT020 Question How good is your eyesight for seeing things up close, like reading ordinary newspaper print whether or not you wear glasses, contacts, or corrective lenses
HT021 Question Have you ever been diagnosed with any hearing or ear-related problem or condition?
HT022 Question [Ask only if HT021=1] Were you diagnosed with an ear or hearing problem or condition in one or both ears?
HT023 Question [Ask only if HT021 =1]Have you ever undergone any treatment or corrective surgery for ear-related problem or condition?
HT024 Question Now, I have some questions about your oral (dental) health. In the last 12 months, have you ever been diagnosed with or suffered from any of the following oral problem(s)? [Multiple answers are allowed]
HT025 Question Have you lost some or all of your natural teeth?
HT026 Question How well can you chew solid foods such as chapati, apple, guava, or nuts?
HT101 Question Now we will ask about some other health concerns, such as injuries and falls. In the past two years, have you sustained any major injury?
HT102 Question [Ask only ifHT101=1] Did you receive medical treatment for that injury?
HT102a Question [Ask only ifHT101=1] What was the cause of that injury? [Multiple answers are allowed] a. Traffic accident b. Struck by person or object c. Fire, flames, burn, electric Shock d. Drowning e. Poisoning f. Animal attack or bite g. Fall h. Other, please specify_______
HT103 Question [Ask only if HT102a!= g]In the past two years, have you fallen down?
HT103a Question [Ask if HT102a=g or HT103=1] How many times have you fallen in the last 2 years? Number of times: ____
HT103b Question [Ask only if HT102a=g or HT103=1] In that fall/in any of these falls, did you injure yourself seriously enough to need medical treatment?
HT104 Question In the past 2 years, have you fractured any of your bones/joints?
HT105 Question In the past 2 years, have you undergone any surgery related to bones or joints?
HT105a Question [Ask only if HT105=1] Which bone or joint have you undergone surgery for? [Multiple answers are allowed]
HT106 Question Now we are going to ask some questions about natural disasters, which may have affected your health as well. In the last five years, has your health been severely affected by disasters such as floods, landslides, extreme cold and hot weather, cyclone/typhoons, droughts, earthquakes, tsunamis, or any other natural calamities?
HT106a Question [Ask only if HT106=1] Which of these natural disasters affected your health? Please identify all natural disasters that affected you. [Multiple answers are allowed]
HT107 Question In the last five years, has your health been severely affected by man-made incidents such as riots, terrorism, building collapses, fires, traffic accidents or any other man-made incidents?
HT107a Question [Ask only if HT107=1] Which of these man-made disasters affected your health? Please identify all man-made incidents that affected you. [Multiple answers are allowed]
HT108 Question [Ask if HT106=1 or HT107=1]What were the health consequences that you suffered as a result of these disasters or incidents? [Multiple answers are allowed]
HT201 Question In the past 2 years, have you had Jaundice/ Hepatitis
HT201a Question [Ask only if HT201-HT210=1]Was this disease treated by a health professional? Jaundice/ Hepatitis
HT202 Question In the past 2 years, have you had Tuberculosis (TB)
HT202a Question [Ask only if HT201-HT210=1]Was this disease treated by a health professional? Tuberculosis (TB)
HT203 Question In the past 2 years, have you had Malaria
HT203a Question [Ask only if HT201-HT210=1]Was this disease treated by a health professional? Malaria
HT204 Question In the past 2 years, have you had Diarrhea/gastroenteritis
HT204a Question [Ask only if HT201-HT210=1]Was this disease treated by a health professional? Diarrhea/gastroenteritis
HT205 Question In the past 2 years, have you had Typhoid
HT205a Question [Ask only if HT201-HT210=1]Was this disease treated by a health professional? Typhoid
HT206 Question In the past 2 years, have you had Urinary Tract Infection
HT206a Question [Ask only if HT201-HT210=1]Was this disease treated by a health professional? Urinary Tract Infection
HT207 Question In the past 2 years, have you had Anemia
HT207a Question [Ask only if HT201-HT210=1]Was this disease treated by a health professional? Anemia
HT208 Question In the past 2 years, have you had Chikungunya
HT208a Question [Ask only if HT201-HT210=1]Was this disease treated by a health professional? Chikungunya
HT209 Question In the past 2 years, have you had Dengue
HT209a Question [Ask only if HT201-HT210=1]Was this disease treated by a health professional? Dengue
HT210 Question In the past 2 years, have you had Other, please specify _____
HT210a Question [Ask only if HT201-HT210=1]Was this disease treated by a health professional? Other, please specify _____
HT211 Question Have you ever received any immunizations for adults, such as the influenza vaccine, pneumococcal vaccine, hepatitis B vaccine, or typhoid vaccine? [Multiple answers are allowed]
HT212 Question Do you ever have any pain or discomfort in your chest?
HT213 Question [Ask only if HT212=1] Do you get this pain or discomfort when you walk uphill or hurry?
HT214 Question Do you get it when you walk at an ordinary pace on the level?
HT215 Question When you get any pain or discomfort in your chest while walking or moving, what do you do?
HT216 Question Does it go away when you stop moving?
HT217 Question How quickly the pain subsides when it occurs?
HT218 Question Where do you get this pain or discomfort? [Multiple answers are allowed] -------
HT219 Question How often do you have trouble falling asleep?
HT220 Question How often did you wake up during the night and had trouble getting back to sleep?
HT221 Question How often did you wake up too early in the morning and were not being able to fall asleep again?
HT222 Question How often did you feel unrested during the day, no matter how many hours of sleep you had?
HT222a Question How often did you take a nap during the day?
HT223 Question In the past 1 month, have you taken any medications or used other treatments to help you sleep?
HT224 Question [Ask only if HT223=1] Were these medications or other treatments recommended to you by a doctor?
HT225 Question Are you often troubled with pain?
HT226 Question [Ask only if HT225 =1] How frequently do you experience pain?
HT227 Question [Ask only if HT225=1] Do you take any medication or therapy to get relief from the pain [Multiple answers are allowed]?
HT228 Question [Ask only if HT225=1] Does the pain make it difficult for you to do your usual activities such as household chores or work?
HT229 Question Have you had any of the following persistent or troublesome problems in past two years? [Multiple answers are allowed]
HT230 Question Aside from any hospital or nursing home stays, about how many days did you stay in bed more than half day because of illness or injury during the last 30 days ? Use 0 for none. Number of days: ___ [Hard check: HT247 >31]
HT231 Question [Ask only if interview is NOT a proxy interview] Now I want to ask you about your overall childhood health up to age 16. In general, would you say your childhood health was very good, good, fair, poor or very poor on the basis of what you remember, or what you heard or perceived from your parents?
HT232 Question [Ask only if interview is a proxy interview] Consider [his/her] health while [he/she] was growing up, from birth to age
HT233 Question When you were growing up, before you were 16 years old, were you ever bedridden for a month or more because of a health problem?
HT234 Question [Ask only if DM006=1] When you were growing up, before you were 16 years old, did you ever miss a month or more of school because of a health problem?
HT235 Question Now think about your family when you were growing up, from birth to age 16. Compared to other families in your community, would you say your family during that time was pretty well off financially, about average, or poor?
HT236 Question When did you have your last menstrual bleeding /period? ._______ Year and _______ month
HT237 Question [Ask only if DM005 < 60years] In the last 12 months, have you had any of the following health problem(s)? [Multiple answers are allowed]
HT238 Question [Ask only if HT237!=i]Did you seek doctor's consultation or treatment for any of these health problems?
HT239 Question Have you undergone an operation to remove your uterus (hysterectomy)?
HT240 Question HT240 [Ask only if HT239= 1] What were the reason(s) for undergoing hysterectomy? [Multiple responses are allowed] [Instructionfor CAPI: If option h is selected, other given options should be freeze]
HT241 Question In the last 2 years, have you had a PAP smear test?
HT242 Question In the last 2 years, have you had a mammogram?
HT300 Question [Ask only WE004=1 or WE005=1] Now I want to ask how your health affects paid work activities. Do you have any impairment or health problem that limits the kind or amount of paid work you can do?
HT301 Question Do you have any form of physical or mental impairment?
HT302 Question [Ask only if HT301= 1] Which form of impairment do you have? [Multiple answers are allowed]
HT303 Question Do you have difficulty with Walking 100 yards
HT304 Question Do you have difficulty with Sitting for 2 hours or more
HT305 Question Do you have difficulty with Getting up from a chair after sitting for long period
HT306 Question Do you have difficulty with Climbing one flight of stairs without resting
HT307 Question Do you have difficulty with Stooping, kneeling or crouching
HT308 Question Do you have difficulty with Reaching or extending arms above shoulder level (either arm)
HT309 Question Do you have difficulty with Pulling or pushing large objects
HT310 Question Do you have difficulty with Lifting or carrying weights over 5 kilos, like a heavy bag of groceries
HT311 Question Do you have difficulty with Picking up a coin from a table
HT401 Question Because of a health or memory problem, do you have any difficulty with Dressing, including putting on chappals, shoes, etc.
HT402 Question Because of a health or memory problem, do you have any difficulty with Walking across a room
HT403 Question Because of a health or memory problem, do you have any difficulty with Bathing
HT404 Question Because of a health or memory problem, do you have any difficulty with Eating, chewing, breaking chapatti, mixing rice, etc.
HT405 Question Because of a health or memory problem, do you have any difficulty with Getting in or out of bed
HT406 Question Because of a health or memory problem, do you have any difficulty with Using the toilet, including getting up and down
HT407 Question Because of a health or memory problem, do you have any difficulty with Preparing a hot meal (cooking and serving)
HT408 Question Because of a health or memory problem, do you have any difficulty with Shopping for groceries
HT409 Question Because of a health or memory problem, do you have any difficulty with Making telephone calls
HT410 Question Because of a health or memory problem, do you have any difficulty with Taking medications
HT411 Question Because of a health or memory problem, do you have any difficulty with Doing work around the house or garden
HT412 Question Because of a health or memory problem, do you have any difficulty with Managing money, such as paying bills and keeping track of expenses
HT413 Question Because of a health or memory problem, do you have any difficulty with Getting around or finding address in unfamiliar place
HT414 Question Are you using any aid or supportive device(s) to assist you in the activities of daily living? Examples of supportive devices include spectacles and dentures, and devices to help you in moving or sitting.
HT415 Question Please tell me which of the following device(s), you have been using to assist you in the activities of daily living Hearing Aid
HT416 Question Please tell me which of the following device(s), you have been using to assist you in the activities of daily living Spectacles/contact lenses
HT417 Question Please tell me which of the following device(s), you have been using to assist you in the activities of daily living Denture
HT418 Question Please tell me which of the following device(s), you have been using to assist you in the activities of daily living Walker/ walking Sticks
HT419 Question Please tell me which of the following device(s), you have been using to assist you in the activities of daily living Wheel chairs
HT420 Question Please tell me which of the following device(s), you have been using to assist you in the activities of daily living Adjustable shower stools /Commodes
HT421 Question Please tell me which of the following device(s), you have been using to assist you in the activities of daily living Back/ neck collar
HT422 Question Please tell me which of the following device(s), you have been using to assist you in the activities of daily living Orthesis and prosthesis
HT423 Question Please tell me which of the following device(s), you have been using to assist you in the activities of daily living Other, please specify.
HT424 Question Does anyone help you with these difficulties you mentioned above?
HT425 Question How many people usually help you with these activities? _______
HT426 Question Who helps you with that most often? Select person if helper is a household member [CAPI will show HH person IDs] ____ Name if helper is not a household member
HT427 Question [Ask only if helper is not a household member].What is that persons relationship to you?
HT428 Question During the last month, on about how many days did [NAME OF CARE PROVIDER] assist you? ______days in last month (Hard check:>31)
HT429 Question On the days [NAME OF CARE PROVIDER] assisted you, about how many hours per day was that? [Instruction for Interviewer: Enter 0 if LESS THAN ONE HOUR] _______hours [Hard check : >24]
HT430 Question Is [NAME OF CARE PROVIDER] paid to help you?
HT431 Question How often did the respondent receive assistance in answering this section?
HT432 Question [Ask only if HT431>1] Who helped the respondent in answering this section?
FM301 Question [Ask only if DM021 < 6]Is your current or former spouse related to you by blood (like a cousin)?
FM302a Question [Ask only if DM021< 6] How many times have you / your spouse been pregnant? Number of pregnancies: _____
FM302b Question [Ask only if DM021< 6] How many times have you / your spouse been pregnant? Number of live births: _____
FM302c Question [Ask only if DM021< 6] How many times have you / your spouse been pregnant? Number of still births: _____
FM302d Question [Ask only if DM021< 6] How many times have you / your spouse been pregnant? Number of Spontaneous abortions /miscarriages: _____
FM302e Question [Ask only if DM021< 6] How many times have you / your spouse been pregnant? Number of Medical Termination of Pregnancy (MTP)/induced abortion: _____
FM303 Question Could you tell me if your father, mother, brother, sister, children, grandchildren, has ever been diagnosed with the following diseases? Please only refer to blood-related family members. Hypertension
FM304 Question Could you tell me if your father, mother, brother, sister, children, grandchildren, has ever been diagnosed with the following diseases? Please only refer to blood-related family members. Diabetes
FM305 Question Could you tell me if your father, mother, brother, sister, children, grandchildren, has ever been diagnosed with the following diseases? Please only refer to blood-related family members. Heart disease
FM306 Question Could you tell me if your father, mother, brother, sister, children, grandchildren, has ever been diagnosed with the following diseases? Please only refer to blood-related family members. Stroke
FM307 Question Could you tell me if your father, mother, brother, sister, children, grandchildren, has ever been diagnosed with the following diseases? Please only refer to blood-related family members. Cancer
FM308 Question Could you tell me if your father, mother, brother, sister, children, grandchildren, has ever been diagnosed with the following diseases? Please only refer to blood-related family members. Alzheimers disease
FM309 Question Could you tell me if your father, mother, brother, sister, children, grandchildren, has ever been diagnosed with the following diseases? Please only refer to blood-related family members. Parkinsons disease
FM310 Question Could you tell me if your father, mother, brother, sister, children, grandchildren, has ever been diagnosed with the following diseases? Please only refer to blood-related family members. Psychotic Disorder
FM311 Question Does your family have a history of birth defects or congenital disorders in children?
FM312 Question [Ask only if FM311=1]Does your family have a history of any of the following? [Multiple answers are allowed]
FM313 Question Who was present while interviewing this module?[Multiple answers are allowed].
FM314 Question How often did the respondent receive assistance in answering this section?
FM315 Question [Ask only if FM314>1] Who helped the respondent in answering this section?
MH001 Question Now Im going to ask several simple questions to test your memory. Some may be easy and some may be hard to answer. Please try to answer as honestly as you can.
MH002 Question Please tell me todays date. Date [display day number]
MH003 Question Please tell me todays date. Month [display month]
MH004 Question Please tell me todays date. Year [display year]
MH005 Question Please tell me which day of week is today. Is it Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, or Sunday? [Instruction for CAPI: Display day of the week]
MH006 Question What is this place used for? [Instruction for Interviewer: plausible answers are specific answers such as living room, house, apartment, hospital, market, etc.]
MH007 Question Name of village/town/city
MH008 Question Street number/ colony name/landmark/neighbourhood
MH009 Question What is name of your district?
MH010 Question I will read a set of 10 words and ask you to recall as many as you can. We have purposely made the list long so that it will be difficult for anyone to recall all the words. Most people recall just a few. Please listen carefully as I read the set of words because I cannot repeat them. When I finish, I will ask you to recall aloud as many of the words as you can, in any order. Is this clear?
MH011 Question [Instructions for Interviewer: One of the following three lists of words will appear on the screen for Interviewer to read] List 1: River, Tree, Temple, School, Hospital, Dog, Cat, Radio, Chair, Gold; List 2: Monkey, Car, Stone, Doctor, Phone, Fire, Road, Silver, Flower, Cow; List 3: Elephant, Bike, Kite, Teacher, House, Water, Butter, Book, Market, Baby; [Instruction for Interviewer: Enter which list appeared on the screen]
MH012 Question Now please tell me the words you can recall from. Number of words R correctly recalls: _____ [Hard check: MH012>10]
MH013 Question Now please tell me the words you can recall from. Number of words R incorrectly recalls: ______ [Soft check:MH013<=15]
