Demographic and Health Survey 2009-10 - Timor-Leste Ministry of ...

338 | Appendix E
LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH
NO. QUESTIONS AND FILTERS NAME ________________ NAME ________________ NAME _________________
520 Now I would like to know how
much (NAME) was given to drink
during the diarrhea (including
breastmilk).
Was he/she given less than
usual to drink, about the same MUCH LESS . . . . . 1 MUCH LESS . . . . . 1 MUCH LESS . . . . . 1
amount, or more than usual to SOMEWHAT LESS . 2 SOMEWHAT LESS . 2 SOMEWHAT LESS . 2
drink? ABOUT THE SAME . 3 ABOUT THE SAME . 3 ABOUT THE SAME . 3
IF LESS, PROBE: Was he/she MORE . . . . . . . . . . . . 4 MORE . . . . . . . . . . . . 4 MORE . . . . . . . . . . . . 4
given much less than usual to NOTHING TO DRINK 5 NOTHING TO DRINK 5 NOTHING TO DRINK 5
drink or somewhat less? DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8
521 When (NAME) had diarrhea, was
he/she given less than usual to MUCH LESS . . . . . 1 MUCH LESS . . . . . 1 MUCH LESS . . . . . 1
eat, about the same amount, more SOMEWHAT LESS . 2 SOMEWHAT LESS . 2 SOMEWHAT LESS . 2
than usual, or nothing to eat? ABOUT THE SAME . 3 ABOUT THE SAME . 3 ABOUT THE SAME . 3
MORE . . . . . . . . . . . . 4 MORE . . . . . . . . . . . . 4 MORE . . . . . . . . . . . . 4
IF LESS, PROBE: Was he/she STOPPED FOOD . 5 STOPPED FOOD . 5 STOPPED FOOD . 5
given much less than usual to NEVER GAVE FOOD 6 NEVER GAVE FOOD 6 NEVER GAVE FOOD 6
eat or somewhat less? DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8
522 Did you seek advice or treatment YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1
for the diarrhea from any source? NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2
(SKIP TO 527) (SKIP TO 527) (SKIP TO 527)
523 Where did you seek advice or PUBLIC SECTOR PUBLIC SECTOR PUBLIC SECTOR
treatment? NATIONAL HOSP. A NATIONAL HOSP. A NATIONAL HOSP. A
REFERRAL REFERRAL REFERRAL
Anywhere else? HOSPITAL ....... B HOSPITAL ....... B HOSPITAL ....... B
COMMUNITY COMMUNITY COMMUNITY
PROBE TO IDENTIFY EACH HEALTH CEN. ... C HEALTH CEN. ... C HEALTH CEN. ... C
TYPE OF SOURCE AND HEALTH POSTS ... D HEALTH POSTS ... D HEALTH POSTS ... D
CIRCLE THE APPROPRIATE SISCa POST .. ... E SISCa POST .. ... E SISCa POST .. ... E
MOBILE CLINIC F MOBILE CLINIC F MOBILE CLINIC F
CODE(S). OTHER PUBLIC OTHER PUBLIC OTHER PUBLIC
G G G
IF UNABLE TO DETERMINE (SPECIFY) (SPECIFY) (SPECIFY)
IF A HOSPITAL, HEALTH
CENTER, OR CLINIC IS NON-GOV (NGO) SEC. NON-GOV (NGO) SEC. NON-GOV (NGO) SEC.
PUBLIC OR PRIVATE NGO H NGO H NGO H
MEDICAL, WRITE THE (SPECIFY) (SPECIFY) (SPECIFY)
THE NAME OF THE PLACE.
PRIVATE MEDICAL PRIVATE MEDICAL PRIVATE MEDICAL
SECTOR SECTOR SECTOR
(NAME OF PLACE(S)) PVT. HOSPITAL/ PVT. HOSPITAL/ PVT. HOSPITAL/
CLINIC . . . . . . . . I CLINIC . . . . . . . . I CLINIC . . . . . . . . I
PHARMACY . . . J PHARMACY . . . J PHARMACY . . . J
PVT DOCTOR . . . K PVT DOCTOR . . . K PVT DOCTOR . . . K
MOBILE CLINIC . L MOBILE CLINIC . L MOBILE CLINIC . L
FIELDWORKER . M FIELDWORKER . M FIELDWORKER . M
OTHER PRIVATE OTHER PRIVATE OTHER PRIVATE
MED. N MED. N MED. N
(SPECIFY) (SPECIFY) (SPECIFY)
OTHER SOURCE OTHER SOURCE OTHER SOURCE
SHOP . . . . . . . . . . O SHOP . . . . . . . . . . O SHOP . . . . . . . . . . O
TRADITIONAL TRADITIONAL TRADITIONAL
PRACTITIONER P PRACTITIONER P PRACTITIONER P
OTHER X OTHER X OTHER X
(SPECIFY) (SPECIFY) (SPECIFY)
524 CHECK 523: TWO OR ONLY TWO OR ONLY TWO OR ONLY
MORE ONE MORE ONE MORE ONE
CODES CODE CODES CODE CODES CODE
CIRCLED CIRCLED CIRCLED CIRCLED CIRCLED CIRCLED
(SKIP TO 526) (SKIP TO 526) (SKIP TO 526)