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

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LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH<br />

NO. QUESTIONS AND FILTERS NAME ________________ NAME ________________ NAME _________________<br />

541 Where did you seek advice or PUBLIC SECTOR PUBLIC SECTOR PUBLIC SECTOR<br />

treatment? NATIONAL HOSP. A NATIONAL HOSP. A NATIONAL HOSP. A<br />

REFERRAL REFERRAL REFERRAL<br />

Anywhere else? HOSPITAL ....... B HOSPITAL ....... B HOSPITAL ....... B<br />

COMMUNITY COMMUNITY COMMUNITY<br />

PROBE TO IDENTIFY EACH HEALTH CEN. ... C HEALTH CEN. ... C HEALTH CEN. ... C<br />

TYPE OF SOURCE AND HEALTH POSTS ... D HEALTH POSTS ... D HEALTH POSTS ... D<br />

CIRCLE THE APPROPRIATE SISCa POST .. ... E SISCa POST .. ... E SISCa POST .. ... E<br />

MOBILE CLINIC F MOBILE CLINIC F MOBILE CLINIC F<br />

CODE(S). OTHER PUBLIC OTHER PUBLIC OTHER PUBLIC<br />

G G G<br />

IF UNABLE TO DETERMINE (SPECIFY) (SPECIFY) (SPECIFY)<br />

IF A HOSPITAL, HEALTH<br />

CENTER, OR CLINIC IS NON-GOVT. (NGO) SEC NON-GOVT. (NGO) SEC NON-GOVT. (NGO) SEC<br />

PUBLIC OR PRIVATE NGO H NGO H NGO H<br />

MEDICAL, WRITE THE (SPECIFY) (SPECIFY) (SPECIFY)<br />

THE NAME OF THE PLACE.<br />

PRIVATE MEDICAL PRIVATE MEDICAL PRIVATE MEDICAL<br />

(NAME OF PLACE(S)) SECTOR SECTOR SECTOR<br />

PVT HOSPITAL/ PVT HOSPITAL/ PVT HOSPITAL/<br />

CLINIC . . . . . . . . I CLINIC . . . . . . . . I CLINIC . . . . . . . . I<br />

PHARMACY . . . J PHARMACY . . . J PHARMACY . . . J<br />

PVT DOCTOR . . . K PVT DOCTOR . . . K PVT DOCTOR . . . K<br />

MOBILE CLINIC . L MOBILE CLINIC . L MOBILE CLINIC . L<br />

FIELDWORKER . M FIELDWORKER . M FIELDWORKER . M<br />

OTHER PRIVATE OTHER PRIVATE OTHER PRIVATE<br />

MED. N MED. N MED. N<br />

(SPECIFY) (SPECIFY) (SPECIFY)<br />

OTHER SOURCE OTHER SOURCE OTHER SOURCE<br />

SHOP . . . . . . . . . . O SHOP . . . . . . . . . . O SHOP . . . . . . . . . . O<br />

TRADITIONAL TRADITIONAL TRADITIONAL<br />

PRACTITIONER P PRACTITIONER P PRACTITIONER P<br />

OTHER X OTHER X OTHER X<br />

(SPECIFY) (SPECIFY) (SPECIFY)<br />

542 CHECK 541: TWO OR ONLY TWO OR ONLY TWO OR ONLY<br />

MORE ONE MORE ONE MORE ONE<br />

CODES CODE CODES CODE CODES CODE<br />

CIRCLED CIRCLED CIRCLED CIRCLED CIRCLED CIRCLED<br />

543 Where did you first seek advice<br />

or treatment?<br />

USE LETTER CODE FROM 541.<br />

(SKIP TO 544) (SKIP TO 544) (SKIP TO 544)<br />

FIRST PLACE . . . FIRST PLACE . . . FIRST PLACE . . .<br />

544 How many days after the illness<br />

began did you first seek advice<br />

or treatment for (NAME)? DAYS . . . . . DAYS . . . . . DAYS . . . . .<br />

IF THE SAME DAY, RECORD '00'.<br />

545 Is (NAME) still sick with a (fever/ FEVER ONLY . . . . . 1 FEVER ONLY . . . . . 1 FEVER ONLY . . . . . 1<br />

cough)? COUGH ONLY . . . 2 COUGH ONLY . . . 2 COUGH ONLY . . . 2<br />

BOTH FEVER AND BOTH FEVER AND BOTH FEVER AND<br />

COUGH . . . . . . . . 3 COUGH . . . . . . . . 3 COUGH . . . . . . . . 3<br />

NO, NEITHER . . . . . 4 NO, NEITHER . . . . . 4 NO, NEITHER . . . . . 4<br />

DON'T KNOW . . . 8 DON'T KNOW . . . 8 DON'T KNOW . . . 8<br />

546 At any time during the illness, did YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1<br />

(NAME) take any drugs for the NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2<br />

illness? (GO BACK TO 503 (GO BACK TO 503 (GO TO 503 IN<br />

IN NEXT COLUMN; IN NEXT COLUMN; NEXT-TO-LAST<br />

OR, IF NO MORE OR, IF NO MORE COLUMN OF NEW<br />

BIRTHS, GO TO 573) BIRTHS, GO TO 573) QUESTIONNAIRE;<br />

DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 OR, IF NO MORE<br />

BIRTHS, GO TO 573)<br />

DON'T KNOW . . . . . 8<br />

Appendix E<br />

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