MH014 Question Please indicate whether any of the following problems occurred in relation to word recall. [Multiple answers are allowed][Instructions for CAPI: if BM014=d then freeze other options]
MH015 Question Now we are going to ask you to think of animals and name as many as you can. If you wish you may also include birds along with animals. I am going to give you one minute and I want to see how many animals you can name. [Instructions for Interviewer: Count Categories of animals (e.g., dogs), as well as specific types (e.g., Doberman, Shepherd) as correct. Any members of the animal kingdom, real or mythical, are scored as correct, except repetitions and proper nouns (e.g., Mickey Mouse)]
MH016 Question Total number of animals and/or birds named [this number is generated from CAPI]: ______
MH017 Question [Instructions for Interviewer: If R did incorrect naming, anything that is not an animal or bird]: Was there incorrect naming?
MH018 Question [Instructions for Interviewer: If R did repetition, giving the same animal name more than once] Was there repetition?
MH019 Question [Instructions for Interviewer: pointing to item #1] What is this? [Instructions for Interviewer: Items can be anything from cell phones, gloves, hats, rings, and umbrella that can be within close reach.]
MH020 Question [Instructions for Interviewer: pointing to item #2] What is this?
MH021a Question Can we now proceed to do similar tests? a. Yes b. No. Go to MH036 c. Refused. Go to MH036
MH021 Question Fill the blank [7, 8, , 10]
MH022 Question Fill the blank [8, , 10, 12]
MH023 Question Fill the blank [18, 10, 6, , 3]
MH024 Question Fill the blank [1, 2, 3, ]
MH025 Question Fill the blank [6, 5, 4, ]
MH026 Question Fill the blank [12, , 16, 18]
MH027 Question Fill the blank [5, , 3, 2]
MH028 Question Fill the blank [4, 7, 10, ]
MH029 Question Fill the blank [, 4, 6, 8]
MH030 Question Fill the blank [1, 3, 3, 5, 7, 7, ]
MH031 Question Fill the blank [3, , 8, 12, 17]
MH032 Question Fill the blank [17, , 12, 8]
MH033 Question Fill the blank [10, , 3, 1]
MH034 Question Fill the blank [18, 17, 15, , 8]
MH035 Question Fill the blank [3, 3, 4, 6, 6, 7, , ]
MH036 Question [Instructions for Interviewer: Please select one of the following]
MH037 Question [Ask if MH036=1 or 2]The time taken for backward counting ___secs You may stop now. Thank you.
MH038 Question [Instruction for Interviewer: Please select the appropriate answer]
MH039 Question [Ask if MH038= 1or 2]The time taken for backward counting ___secs [Hard check : >120 secs]
MH040 Question Now let's try some subtraction of numbers. One hundred minus 7 equals what? Enter the answer R gave:
MH041 Question And 7 from that equals what? [Interviewer: enter the answer R gave] ____
MH042 Question And 7 from that equals what? [Interviewer: enter the answer R gave] ____
MH043 Question And 7 from that equals what? [Interviewer: enter the answer R gave] ____
MH044 Question And 7 from that equals what? [Interviewer: enter the answer R gave] ____
MH045 Question [CAPI generated score] ____
MH046 Question A shop is having a sale and selling all items at half price. Before the sale, a sari costs 300 Rs. How much will it cost in the sale?
MH047 Question If 5 people all have the winning numbers in the lottery and the prize is 1,000 Rs, how much will each of them get?
MH048 Question [Instruction for Interviewer: Make sure R doesnt see the test paper with the words Close your eyes written before asking the question. Make sure that someone doesnt read the sentence to R] I will show you a sentence. Please read the sentence aloud and act it out.
MH049 Question [Ask if MH048 != 4] [Instruction for Interviewer: Give R a pen and point to the blank part of the paper] Please write one sentence about how you are feeling today or todays weather. [Instruction for Interviewer: spelling error is OK, as long as you can understand the meaning of the sentence written]
MH050 Question Now, listen carefully and follow my direction. Are you ready? When I give you a piece of paper, please turn it over, fold it in half, and give it back to me. [Instruction for Interviewer: (1) Tidy up the surroundings (especially the front) so it doesnt interfere with the respondent. (2) Do not repeat the question in the middle of the process. (3) Do not give out the paper in advance. (4) Directions can be repeated if the respondent seems unable to understand the directions or if the respondent asks you to repeat the directions. In this case, the paper first given out should be collected and the process should start over]
MH051 Question [Instruction for Interviewer: Show the picture of two pentagons overlapped] Do you see this picture? Please draw that picture on this paper.
MH052 Question Could you draw picture of clock, showing ten past eleven and Contour looks OK?
MH053 Question Could you draw picture of clock, showing ten past eleven and Number looks OK?
MH054 Question Could you draw picture of clock, showing ten past eleven and Hands look right?
MH055 Question A little while ago, I read you a list of words and you repeated the ones you could remember. Please tell me any of the words that you remember now. [Instruction for Interviewer: Permit as much time as R wishes, up to 2 minutes] The list of words is: [The same list of words will appear on the screen for Interviewer] List 1: River, Tree, Temple, School, Hospital, Dog, Cat, Radio, Chair, Gold; List 2: Monkey, Car, Stone, Doctor, Phone, Fire, Road, Silver, Flower, Cow; List 3: Elephant, Bike, Kite, Teacher, House, Water, Butter, Book, Market, Baby;
MH056 Question Number of words R correctly recalls ______ [Hard check: MH056>10]
MH057 Question [For the interviewer] Was there any interruptions or noise that could distract the respondent during administering this module?
MH058 Question [For the interviewer] How often did the respondent receive assistance in answering this section?
MH059 Question [Ask only if MH058>1] Who helped the respondent in answering this section?
MH101 Question Part of this study is concerned with people's memory, and ability to think about things. First, how would you rate [NAME]'s memory at the present time? Would you say it is excellent, very good, good, fair, or poor?
MH102 Question 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 [Year]. Compared to ten years ago, would you say [Rs NAME]'s memory is better now, about the same, or worse now than it was then?
MH103 Question I will present situations where this person has to use his/her memory or intelligence and I want you to indicate whether this has improved, stayed the same or got worse than in that situation over the past 10 years. Note the importance of comparing his/h
MH104 Question Remembering things about family and friends, e.g. occupations, birthdays, addresses
MH105 Question Remembering things that have happened recently
MH106 Question Recalling conversations a few days later
MH107 Question Remembering her/his address and telephone number
MH108 Question Remembering what day and month it is
MH109 Question Remembering where things are usually kept
MH110 Question Remembering where to find things which have been put in a different place from usual
MH111 Question Knowing how to work familiar machines around the house
MH112 Question Learning to use a new gadget or machine around the house
MH113 Question Learning new things in general
MH114 Question Following a story in a book or on TV
MH115 Question Making decisions on everyday matters
MH116 Question Handling money for shopping
MH117 Question Handling financial matters, e.g. the pension, dealing with the bank
MH118 Question Handling other everyday arithmetic problems, e.g. knowing how much food to buy, knowing how long between visits from family or friends
MH119 Question Using his/her intelligence to understand whats going on and to reason things through
MH120 Question Now, please think about [Rs NAME] some current behaviors,
MH121 Question Does [she/he] ever get lost in a familiar environment?
MH122 Question Does [she/he] ever wander off and not return by [her-self/him-self]?
MH123 Question Can [she/he] be left alone for an hour or so?
MH124 Question Does [she/he] ever see or hear things that are not really there?
MH125 Question During the past week, how often has [Rs NAME] become angry or hostile without reason? Was it most of the time, some of the time, or never?
MH126 Question [Interviewer: if proxy is a household member, please enter Household Person ID from pre-loaded household roster] Proxys Household Person ID: ___________
MH127 Question How often did the proxy receive assistance in answering this section?
MH128 Question Who helped the respondent in answering this section?
MH201 Question [Screening Question] During the last 12 months, was there ever a time when you felt sad, blue, or depressed for two weeks or more in a row?
MH202 Question [Ask only If MH201=1]Please think of the two-week period during the last 12 months when these feelings were worst. During that time did the feelings of being sad, blue, or depressed usually last all day long, most of the day, about half the day, or less than half the day?
MH203 Question [Ask If MH202=1 or 2]During those two weeks, did you feel this way every day, almost every day, or less often than that?
MH204 Question Thinking about those same two weeks, Did you lose interest in most things?
MH205 Question Thinking about those same two weeks, Did you ever feel more tired out or low in energy than is usual for you?
MH206 Question Thinking about those same two weeks, Did you lose your appetite?
MH207 Question Thinking about those same two weeks, [Ask only if MH206=2]Did your appetite increase during those same two weeks?
MH208 Question Thinking about those same two weeks, During the same two-week period did you have a lot more trouble concentrating than usual?
MH209 Question Thinking about those same two weeks, People sometimes feel down on themselves, and no good or worthless. During that two-week period, did you feel this way?
MH210 Question Thinking about those same two weeks, Did you think a lot about death - either your own, someone elses, or death in general - during those two weeks?
MH211 Question Thinking about those same two weeks, Did you have more trouble falling asleep than you usually do during those two weeks?
MH212 Question [Ask only If MH211=1] Did the problem with falling asleep happen every night, nearly every night, or less often during those two weeks?
MH213 Question [Ask only if CIDI_1 > 0] About how many weeks altogether - out of 52 - did you feel sad, blue, or depressed during the last 12 months? ____ Number of weeks [Hard check: MH213<2 &>52]
MH214 Question [Screening Question] During the past 12 months, was there ever a time lasting two weeks or more when you lost interest in most things like hobbies, work, or activities that usually give you pleasure?
MH215 Question [Ask only if MH214=1] Please think of the two-week period during the last 12 months when you had the most complete loss of interest in things. During that two-week period, did the loss of interest usually last all day long, most of the day, about half the day, or less than half the day?
MH216 Question [Ask if MH215 = 1 or 2] Did you feel this way every day, almost every day, or less often during the two weeks?
MH217 Question Did you feel tired out or low on energy all the time during those two weeks?
MH218 Question During those same two weeks, did you lose your appetite during those two weeks?
MH219 Question During those two weeks, did you have more trouble concentrating than usual during those two weeks?
MH220 Question People sometimes feel down on themselves, no good or worthless. Did you feel this way during that two-week period during those two weeks?
MH221 Question Did you think a lot about death during those two weeks - either your own, someone elses, or death in general during those two weeks?
MH222 Question During those same two weeks, did you have more trouble falling asleep than you usually do during those two weeks?
MH223 Question [Ask only if CIDI_2>0] About how many weeks altogether - out of 52 - did you lose interest in most things like hobbies, work, or activities that usually give you pleasure during the last 12 months? ____ Number of weeks [Hard check : MH223 <2 &>52]
HB001 Question Have you ever smoked tobacco (cigarette, bidi, cigar, hookah, cheroot) or used smokeless tobacco (such as chewing tobacco, gutka, pan masala, etc.)?
HB002 Question [Ask only if HB001=1] How old were you when you first started smoking or using smokeless tobacco? Age _____ OR Year started smoking or consume smokeless tobacco _____ OR ______ Years ago [Soft check: 5 years<=HB002_age<=Rs current age][HB002_Years ago <=Current age -5years] [HB002<=Rs current age]
HB003 Question [Ask only if HB001 = 1] What type of tobacco product have you used or consumed?
HB003a Question [Ask if HB001=1 and HB003=1 or 3] Do you currently smoke any tobacco products (cigarettes, bidis, cigars, hookah, cheroot)?
HB004 Question [Ask if HB003=1 or 3] How many cigarettes, bidis, cigars, cheroot do you usually smoke in a day? ____ Number of cigarettes/bidis/cigars/ cheroot [Soft check: HB004_Number of cigarettes bidis/cigars/cheroots<=30]
HB005 Question [Ask only if HB003_a=2]At what age did you completely stop smoking? Age _____ OR Year quit smoking_____ OR _____ years ago [Soft check: HB005_Age<=Rs current age] [HB005_years ago<=Rs current age-5 years]
HB006 Question [Ask if HB001=1 AND HB003=2 or 3]Do you currently consume any smokeless tobacco products such as chewing tobacco, gutka, or pan masala?
HB007 Question [Ask only if HB006=1]Please tell me approximately how many grams of tobacco you normally consume per day, including chewing tobacco, sniffing tobacco, and other tobacco products. If it is easier you can tell me how many grams per week. Grams: ____
HB008 Question [Ask only if HB006=1]Please tell me approximately how many grams of tobacco you normally consume per day, including chewing tobacco, sniffing tobacco, and other tobacco products. If it is easier you can tell me how many grams per week. Per: day/week
HB009 Question [Ask only if HB007 is DK]How many times per day/week do you chew tobacco, pan masala, etc.? Times: ____
HB010 Question [Ask only if HB007 is DK]How many times per day/week do you chew tobacco, pan masala, etc.? Per: day/week
HB011 Question [Ask only if HB006=2]At what age did you totally stop consuming smokeless tobacco? Age _____ OR Year quit consuming smokeless tobacco_____ OR _____ years ago [Soft check: HB011_Age<=Rs current age] [HB011_years ago<=Rs current age-5years]
HB101 Question Have you ever consumed any alcoholic beverages such as beer, wine, liquor, country liquor etc.?
HB102 Question [Ask only if HB101=1] At what age did you first consume alcoholic beverages? Age------- OR ---------Year [Soft Check: 5 years<=HB102_age<=Rs current age]
HB103 Question [Ask only if HB101=1] In the past three months, on an average, how frequently [on how many days], have you had at least one alcoholic drink? (For example, beer, wine, or any drink, such as country liquor, containing alcohol.)
HB104 Question [Ask only if HB103>0] What type of drinks do you usually drink? [ Multiple answers allowed]
HB105 Question [Ask only if HB103>0] In the past 3 months, on the days you drank alcoholic beverages; about how many drinks did you have on average? (SHOW CARD: number of standard drinks (cc cl/ unit in ml)) ____ Number of drinks
HB106 Question [Ask only If HB103>0]In the last 3 months, how frequently on average, have you had atleast 5 or more drinks on one occasion?
HB107 Question Have you ever felt that you should cut down on drinking?
HB108 Question Have people ever annoyed you by criticizing your drinking?
HB109 Question Have you ever felt bad or guilty about drinking?
HB110 Question Have you ever taken a drink first thing in the morning to steady your nerves or get rid of a hangover?
HB211 Question We would like to know the type and amount of physical activity involved in your daily life. How often do you take part in sports or vigorous activities, such as running or jogging, swimming, going to a health center or gym, cycling, or digging with a spade or shovel, heavy lifting, chopping, farm work, fast bicycling, cycling with loads: everyday, more than once a week, once a week, one to three times a month, or hardly ever or never?
HB212 Question [Ask only if HT211<5] On the days you did vigorous activity, how much time did you usually spend doing any vigorous activity? MINUTES____ [Soft check: 0
HB213 Question How often do you take part in sports or activities that are moderately energetic such as, cleaning house, washing clothes by hand, fetching water or wood, drawing water from a well, gardening, bicycling at a regular pace, walking at a moderate pace, dancing, floor or stretching exercises (everyday, more than once a week, once a week, one to three times a month, hardly ever, or never)?
HB214 Question [Ask only if HB213<5] How much time did you usually spend doing any moderate activity on an average in a day? MINUTES____ [Soft check: 0
HB215 Question How often do you engage in any of the following activities like yoga, meditation, asana, pranayama or similar?
HB216 Question [Ask only if HB215<5] How much time do you usually spend doing these activities on an average in a day? MINUTES____ [Soft Check: 0
HB217 Question How often did the respondent receive assistance in answering this section?
HB219 Question [Ask only if HB217>1] What is his/her relationship to [NAME OF RESPONDENT]?
FO230 Question [Now we would like to ask you questions about household food availability. In India many people have uncertain access to adequate quantity and quality of food due to constrained resources, either temporary or on a chronic basis. Also food availability, variety, and quality are often not enough to meet household needs. As a result some policy discussions are going on to ensure food and nutrition security for the people of our country. We would very much appreciate your honest participation in this section. (For the interviewer: Please ensure that the respondent is alone while answering this section]. In the last 12 months, did you ever reduce the size of your meals or skip meals because there was not enough food at your household?
FO231 Question In the last 12 months, did you eat enough food of your choice? Please exclude fasting/food related restrictions due to religious or health related reason.
FO232 Question In the last 12 months, were you hungry but didnt eat because there was not enough food at your household? Please exclude fasting/food related restrictions due to religious or health related reasons.
FO233 Question In the past 12 months did you ever not eat for a whole day because there was not enough food at your household? Please exclude fasting/food related restrictions due to religious or health related reasons.
FO234 Question Do you think that you have lost weight in the last 12 months because there was not enough food at your household?
FO236 Question How often did the respondent receive assistance in answering this section?
FO238 Question [Ask only if FO236>1What is his/her relationship to [NAME OF RESPONDENT]?
Start of I_C. Health (HT)
 
HT001A

Now I want to ask you about your health. In general, would you say your health is excellent, very good, good, fair, or poor?

NOW I WANT TO ASK YOU ABOUT YOUR HEALTH. IN GENERAL, WOULD YOU SAY YOUR HEALTH IS EXCELLENT, VERY GOOD, GOOD, FAIR, OR POOR?
expand
 
If HT001A is not asked »
 
   
 
HT001B

[If HT001_a was not asked] Now I want to ask you about your general health. Overall, how is your health in general? Would you say it is very good, good, fair, poor, or very poor?

[IF HT001_A WAS NOT ASKED] NOW I WANT TO ASK YOU ABOUT YOUR GENERAL HEALTH. OVERALL, HOW IS YOUR HEALTH IN GENERAL? WOULD YOU SAY IT IS VERY GOOD, GOOD, FAIR, POOR, OR VERY POOR?
expand
   
HT002

Has any health professional ever told you that you have Hypertension or high blood pressure ?

HAS ANY HEALTH PROFESSIONAL EVER TOLD YOU THAT YOU HAVE HYPERTENSION OR HIGH BLOOD PRESSURE ?
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HT003

Has any health professional ever told you that you have Diabetes or high blood sugar ?

HAS ANY HEALTH PROFESSIONAL EVER TOLD YOU THAT YOU HAVE DIABETES OR HIGH BLOOD SUGAR ?
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HT004

Has any health professional ever told you that you have Cancer or a malignant tumor ?

HAS ANY HEALTH PROFESSIONAL EVER TOLD YOU THAT YOU HAVE CANCER OR A MALIGNANT TUMOR ?
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HT005

Has any health professional ever told you that you have Chronic lung disease such as asthma ,chronic obstructive pulmonary disease/Chronic bronchitis or other chronic lung problems ?

HAS ANY HEALTH PROFESSIONAL EVER TOLD YOU THAT YOU HAVE CHRONIC LUNG DISEASE SUCH AS ASTHMA ,CHRONIC OBSTRUCTIVE PULMONARY DISEASE/CHRONIC BRONCHITIS OR OTHER CHRONIC LUNG PROBLEMS ?
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HT006

Has any health professional ever told you that you have Chronic heart diseases such as Coronary heart disease (heart attack or Myocardial Infarction), congestive heart failure, or other chronic heart problems ?

HAS ANY HEALTH PROFESSIONAL EVER TOLD YOU THAT YOU HAVE CHRONIC HEART DISEASES SUCH AS CORONARY HEART DISEASE (HEART ATTACK OR MYOCARDIAL INFARCTION), CONGESTIVE HEART FAILURE, OR OTHER CHRONIC HEART PROBLEMS ?
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HT007

Has any health professional ever told you that you have Stroke ?

HAS ANY HEALTH PROFESSIONAL EVER TOLD YOU THAT YOU HAVE STROKE ?
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HT008

Has any health professional ever told you that you have Arthritis or rheumatism, Osteoporosis or other bone/joint diseases ?

HAS ANY HEALTH PROFESSIONAL EVER TOLD YOU THAT YOU HAVE ARTHRITIS OR RHEUMATISM, OSTEOPOROSIS OR OTHER BONE/JOINT DISEASES ?
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HT009

Has any health professional ever told you that you have Any neurological, or psychiatric problems such as depression , Alzheimers/Dementia, unipolar/bipolar disorders, convulsions, Parkinsons etc. ?

HAS ANY HEALTH PROFESSIONAL EVER TOLD YOU THAT YOU HAVE ANY NEUROLOGICAL, OR PSYCHIATRIC PROBLEMS SUCH AS DEPRESSION , ALZHEIMERS/DEMENTIA, UNIPOLAR/BIPOLAR DISORDERS, CONVULSIONS, PARKINSONS ETC. ?
expand
 
HT010

Has any health professional ever told you that you have High cholesterol?

HAS ANY HEALTH PROFESSIONAL EVER TOLD YOU THAT YOU HAVE HIGH CHOLESTEROL?
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If Has any health professional ever told you that you have Hypertension or high blood pressure ? = 1 Yes 2 No  »
 
   
 
HT002A

[Ask only if HT002=1] Who first diagnosed you with high blood pressure or hypertension?

[ASK ONLY IF HT002=1] WHO FIRST DIAGNOSED YOU WITH HIGH BLOOD PRESSURE OR HYPERTENSION?
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HT002B

[Ask only if HT002=1] When were you first diagnosed with high blood pressure or hypertension? Year _____ [Hard check: HT002b_year > current year] OR Age ______ [Hard check: HT002b_age > Rs current age]

[ASK ONLY IF HT002=1] WHEN WERE YOU FIRST DIAGNOSED WITH HIGH BLOOD PRESSURE OR HYPERTENSION? YEAR _____ [HARD CHECK: HT002B_YEAR > CURRENT YEAR] OR AGE ______ [HARD CHECK: HT002B_AGE > RS CURRENT AGE]
   
 
HT002C

[Ask only if HT002=1] In order to control your blood pressure or hypertension, are you currently taking any medication?

[ASK ONLY IF HT002=1] IN ORDER TO CONTROL YOUR BLOOD PRESSURE OR HYPERTENSION, ARE YOU CURRENTLY TAKING ANY MEDICATION?
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HT002D

[Ask only if HT002=1] In order to control your blood pressure, are you under salt or other diet restrictions?

[ASK ONLY IF HT002=1] IN ORDER TO CONTROL YOUR BLOOD PRESSURE, ARE YOU UNDER SALT OR OTHER DIET RESTRICTIONS?
expand
   
If Has any health professional ever told you that you have Diabetes or high blood sugar ? = 1 Yes 2 No  »
 
   
 
HT003A

[Ask only if HT003=1] Who first diagnosed you with diabetes or high blood sugar?

[ASK ONLY IF HT003=1] WHO FIRST DIAGNOSED YOU WITH DIABETES OR HIGH BLOOD SUGAR?
expand
   
 
HT003B

[Ask only if HT003=1] When were you first diagnosed with diabetes or high blood sugar? Year _____ [Hard check: HT003b_year is > current year] OR Age ______ [Hard check: HT003b_age is > Rs current age]

[ASK ONLY IF HT003=1] WHEN WERE YOU FIRST DIAGNOSED WITH DIABETES OR HIGH BLOOD SUGAR? YEAR _____ [HARD CHECK: HT003B_YEAR IS > CURRENT YEAR] OR AGE ______ [HARD CHECK: HT003B_AGE IS > RS CURRENT AGE]
   
 
HT003C

[Ask only if HT003=1] In order to treat or control your diabetes or high blood sugar, are you currently taking medications that you swallow?

[ASK ONLY IF HT003=1] IN ORDER TO TREAT OR CONTROL YOUR DIABETES OR HIGH BLOOD SUGAR, ARE YOU CURRENTLY TAKING MEDICATIONS THAT YOU SWALLOW?
expand
   
 
HT003D

[Ask only if HT003=1] Are you currently using insulin shots/injections?

[ASK ONLY IF HT003=1] ARE YOU CURRENTLY USING INSULIN SHOTS/INJECTIONS?
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HT003E

[Ask only if HT003=1] In order to control your diabetes, are you following a special diet?

[ASK ONLY IF HT003=1] IN ORDER TO CONTROL YOUR DIABETES, ARE YOU FOLLOWING A SPECIAL DIET?
expand
   
If Has any health professional ever told you that you have Cancer or a malignant tumor ? = 1 Yes 2 No  »
 
   
 
HT004A

[Ask only if HT004=1] Who first diagnosed you with cancer?

[ASK ONLY IF HT004=1] WHO FIRST DIAGNOSED YOU WITH CANCER?
expand
   
 
HT004B

[Ask only if HT004=1] When were you first diagnosed with cancer? Year _____[Hard check: HT004b_year is > current year] OR Age ______ [Hard check: HT004b_age is > Rs current age]

[ASK ONLY IF HT004=1] WHEN WERE YOU FIRST DIAGNOSED WITH CANCER? YEAR _____[HARD CHECK: HT004B_YEAR IS > CURRENT YEAR] OR AGE ______ [HARD CHECK: HT004B_AGE IS > RS CURRENT AGE]
   
 
HT004C

[Ask only if HT004=1] Have you been diagnosed with more than one type of cancer?

[ASK ONLY IF HT004=1] HAVE YOU BEEN DIAGNOSED WITH MORE THAN ONE TYPE OF CANCER?
expand
   
 
HT004D

[Ask only if HT004=1] first diagnosed organ/body part: ____[CAPI will provide drop down list for single answer]

[ASK ONLY IF HT004=1] FIRST DIAGNOSED ORGAN/BODY PART: ____[CAPI WILL PROVIDE DROP DOWN LIST FOR SINGLE ANSWER]
   
 
HT004E

[Ask only if HT004c=1] all other organs/body parts: ____ [CAPI will provide drop down list] [Multiple answers are allowed]

[ASK ONLY IF HT004C=1] ALL OTHER ORGANS/BODY PARTS: ____ [CAPI WILL PROVIDE DROP DOWN LIST] [MULTIPLE ANSWERS ARE ALLOWED]
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HT004F

[Ask only if HT004=1] During the last two years, what type of treatments have you received for cancer? [Multiple answers are allowed] [Hard check: if response is None, freeze all other option categories]

[ASK ONLY IF HT004=1] DURING THE LAST TWO YEARS, WHAT TYPE OF TREATMENTS HAVE YOU RECEIVED FOR CANCER? [MULTIPLE ANSWERS ARE ALLOWED] [HARD CHECK: IF RESPONSE IS NONE, FREEZE ALL OTHER OPTION CATEGORIES]
expand
   
 
If HB004F != f and HB004C = 1 »
 
     
   
HT004G

[Ask if HT004f != fand HT004c=1] for which cancer(s) have you received the treatment? [Multiple answers allowed]

[ASK IF HT004F != FAND HT004C=1] FOR WHICH CANCER(S) HAVE YOU RECEIVED THE TREATMENT? [MULTIPLE ANSWERS ALLOWED]
expand
     
If Has any health professional ever told you that you have Chronic lung disease such as asthma ,chronic obstructive pulmonary disease/Chronic bronchitis or other chronic lung problems ? = 1 Yes 2 No  »
 
   
 
HT005A

[Ask only if HT005=1] Who first diagnosed you with chronic lung disease?

[ASK ONLY IF HT005=1] WHO FIRST DIAGNOSED YOU WITH CHRONIC LUNG DISEASE?
expand
   
 
HT005B

[Ask only if HT005=1] When were you first diagnosed with a chronic lung disease such as asthma, chronic obstructive pulmonary disease/chronic bronchitis or other chronic lung problems? Year_____ [Hard check: HT005b_year is > current year] OR Age ______ [Hard check:HT005b_age>Rs current age ]

[ASK ONLY IF HT005=1] WHEN WERE YOU FIRST DIAGNOSED WITH A CHRONIC LUNG DISEASE SUCH AS ASTHMA, CHRONIC OBSTRUCTIVE PULMONARY DISEASE/CHRONIC BRONCHITIS OR OTHER CHRONIC LUNG PROBLEMS? YEAR_____ [HARD CHECK: HT005B_YEAR IS > CURRENT YEAR] OR AGE ______ [HARD CHECK:HT005B_AGE>RS CURRENT AGE ]
   
 
HT005C

[Ask only if HT005=1] Are you receiving physical or respiratory therapy, or any other treatment for your lung disease?

[ASK ONLY IF HT005=1] ARE YOU RECEIVING PHYSICAL OR RESPIRATORY THERAPY, OR ANY OTHER TREATMENT FOR YOUR LUNG DISEASE?
expand
   
 
HT005D

[Ask only if HT005=1] Which type of chronic lung disease do you have? [Multiple answers are allowed]

[ASK ONLY IF HT005=1] WHICH TYPE OF CHRONIC LUNG DISEASE DO YOU HAVE? [MULTIPLE ANSWERS ARE ALLOWED]
expand
   
If Has any health professional ever told you that you have Chronic heart diseases such as Coronary heart disease (heart attack or Myocardial Infarction), congestive heart failure, or other chronic heart problems ? = 1 Yes 2 No  »
 
   
 
HT006A

[Ask only if HT006=1] Have you ever had a heart attack?

[ASK ONLY IF HT006=1] HAVE YOU EVER HAD A HEART ATTACK?
expand
   
 
HT006B

[Ask only if HT006a=1] When did you first have a heart attack? Year _____ [Hard check: HT006b_year >current year] OR Age ______ [Hard check:HT006b_age > Rs current age]

[ASK ONLY IF HT006A=1] WHEN DID YOU FIRST HAVE A HEART ATTACK? YEAR _____ [HARD CHECK: HT006B_YEAR >CURRENT YEAR] OR AGE ______ [HARD CHECK:HT006B_AGE > RS CURRENT AGE]
   
 
HT006C

[Ask only if HT006a=1] Was this the time when you were first diagnosed with a heart disease?

[ASK ONLY IF HT006A=1] WAS THIS THE TIME WHEN YOU WERE FIRST DIAGNOSED WITH A HEART DISEASE?
expand
   
 
HT006E

[Ask only if HT006=1] Who first diagnosed you with heart disease?

[ASK ONLY IF HT006=1] WHO FIRST DIAGNOSED YOU WITH HEART DISEASE?
expand
   
 
HT006F

[Ask if HT006 =1] What kind of heart related conditions have you been diagnosed with? a. Rheumatic heart disease b. Congenital / Structural Disorders c. Conduction Disorders / Cardiac arrhythmias d. Congestive heart failure e. Other heart conditions please specify

[ASK IF HT006 =1] WHAT KIND OF HEART RELATED CONDITIONS HAVE YOU BEEN DIAGNOSED WITH?
expand
   
 
If current age of respondent- (minus) respondents age in HT006b > 2 »
 
     
   
HT006G

[Ask only if current age of respondent- (minus) respondents age in HT006b > 2] In the last two years, have you had a heart attack?

[ASK ONLY IF CURRENT AGE OF RESPONDENT- (MINUS) RESPONDENTS AGE IN HT006B > 2] IN THE LAST TWO YEARS, HAVE YOU HAD A HEART ATTACK?
expand
     
 
HT006H

[Ask only if HT006=1] Are you currently taking any medication for your heart disease?

[ASK ONLY IF HT006=1] ARE YOU CURRENTLY TAKING ANY MEDICATION FOR YOUR HEART DISEASE?
expand
   
If Has any health professional ever told you that you have Chronic heart diseases such as Coronary heart disease (heart attack or Myocardial Infarction), congestive heart failure, or other chronic heart problems ? = 2 »
 
   
 
HT006D

[Ask only if HT006c=2] When were you first diagnosed with a heart disease? Year _____ [Hard check: HT006d_year is > current year] OR Age ______ [Hard check: HT006d_age is> Rs current age]

[ASK ONLY IF HT006C=2] WHEN WERE YOU FIRST DIAGNOSED WITH A HEART DISEASE? YEAR _____ [HARD CHECK: HT006D_YEAR IS > CURRENT YEAR] OR AGE ______ [HARD CHECK: HT006D_AGE IS> RS CURRENT AGE]
   
If Has any health professional ever told you that you have Stroke ? = 1 Yes 2 No  »
 
   
 
HT007A

[Ask only if HT007=1] Who first diagnosed you with a stroke?

[ASK ONLY IF HT007=1] WHO FIRST DIAGNOSED YOU WITH A STROKE?
expand
   
 
HT007B

[Ask only if HT007=1] When were you first diagnosed with a stroke? Year _____ [Hard check: HT007b_year > current year] OR Age ______ [Hard check: HT007b_age > Rs current age]

[ASK ONLY IF HT007=1] WHEN WERE YOU FIRST DIAGNOSED WITH A STROKE? YEAR _____ [HARD CHECK: HT007B_YEAR > CURRENT YEAR] OR AGE ______ [HARD CHECK: HT007B_AGE > RS CURRENT AGE]
   
 
HT007C

[Ask only if HT007=1] Are you currently taking any medications because of your stroke or its complications?

[ASK ONLY IF HT007=1] ARE YOU CURRENTLY TAKING ANY MEDICATIONS BECAUSE OF YOUR STROKE OR ITS COMPLICATIONS?
expand
   
 
HT007D

[Ask only if HT007=1] Are you receiving physical or occupational therapy because of your stroke or its complications?

[ASK ONLY IF HT007=1] ARE YOU RECEIVING PHYSICAL OR OCCUPATIONAL THERAPY BECAUSE OF YOUR STROKE OR ITS COMPLICATIONS?
expand
   
 
HT007E

[Ask only if HT007=1] Have you had any subsequent stroke after the first diagnosed stroke you just told me about?

[ASK ONLY IF HT007=1] HAVE YOU HAD ANY SUBSEQUENT STROKE AFTER THE FIRST DIAGNOSED STROKE YOU JUST TOLD ME ABOUT?
expand
   
 
HT007F

[Ask only if HT007e=1] In the last two years, have you consulted a doctor in connection with this most recent stroke?

[ASK ONLY IF HT007E=1] IN THE LAST TWO YEARS, HAVE YOU CONSULTED A DOCTOR IN CONNECTION WITH THIS MOST RECENT STROKE?
expand
   
 
HT007G

[Ask only if HT007=1] Do you still have any remaining problems because of your stroke(s), such as difficulty in moving or speaking?

[ASK ONLY IF HT007=1] DO YOU STILL HAVE ANY REMAINING PROBLEMS BECAUSE OF YOUR STROKE(S), SUCH AS DIFFICULTY IN MOVING OR SPEAKING?
expand
   
 
HT007H
   
 
HT007I
   
 
HT007J
   
 
HT007K
   
If Has any health professional ever told you that you have Arthritis or rheumatism, Osteoporosis or other bone/joint diseases ? = 1 Yes 2 No  »
 
   
 
HT008A

[Ask only if HT008=1] Have you ever been diagnosed with the following bone/joint diseases/problems? [Multiple answers are allowed]? a. Arthritis b. Rheumatism c. Osteoporosis d. Other, please specify______

[ASK ONLY IF HT008=1] HAVE YOU EVER BEEN DIAGNOSED WITH THE FOLLOWING BONE/JOINT DISEASES/PROBLEMS? [MULTIPLE ANSWERS ARE ALLOWED]?
expand
   
 
If [Ask only if HT008=1] Have you ever been diagnosed with the following bone/joint diseases/problems? [Multiple answers are allowed]? a. Arthritis b. Rheumatism c. Osteoporosis d. Other, please specify______ = a or b »
 
     
   
HT008B

[Ask if HT008a= a or b] Who first diagnosed you with arthritis or rheumatism?

[ASK IF HT008A= A OR B] WHO FIRST DIAGNOSED YOU WITH ARTHRITIS OR RHEUMATISM?
expand
     
   
HT008C

[Ask if HT008a=a or b] When were you first diagnosed with arthritis or rheumatism? Year _____ [Hard check: HT008c_year> current year] OR Age ______ [Hard check: HT008c_age > Rs current age]

[ASK IF HT008A=A OR B] WHEN WERE YOU FIRST DIAGNOSED WITH ARTHRITIS OR RHEUMATISM? YEAR _____ [HARD CHECK: HT008C_YEAR> CURRENT YEAR] OR AGE ______ [HARD CHECK: HT008C_AGE > RS CURRENT AGE]
     
 
If [Ask only if HT008=1] Have you ever been diagnosed with the following bone/joint diseases/problems? [Multiple answers are allowed]? a. Arthritis b. Rheumatism c. Osteoporosis d. Other, please specify______ = c »
 
     
   
HT008D

[Ask only if HT008a=c]Who first diagnosed you with osteoporosis?

[ASK ONLY IF HT008A=C]WHO FIRST DIAGNOSED YOU WITH OSTEOPOROSIS?
expand
     
   
HT008E

[Ask only if HT008a=c]When you were first diagnosed with osteoporosis? Year _____ [Hard check: HT008e year> current year] OR ______ Age [Hard check: HT008e_age > Rs current age]

[ASK ONLY IF HT008A=C]WHEN YOU WERE FIRST DIAGNOSED WITH OSTEOPOROSIS? YEAR _____ [HARD CHECK: HT008E YEAR> CURRENT YEAR] OR ______ AGE [HARD CHECK: HT008E_AGE > RS CURRENT AGE]
     
 
HT008F

[Ask only if HT008=1] Are you currently taking any medication or receiving other treatments for your arthritis, rheumatism or osteoporosis?

[ASK ONLY IF HT008=1] ARE YOU CURRENTLY TAKING ANY MEDICATION OR RECEIVING OTHER TREATMENTS FOR YOUR ARTHRITIS, RHEUMATISM OR OSTEOPOROSIS?
expand
   
If Has any health professional ever told you that you have Any neurological, or psychiatric problems such as depression , Alzheimers/Dementia, unipolar/bipolar disorders, convulsions, Parkinsons etc. ? = 1 Yes 2 No  »
 
   
 
HT009A

[Ask only if HT009=1] Which type of neurological or psychiatric problem(s) have you been diagnosed with [Multiple answers are allowed]?

[ASK ONLY IF HT009=1] WHICH TYPE OF NEUROLOGICAL OR PSYCHIATRIC PROBLEM(S) HAVE YOU BEEN DIAGNOSED WITH [MULTIPLE ANSWERS ARE ALLOWED]?
expand
   
 
HT009B

[Ask only ifHT009=1] Who first diagnosed you with your neurological, or psychiatric problems or conditions?

[ASK ONLY IFHT009=1] WHO FIRST DIAGNOSED YOU WITH YOUR NEUROLOGICAL, OR PSYCHIATRIC PROBLEMS OR CONDITIONS?
expand
   
 
HT009C

[Ask only if HT009=1] When were you first diagnosed with this problem? _____Year [Hard check: HT009c_year > current year] OR ______ Age [Hard check: HT009b_age > Rs current age]

[ASK ONLY IF HT009=1] WHEN WERE YOU FIRST DIAGNOSED WITH THIS PROBLEM? _____YEAR [HARD CHECK: HT009C_YEAR > CURRENT YEAR] OR ______ AGE [HARD CHECK: HT009B_AGE > RS CURRENT AGE]
   
 
HT009D

[Ask only if HT009=1] Are you currently taking any psychiatric or psychological treatment or therapy for your condition?

[ASK ONLY IF HT009=1] ARE YOU CURRENTLY TAKING ANY PSYCHIATRIC OR PSYCHOLOGICAL TREATMENT OR THERAPY FOR YOUR CONDITION?
expand
   
 
HT009E

[Ask only if HT009=1] Are you currently taking tranquilizers, antidepressants, or other types of medication for neurological or psychiatric problem (s)?

[ASK ONLY IF HT009=1] ARE YOU CURRENTLY TAKING TRANQUILIZERS, ANTIDEPRESSANTS, OR OTHER TYPES OF MEDICATION FOR NEUROLOGICAL OR PSYCHIATRIC PROBLEM (S)?
expand
   
If Has any health professional ever told you that you have High cholesterol? = 1 Yes 2 No  »
 
   
 
HT010A

[Ask only if HT010=1] Who first diagnosed you with high cholesterol?

[ASK ONLY IF HT010=1] WHO FIRST DIAGNOSED YOU WITH HIGH CHOLESTEROL?
expand
   
 
HT010B

[Ask only if HT010=1] When were you first diagnosed with high cholesterol? Year _____ [Hard check: HT0010b_year > current year] OR Age ______ [Hard check:HT0010b_age > Rs current age]

[ASK ONLY IF HT010=1] WHEN WERE YOU FIRST DIAGNOSED WITH HIGH CHOLESTEROL? YEAR _____ [HARD CHECK: HT0010B_YEAR > CURRENT YEAR] OR AGE ______ [HARD CHECK:HT0010B_AGE > RS CURRENT AGE]
   
 
HT010C

[Ask only if HT010=1] Do you regularly take medications to help lower your cholesterol?

[ASK ONLY IF HT010=1] DO YOU REGULARLY TAKE MEDICATIONS TO HELP LOWER YOUR CHOLESTEROL?
expand
   
 
HT010D

[Ask ALL respondents] In the past 2 years, have you had a blood test for cholesterol?

[ASK ALL RESPONDENTS] IN THE PAST 2 YEARS, HAVE YOU HAD A BLOOD TEST FOR CHOLESTEROL?
expand
   
HT011

Now I would like to ask about other chronic conditions. Have you ever been diagnosed with any of the following chronic conditions or diseases? [Multiple answers are allowed]

NOW I WOULD LIKE TO ASK ABOUT OTHER CHRONIC CONDITIONS. HAVE YOU EVER BEEN DIAGNOSED WITH ANY OF THE FOLLOWING CHRONIC CONDITIONS OR DISEASES? [MULTIPLE ANSWERS ARE ALLOWED]
expand
 
HT012

Have you ever been diagnosed with any of the following urogenital conditions or diseases? [Multiple answers are allowed] [Instruction for CAPI : Freeze all other option if HT012 = e]

HAVE YOU EVER BEEN DIAGNOSED WITH ANY OF THE FOLLOWING UROGENITAL CONDITIONS OR DISEASES? [MULTIPLE ANSWERS ARE ALLOWED] [INSTRUCTION FOR CAPI : FREEZE ALL OTHER OPTION IF HT012 = E]
expand
 
If Have you ever been diagnosed with any of the following urogenital conditions or diseases? [Multiple answers are allowed] [Instruction for CAPI : Freeze all other option if HT012 = e] = a »
 
   
 
HT013

[Ask only if HT012=a] In last two years, have you been on dialysis?

[ASK ONLY IF HT012=A] IN LAST TWO YEARS, HAVE YOU BEEN ON DIALYSIS?
expand
   
HT014

Do you ever pass urine while sneezing, coughing, laughing or lifting heavy objects?

DO YOU EVER PASS URINE WHILE SNEEZING, COUGHING, LAUGHING OR LIFTING HEAVY OBJECTS?
expand
 
HT015

Now I have some questions about your eyesight. Have you ever been diagnosed with any eye or vision problem or condition, including ordinary nearsightedness or farsightedness?

NOW I HAVE SOME QUESTIONS ABOUT YOUR EYESIGHT. HAVE YOU EVER BEEN DIAGNOSED WITH ANY EYE OR VISION PROBLEM OR CONDITION, INCLUDING ORDINARY NEARSIGHTEDNESS OR FARSIGHTEDNESS?
expand
 
If Now I have some questions about your eyesight. Have you ever been diagnosed with any eye or vision problem or condition, including ordinary nearsightedness or farsightedness? = 1 Yes 2 No -> Go to HT019  »
 
   
 
HT016

[Ask only if HT015 =1] Were you diagnosed with an eye or vision problem or condition in one or both eyes?

[ASK ONLY IF HT015 =1] WERE YOU DIAGNOSED WITH AN EYE OR VISION PROBLEM OR CONDITION IN ONE OR BOTH EYES?
expand
   
 
HT017

[Ask only if HT015=1] With which problem or condition were you diagnosed? [Multiple answers are allowed]

[ASK ONLY IF HT015=1] WITH WHICH PROBLEM OR CONDITION WERE YOU DIAGNOSED? [MULTIPLE ANSWERS ARE ALLOWED]
expand
   
 
HT018

[Ask only if HT015=1] Have you ever undergone any treatment or corrective surgery for an eye problem or condition?

[ASK ONLY IF HT015=1] HAVE YOU EVER UNDERGONE ANY TREATMENT OR CORRECTIVE SURGERY FOR AN EYE PROBLEM OR CONDITION?
expand
   
HT019

How good is your eyesight for seeing things at a distance, like recognizing a person across the street (or 20 meters away) whether or not you wear glasses, contacts, or corrective lenses?

HOW GOOD IS YOUR EYESIGHT FOR SEEING THINGS AT A DISTANCE, LIKE RECOGNIZING A PERSON ACROSS THE STREET (OR 20 METERS AWAY) WHETHER OR NOT YOU WEAR GLASSES, CONTACTS, OR CORRECTIVE LENSES?
expand
 
HT020

How good is your eyesight for seeing things up close, like reading ordinary newspaper print whether or not you wear glasses, contacts, or corrective lenses

HOW GOOD IS YOUR EYESIGHT FOR SEEING THINGS UP CLOSE, LIKE READING ORDINARY NEWSPAPER PRINT WHETHER OR NOT YOU WEAR GLASSES, CONTACTS, OR CORRECTIVE LENSES
expand
 
HT021

Have you ever been diagnosed with any hearing or ear-related problem or condition?

HAVE YOU EVER BEEN DIAGNOSED WITH ANY HEARING OR EAR-RELATED PROBLEM OR CONDITION?
expand
 
If Have you ever been diagnosed with any hearing or ear-related problem or condition? = 1 Yes 2 No -> Go to HT024  »
 
   
 
HT022

[Ask only if HT021=1] Were you diagnosed with an ear or hearing problem or condition in one or both ears?

[ASK ONLY IF HT021=1] WERE YOU DIAGNOSED WITH AN EAR OR HEARING PROBLEM OR CONDITION IN ONE OR BOTH EARS?
expand
   
 
HT023

[Ask only if HT021 =1]Have you ever undergone any treatment or corrective surgery for ear-related problem or condition?

[ASK ONLY IF HT021 =1]HAVE YOU EVER UNDERGONE ANY TREATMENT OR CORRECTIVE SURGERY FOR EAR-RELATED PROBLEM OR CONDITION?
expand
   
HT024

Now, I have some questions about your oral (dental) health. In the last 12 months, have you ever been diagnosed with or suffered from any of the following oral problem(s)? [Multiple answers are allowed]

NOW, I HAVE SOME QUESTIONS ABOUT YOUR ORAL (DENTAL) HEALTH. IN THE LAST 12 MONTHS, HAVE YOU EVER BEEN DIAGNOSED WITH OR SUFFERED FROM ANY OF THE FOLLOWING ORAL PROBLEM(S)? [MULTIPLE ANSWERS ARE ALLOWED]
expand
 
HT025

Have you lost some or all of your natural teeth?

HAVE YOU LOST SOME OR ALL OF YOUR NATURAL TEETH?
expand
 
HT026

How well can you chew solid foods such as chapati, apple, guava, or nuts?

HOW WELL CAN YOU CHEW SOLID FOODS SUCH AS CHAPATI, APPLE, GUAVA, OR NUTS?
expand
 
HT101

Now we will ask about some other health concerns, such as injuries and falls. In the past two years, have you sustained any major injury?

NOW WE WILL ASK ABOUT SOME OTHER HEALTH CONCERNS, SUCH AS INJURIES AND FALLS. IN THE PAST TWO YEARS, HAVE YOU SUSTAINED ANY MAJOR INJURY?
expand
 
If Now we will ask about some other health concerns, such as injuries and falls. In the past two years, have you sustained any major injury? = 1 Yes 2 No .Go to HT103  »
 
   
 
HT102

[Ask only ifHT101=1] Did you receive medical treatment for that injury?

[ASK ONLY IFHT101=1] DID YOU RECEIVE MEDICAL TREATMENT FOR THAT INJURY?
expand
   
 
HT102A

[Ask only ifHT101=1] What was the cause of that injury? [Multiple answers are allowed] a. Traffic accident b. Struck by person or object c. Fire, flames, burn, electric Shock d. Drowning e. Poisoning f. Animal attack or bite g. Fall h. Other, please specify_______

[ASK ONLY IFHT101=1] WHAT WAS THE CAUSE OF THAT INJURY? [MULTIPLE ANSWERS ARE ALLOWED]
expand
   
 
If [Ask only ifHT101=1] What was the cause of that injury? [Multiple answers are allowed] a. Traffic accident b. Struck by person or object c. Fire, flames, burn, electric Shock d. Drowning e. Poisoning f. Animal attack or bite g. Fall h. Other, please specify_______ != g »
 
     
   
HT103

[Ask only if HT102a!= g]In the past two years, have you fallen down?

[ASK ONLY IF HT102A!= G]IN THE PAST TWO YEARS, HAVE YOU FALLEN DOWN?
expand
     
 
If [Ask only ifHT101=1] What was the cause of that injury? [Multiple answers are allowed] a. Traffic accident b. Struck by person or object c. Fire, flames, burn, electric Shock d. Drowning e. Poisoning f. Animal attack or bite g. Fall h. Other, please specify_______ = g or [Ask only if HT102a!= g]In the past two years, have you fallen down? = 1 Yes 2 No.Go to HT104 THEN
 
     
   
HT103A

[Ask if HT102a=g or HT103=1] How many times have you fallen in the last 2 years? Number of times: ____

[ASK IF HT102A=G OR HT103=1] HOW MANY TIMES HAVE YOU FALLEN IN THE LAST 2 YEARS? NUMBER OF TIMES: ____
     
   
HT103B

[Ask only if HT102a=g or HT103=1] In that fall/in any of these falls, did you injure yourself seriously enough to need medical treatment?

[ASK ONLY IF HT102A=G OR HT103=1] IN THAT FALL/IN ANY OF THESE FALLS, DID YOU INJURE YOURSELF SERIOUSLY ENOUGH TO NEED MEDICAL TREATMENT?
expand
     
HT104

In the past 2 years, have you fractured any of your bones/joints?

IN THE PAST 2 YEARS, HAVE YOU FRACTURED ANY OF YOUR BONES/JOINTS?
expand
 
HT105

In the past 2 years, have you undergone any surgery related to bones or joints?

IN THE PAST 2 YEARS, HAVE YOU UNDERGONE ANY SURGERY RELATED TO BONES OR JOINTS?
expand
 
If In the past 2 years, have you undergone any surgery related to bones or joints? = 1 Yes 2 No.Go to HT106  »
 
   
 
HT105A

[Ask only if HT105=1] Which bone or joint have you undergone surgery for? [Multiple answers are allowed]

[ASK ONLY IF HT105=1] WHICH BONE OR JOINT HAVE YOU UNDERGONE SURGERY FOR? [MULTIPLE ANSWERS ARE ALLOWED]
expand
   
HT106

Now we are going to ask some questions about natural disasters, which may have affected your health as well. In the last five years, has your health been severely affected by disasters such as floods, landslides, extreme cold and hot weather, cyclone/typhoons, droughts, earthquakes, tsunamis, or any other natural calamities?

NOW WE ARE GOING TO ASK SOME QUESTIONS ABOUT NATURAL DISASTERS, WHICH MAY HAVE AFFECTED YOUR HEALTH AS WELL. IN THE LAST FIVE YEARS, HAS YOUR HEALTH BEEN SEVERELY AFFECTED BY DISASTERS SUCH AS FLOODS, LANDSLIDES, EXTREME COLD AND HOT WEATHER, CYCLONE/TYPHOONS, DROUGHTS, EARTHQUAKES, TSUNAMIS, OR ANY OTHER NATURAL CALAMITIES?
expand
 
If Now we are going to ask some questions about natural disasters, which may have affected your health as well. In the last five years, has your health been severely affected by disasters such as floods, landslides, extreme cold and hot weather, cyclone/typhoons, droughts, earthquakes, tsunamis, or any other natural calamities? = 1 Yes 2 No.Go to HT107  »
 
   
 
HT106A

[Ask only if HT106=1] Which of these natural disasters affected your health? Please identify all natural disasters that affected you. [Multiple answers are allowed]

[ASK ONLY IF HT106=1] WHICH OF THESE NATURAL DISASTERS AFFECTED YOUR HEALTH? PLEASE IDENTIFY ALL NATURAL DISASTERS THAT AFFECTED YOU. [MULTIPLE ANSWERS ARE ALLOWED]
expand
   
HT107

In the last five years, has your health been severely affected by man-made incidents such as riots, terrorism, building collapses, fires, traffic accidents or any other man-made incidents?

IN THE LAST FIVE YEARS, HAS YOUR HEALTH BEEN SEVERELY AFFECTED BY MAN-MADE INCIDENTS SUCH AS RIOTS, TERRORISM, BUILDING COLLAPSES, FIRES, TRAFFIC ACCIDENTS OR ANY OTHER MAN-MADE INCIDENTS?
expand
 
If In the last five years, has your health been severely affected by man-made incidents such as riots, terrorism, building collapses, fires, traffic accidents or any other man-made incidents? = 1 Yes 2 No .Go to HT201  »
 
   
 
HT107A

[Ask only if HT107=1] Which of these man-made disasters affected your health? Please identify all man-made incidents that affected you. [Multiple answers are allowed]

[ASK ONLY IF HT107=1] WHICH OF THESE MAN-MADE DISASTERS AFFECTED YOUR HEALTH? PLEASE IDENTIFY ALL MAN-MADE INCIDENTS THAT AFFECTED YOU. [MULTIPLE ANSWERS ARE ALLOWED]
expand
   
If Now we are going to ask some questions about natural disasters, which may have affected your health as well. In the last five years, has your health been severely affected by disasters such as floods, landslides, extreme cold and hot weather, cyclone/typhoons, droughts, earthquakes, tsunamis, or any other natural calamities? = 1 Yes 2 No.Go to HT107 or In the last five years, has your health been severely affected by man-made incidents such as riots, terrorism, building collapses, fires, traffic accidents or any other man-made incidents? = 1 Yes 2 No .Go to HT201 THEN
 
   
 
HT108

[Ask if HT106=1 or HT107=1]What were the health consequences that you suffered as a result of these disasters or incidents? [Multiple answers are allowed]

[ASK IF HT106=1 OR HT107=1]WHAT WERE THE HEALTH CONSEQUENCES THAT YOU SUFFERED AS A RESULT OF THESE DISASTERS OR INCIDENTS? [MULTIPLE ANSWERS ARE ALLOWED]
expand
   
HT201

In the past 2 years, have you had Jaundice/ Hepatitis

IN THE PAST 2 YEARS, HAVE YOU HAD JAUNDICE/ HEPATITIS
expand
 
If In the past 2 years, have you had Jaundice/ Hepatitis = 1 Yes 2 No  »
 
   
 
HT201A

[Ask only if HT201-HT210=1]Was this disease treated by a health professional? Jaundice/ Hepatitis

[ASK ONLY IF HT201-HT210=1]WAS THIS DISEASE TREATED BY A HEALTH PROFESSIONAL? JAUNDICE/ HEPATITIS
expand
   
HT202

In the past 2 years, have you had Tuberculosis (TB)

IN THE PAST 2 YEARS, HAVE YOU HAD TUBERCULOSIS (TB)
expand
 
If In the past 2 years, have you had Tuberculosis (TB) = 1 Yes 2 No  »
 
   
 
HT202A

[Ask only if HT201-HT210=1]Was this disease treated by a health professional? Tuberculosis (TB)

[ASK ONLY IF HT201-HT210=1]WAS THIS DISEASE TREATED BY A HEALTH PROFESSIONAL? TUBERCULOSIS (TB)
expand
   
HT203

In the past 2 years, have you had Malaria

IN THE PAST 2 YEARS, HAVE YOU HAD MALARIA
expand
 
If In the past 2 years, have you had Malaria = 1 Yes 2 No  »
 
   
 
HT203A

[Ask only if HT201-HT210=1]Was this disease treated by a health professional? Malaria

[ASK ONLY IF HT201-HT210=1]WAS THIS DISEASE TREATED BY A HEALTH PROFESSIONAL? MALARIA
expand
   
HT204

In the past 2 years, have you had Diarrhea/gastroenteritis

IN THE PAST 2 YEARS, HAVE YOU HAD DIARRHEA/GASTROENTERITIS
expand
 
If In the past 2 years, have you had Diarrhea/gastroenteritis = 1 Yes 2 No  »
 
   
 
HT204A

[Ask only if HT201-HT210=1]Was this disease treated by a health professional? Diarrhea/gastroenteritis

[ASK ONLY IF HT201-HT210=1]WAS THIS DISEASE TREATED BY A HEALTH PROFESSIONAL? DIARRHEA/GASTROENTERITIS
expand
   
HT205

In the past 2 years, have you had Typhoid

IN THE PAST 2 YEARS, HAVE YOU HAD TYPHOID
expand
 
If In the past 2 years, have you had Typhoid = 1 Yes 2 No  »
 
   
 
HT205A

[Ask only if HT201-HT210=1]Was this disease treated by a health professional? Typhoid

[ASK ONLY IF HT201-HT210=1]WAS THIS DISEASE TREATED BY A HEALTH PROFESSIONAL? TYPHOID
expand
   
HT206

In the past 2 years, have you had Urinary Tract Infection

IN THE PAST 2 YEARS, HAVE YOU HAD URINARY TRACT INFECTION
expand
 
If In the past 2 years, have you had Urinary Tract Infection = 1 Yes 2 No  »
 
   
 
HT206A

[Ask only if HT201-HT210=1]Was this disease treated by a health professional? Urinary Tract Infection

[ASK ONLY IF HT201-HT210=1]WAS THIS DISEASE TREATED BY A HEALTH PROFESSIONAL? URINARY TRACT INFECTION
expand
   
HT207

In the past 2 years, have you had Anemia

IN THE PAST 2 YEARS, HAVE YOU HAD ANEMIA
expand
 
If In the past 2 years, have you had Anemia = 1 Yes 2 No  »
 
   
 
HT207A

[Ask only if HT201-HT210=1]Was this disease treated by a health professional? Anemia

[ASK ONLY IF HT201-HT210=1]WAS THIS DISEASE TREATED BY A HEALTH PROFESSIONAL? ANEMIA
expand
   
HT208

In the past 2 years, have you had Chikungunya

IN THE PAST 2 YEARS, HAVE YOU HAD CHIKUNGUNYA
expand
 
If In the past 2 years, have you had Chikungunya = 1 Yes 2 No  »
 
   
 
HT208A

[Ask only if HT201-HT210=1]Was this disease treated by a health professional? Chikungunya

[ASK ONLY IF HT201-HT210=1]WAS THIS DISEASE TREATED BY A HEALTH PROFESSIONAL? CHIKUNGUNYA
expand
   
HT209

In the past 2 years, have you had Dengue

IN THE PAST 2 YEARS, HAVE YOU HAD DENGUE
expand
 
If In the past 2 years, have you had Dengue = 1 Yes 2 No  »
 
   
 
HT209A

[Ask only if HT201-HT210=1]Was this disease treated by a health professional? Dengue

[ASK ONLY IF HT201-HT210=1]WAS THIS DISEASE TREATED BY A HEALTH PROFESSIONAL? DENGUE
expand
   
HT210

In the past 2 years, have you had Other, please specify _____

IN THE PAST 2 YEARS, HAVE YOU HAD OTHER, PLEASE SPECIFY _____
expand
 
If In the past 2 years, have you had Other, please specify _____ = 1 Yes 2 No  »
 
   
 
HT210A

[Ask only if HT201-HT210=1]Was this disease treated by a health professional? Other, please specify _____

[ASK ONLY IF HT201-HT210=1]WAS THIS DISEASE TREATED BY A HEALTH PROFESSIONAL? OTHER, PLEASE SPECIFY _____
expand
   
HT211

Have you ever received any immunizations for adults, such as the influenza vaccine, pneumococcal vaccine, hepatitis B vaccine, or typhoid vaccine? [Multiple answers are allowed]

HAVE YOU EVER RECEIVED ANY IMMUNIZATIONS FOR ADULTS, SUCH AS THE INFLUENZA VACCINE, PNEUMOCOCCAL VACCINE, HEPATITIS B VACCINE, OR TYPHOID VACCINE? [MULTIPLE ANSWERS ARE ALLOWED]
expand
 
HT212

Do you ever have any pain or discomfort in your chest?

DO YOU EVER HAVE ANY PAIN OR DISCOMFORT IN YOUR CHEST?
expand
 
If Do you ever have any pain or discomfort in your chest? = 1 Yes 2 No .Go to HT219  »
 
   
 
HT213

[Ask only if HT212=1] Do you get this pain or discomfort when you walk uphill or hurry?

[ASK ONLY IF HT212=1] DO YOU GET THIS PAIN OR DISCOMFORT WHEN YOU WALK UPHILL OR HURRY?
expand
   
 
If [Ask only if HT212=1] Do you get this pain or discomfort when you walk uphill or hurry? != 3 »
 
     
   
HT214

Do you get it when you walk at an ordinary pace on the level?

DO YOU GET IT WHEN YOU WALK AT AN ORDINARY PACE ON THE LEVEL?
expand
     
   
HT215

When you get any pain or discomfort in your chest while walking or moving, what do you do?

WHEN YOU GET ANY PAIN OR DISCOMFORT IN YOUR CHEST WHILE WALKING OR MOVING, WHAT DO YOU DO?
expand
     
   
HT216

Does it go away when you stop moving?

DOES IT GO AWAY WHEN YOU STOP MOVING?
expand
     
   
HT217

How quickly the pain subsides when it occurs?

HOW QUICKLY THE PAIN SUBSIDES WHEN IT OCCURS?
expand
     
   
HT218

Where do you get this pain or discomfort? [Multiple answers are allowed] -------

WHERE DO YOU GET THIS PAIN OR DISCOMFORT? [MULTIPLE ANSWERS ARE ALLOWED] -------
     
HT219

How often do you have trouble falling asleep?

HOW OFTEN DO YOU HAVE TROUBLE FALLING ASLEEP?
expand
 
HT220

How often did you wake up during the night and had trouble getting back to sleep?

HOW OFTEN DID YOU WAKE UP DURING THE NIGHT AND HAD TROUBLE GETTING BACK TO SLEEP?
expand
 
HT221

How often did you wake up too early in the morning and were not being able to fall asleep again?

HOW OFTEN DID YOU WAKE UP TOO EARLY IN THE MORNING AND WERE NOT BEING ABLE TO FALL ASLEEP AGAIN?
expand
 
HT222

How often did you feel unrested during the day, no matter how many hours of sleep you had?

HOW OFTEN DID YOU FEEL UNRESTED DURING THE DAY, NO MATTER HOW MANY HOURS OF SLEEP YOU HAD?
expand
 
HT223

In the past 1 month, have you taken any medications or used other treatments to help you sleep?

IN THE PAST 1 MONTH, HAVE YOU TAKEN ANY MEDICATIONS OR USED OTHER TREATMENTS TO HELP YOU SLEEP?
expand
 
If In the past 1 month, have you taken any medications or used other treatments to help you sleep? = 1 Yes 2 No  »
 
   
 
HT224

[Ask only if HT223=1] Were these medications or other treatments recommended to you by a doctor?

[ASK ONLY IF HT223=1] WERE THESE MEDICATIONS OR OTHER TREATMENTS RECOMMENDED TO YOU BY A DOCTOR?
expand
   
HT225

Are you often troubled with pain?

ARE YOU OFTEN TROUBLED WITH PAIN?
expand
 
If Are you often troubled with pain? = 1 Yes 2 No.Go to HT229  »
 
   
 
HT226

[Ask only if HT225 =1] How frequently do you experience pain?

[ASK ONLY IF HT225 =1] HOW FREQUENTLY DO YOU EXPERIENCE PAIN?
expand
   
 
HT227

[Ask only if HT225=1] Do you take any medication or therapy to get relief from the pain [Multiple answers are allowed]?

[ASK ONLY IF HT225=1] DO YOU TAKE ANY MEDICATION OR THERAPY TO GET RELIEF FROM THE PAIN [MULTIPLE ANSWERS ARE ALLOWED]?
expand
   
 
HT228

[Ask only if HT225=1] Does the pain make it difficult for you to do your usual activities such as household chores or work?

[ASK ONLY IF HT225=1] DOES THE PAIN MAKE IT DIFFICULT FOR YOU TO DO YOUR USUAL ACTIVITIES SUCH AS HOUSEHOLD CHORES OR WORK?
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HT229

Have you had any of the following persistent or troublesome problems in past two years? [Multiple answers are allowed]

HAVE YOU HAD ANY OF THE FOLLOWING PERSISTENT OR TROUBLESOME PROBLEMS IN PAST TWO YEARS? [MULTIPLE ANSWERS ARE ALLOWED]
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HT230

Aside from any hospital or nursing home stays, about how many days did you stay in bed more than half day because of illness or injury during the last 30 days ? Use 0 for none. Number of days: ___ [Hard check: HT247 >31]

ASIDE FROM ANY HOSPITAL OR NURSING HOME STAYS, ABOUT HOW MANY DAYS DID YOU STAY IN BED MORE THAN HALF DAY BECAUSE OF ILLNESS OR INJURY DURING THE LAST 30 DAYS ? USE 0 FOR NONE. NUMBER OF DAYS: ___ [HARD CHECK: HT247 >31]
 
If interview is a proxy interview »
 
   
 
HT231

[Ask only if interview is NOT a proxy interview] Now I want to ask you about your overall childhood health up to age 16. In general, would you say your childhood health was very good, good, fair, poor or very poor on the basis of what you remember, or what you heard or perceived from your parents?

[ASK ONLY IF INTERVIEW IS NOT A PROXY INTERVIEW] NOW I WANT TO ASK YOU ABOUT YOUR OVERALL CHILDHOOD HEALTH UP TO AGE 16. IN GENERAL, WOULD YOU SAY YOUR CHILDHOOD HEALTH WAS VERY GOOD, GOOD, FAIR, POOR OR VERY POOR ON THE BASIS OF WHAT YOU REMEMBER, OR WHAT YOU HEARD OR PERCEIVED FROM YOUR PARENTS?
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HT232

[Ask only if interview is a proxy interview] Consider [his/her] health while [he/she] was growing up, from birth to age

[ASK ONLY IF INTERVIEW IS A PROXY INTERVIEW] CONSIDER [HIS/HER] HEALTH WHILE [HE/SHE] WAS GROWING UP, FROM BIRTH TO AGE
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HT233

When you were growing up, before you were 16 years old, were you ever bedridden for a month or more because of a health problem?

WHEN YOU WERE GROWING UP, BEFORE YOU WERE 16 YEARS OLD, WERE YOU EVER BEDRIDDEN FOR A MONTH OR MORE BECAUSE OF A HEALTH PROBLEM?
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If Have you ever attended school? = 1 »
 
   
 
HT234

[Ask only if DM006=1] When you were growing up, before you were 16 years old, did you ever miss a month or more of school because of a health problem?

[ASK ONLY IF DM006=1] WHEN YOU WERE GROWING UP, BEFORE YOU WERE 16 YEARS OLD, DID YOU EVER MISS A MONTH OR MORE OF SCHOOL BECAUSE OF A HEALTH PROBLEM?
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HT235

Now think about your family when you were growing up, from birth to age 16. Compared to other families in your community, would you say your family during that time was pretty well off financially, about average, or poor?

NOW THINK ABOUT YOUR FAMILY WHEN YOU WERE GROWING UP, FROM BIRTH TO AGE 16. COMPARED TO OTHER FAMILIES IN YOUR COMMUNITY, WOULD YOU SAY YOUR FAMILY DURING THAT TIME WAS PRETTY WELL OFF FINANCIALLY, ABOUT AVERAGE, OR POOR?
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HT236

When did you have your last menstrual bleeding /period? ._______ Year and _______ month

WHEN DID YOU HAVE YOUR LAST MENSTRUAL BLEEDING /PERIOD? ._______ YEAR AND _______ MONTH
 
If How old were you at your last birthday? [Instruction for CAPI: CAPI should prompt if DM004 and DM005 are inconsistent; then interviewer should check with the respondent for the age or birth date and correct it] < 60 »
 
   
 
HT237

[Ask only if DM005 < 60years] In the last 12 months, have you had any of the following health problem(s)? [Multiple answers are allowed]

[ASK ONLY IF DM005 < 60YEARS] IN THE LAST 12 MONTHS, HAVE YOU HAD ANY OF THE FOLLOWING HEALTH PROBLEM(S)? [MULTIPLE ANSWERS ARE ALLOWED]
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If [Ask only if DM005 < 60years] In the last 12 months, have you had any of the following health problem(s)? [Multiple answers are allowed] != i »
 
   
 
HT238

[Ask only if HT237!=i]Did you seek doctor's consultation or treatment for any of these health problems?

[ASK ONLY IF HT237!=I]DID YOU SEEK DOCTOR'S CONSULTATION OR TREATMENT FOR ANY OF THESE HEALTH PROBLEMS?
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HT239

Have you undergone an operation to remove your uterus (hysterectomy)?

HAVE YOU UNDERGONE AN OPERATION TO REMOVE YOUR UTERUS (HYSTERECTOMY)?
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If Have you undergone an operation to remove your uterus (hysterectomy)? = 1 Yes »
 
   
 
HT240

HT240 [Ask only if HT239= 1] What were the reason(s) for undergoing hysterectomy? [Multiple responses are allowed] [Instructionfor CAPI: If option h is selected, other given options should be freeze]

HT240 [ASK ONLY IF HT239= 1] WHAT WERE THE REASON(S) FOR UNDERGOING HYSTERECTOMY? [MULTIPLE RESPONSES ARE ALLOWED] [INSTRUCTIONFOR CAPI: IF OPTION H IS SELECTED, OTHER GIVEN OPTIONS SHOULD BE FREEZE]
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HT241

In the last 2 years, have you had a PAP smear test?

IN THE LAST 2 YEARS, HAVE YOU HAD A PAP SMEAR TEST?
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HT242

In the last 2 years, have you had a mammogram?

IN THE LAST 2 YEARS, HAVE YOU HAD A MAMMOGRAM?
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HT300

[Ask only WE004=1 or WE005=1] Now I want to ask how your health affects paid work activities. Do you have any impairment or health problem that limits the kind or amount of paid work you can do?

[ASK ONLY WE004=1 OR WE005=1] NOW I WANT TO ASK HOW YOUR HEALTH AFFECTS PAID WORK ACTIVITIES. DO YOU HAVE ANY IMPAIRMENT OR HEALTH PROBLEM THAT LIMITS THE KIND OR AMOUNT OF PAID WORK YOU CAN DO?
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HT301

Do you have any form of physical or mental impairment?

DO YOU HAVE ANY FORM OF PHYSICAL OR MENTAL IMPAIRMENT?
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If Do you have any form of physical or mental impairment? = 1 Yes 2 No.Go to HT303  »
 
   
 
HT302

[Ask only if HT301= 1] Which form of impairment do you have? [Multiple answers are allowed]

[ASK ONLY IF HT301= 1] WHICH FORM OF IMPAIRMENT DO YOU HAVE? [MULTIPLE ANSWERS ARE ALLOWED]
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HT303

Do you have difficulty with Walking 100 yards

DO YOU HAVE DIFFICULTY WITH WALKING 100 YARDS
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HT304

Do you have difficulty with Sitting for 2 hours or more

DO YOU HAVE DIFFICULTY WITH SITTING FOR 2 HOURS OR MORE
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HT305

Do you have difficulty with Getting up from a chair after sitting for long period

DO YOU HAVE DIFFICULTY WITH GETTING UP FROM A CHAIR AFTER SITTING FOR LONG PERIOD
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HT306

Do you have difficulty with Climbing one flight of stairs without resting

DO YOU HAVE DIFFICULTY WITH CLIMBING ONE FLIGHT OF STAIRS WITHOUT RESTING
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HT307

Do you have difficulty with Stooping, kneeling or crouching

DO YOU HAVE DIFFICULTY WITH STOOPING, KNEELING OR CROUCHING
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HT308

Do you have difficulty with Reaching or extending arms above shoulder level (either arm)

DO YOU HAVE DIFFICULTY WITH REACHING OR EXTENDING ARMS ABOVE SHOULDER LEVEL (EITHER ARM)
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HT309

Do you have difficulty with Pulling or pushing large objects

DO YOU HAVE DIFFICULTY WITH PULLING OR PUSHING LARGE OBJECTS
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HT310

Do you have difficulty with Lifting or carrying weights over 5 kilos, like a heavy bag of groceries

DO YOU HAVE DIFFICULTY WITH LIFTING OR CARRYING WEIGHTS OVER 5 KILOS, LIKE A HEAVY BAG OF GROCERIES
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HT311

Do you have difficulty with Picking up a coin from a table

DO YOU HAVE DIFFICULTY WITH PICKING UP A COIN FROM A TABLE
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HT401

Because of a health or memory problem, do you have any difficulty with Dressing, including putting on chappals, shoes, etc.

BECAUSE OF A HEALTH OR MEMORY PROBLEM, DO YOU HAVE ANY DIFFICULTY WITH DRESSING, INCLUDING PUTTING ON CHAPPALS, SHOES, ETC.
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HT402

Because of a health or memory problem, do you have any difficulty with Walking across a room

BECAUSE OF A HEALTH OR MEMORY PROBLEM, DO YOU HAVE ANY DIFFICULTY WITH WALKING ACROSS A ROOM
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HT403

Because of a health or memory problem, do you have any difficulty with Bathing

BECAUSE OF A HEALTH OR MEMORY PROBLEM, DO YOU HAVE ANY DIFFICULTY WITH BATHING
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HT404

Because of a health or memory problem, do you have any difficulty with Eating, chewing, breaking chapatti, mixing rice, etc.

BECAUSE OF A HEALTH OR MEMORY PROBLEM, DO YOU HAVE ANY DIFFICULTY WITH EATING, CHEWING, BREAKING CHAPATTI, MIXING RICE, ETC.
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HT405

Because of a health or memory problem, do you have any difficulty with Getting in or out of bed

BECAUSE OF A HEALTH OR MEMORY PROBLEM, DO YOU HAVE ANY DIFFICULTY WITH GETTING IN OR OUT OF BED
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HT406

Because of a health or memory problem, do you have any difficulty with Using the toilet, including getting up and down

BECAUSE OF A HEALTH OR MEMORY PROBLEM, DO YOU HAVE ANY DIFFICULTY WITH USING THE TOILET, INCLUDING GETTING UP AND DOWN
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HT407

Because of a health or memory problem, do you have any difficulty with Preparing a hot meal (cooking and serving)

BECAUSE OF A HEALTH OR MEMORY PROBLEM, DO YOU HAVE ANY DIFFICULTY WITH PREPARING A HOT MEAL (COOKING AND SERVING)
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HT408

Because of a health or memory problem, do you have any difficulty with Shopping for groceries

BECAUSE OF A HEALTH OR MEMORY PROBLEM, DO YOU HAVE ANY DIFFICULTY WITH SHOPPING FOR GROCERIES
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HT409

Because of a health or memory problem, do you have any difficulty with Making telephone calls

BECAUSE OF A HEALTH OR MEMORY PROBLEM, DO YOU HAVE ANY DIFFICULTY WITH MAKING TELEPHONE CALLS
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HT410

Because of a health or memory problem, do you have any difficulty with Taking medications

BECAUSE OF A HEALTH OR MEMORY PROBLEM, DO YOU HAVE ANY DIFFICULTY WITH TAKING MEDICATIONS
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HT411

Because of a health or memory problem, do you have any difficulty with Doing work around the house or garden

BECAUSE OF A HEALTH OR MEMORY PROBLEM, DO YOU HAVE ANY DIFFICULTY WITH DOING WORK AROUND THE HOUSE OR GARDEN