respondent code from board
DAY of interview
MONTH of interview
YEAR of interview
interviewer 1
interviewer 2
village/hamlet code
names of other people present during interview
starting time of module, hour
starting time of module, minute
In what year were you born, or how old are you now? YEAR
In what year were you born, or how old are you now? AGE
are you literate?
What is the highest level of education you have achieved?
Are you still studying?
What is your marital status? MARRIED, LIVING WITH SPOUSE
What is your marital status? MARRIED, NOT LIVING WITH SPOUSE YET
What is your marital status? SEPARATED/DIVORCED
What is your marital status? SPOUSE/PARTNER DIED
What is your marital status? NATA
What is your marital status? NEVER MARRIED/DONE NATA
CP: Has the respondent ever been married?
How many times did you get married?
Does your spouse live in this household?
What is the name of your spouse? (WRITE IN CODE NUMBER FROM BOARD)
In what year, or at what age, did you get married to this person? YEAR
In what year, or at what age, did you get married to this person? AGE
Are you still married to this person?
When did you become separated/divorced or did your spouse die? YEAR
When did you become separated/divorced or did your spouse die? AGE
Did you get married again after that?
CP: Has the respondent ever done nata?
How many times have you done nata?
Does your nata partner live in this household?
What is the name of your nata partner? (WRITE IN CODE NUMBER FROM BOARD)
In what year, or at what age, did you do nata with this person? YEAR
In what year, or at what age, did you do nata with this person? AGE
Are you still in nata with this person?
When did you become separated or did your nata partner die? YEAR
When did you become separated or did your nata partner die? AGE
Did you do nata again after that?
Please remind me, is your mother alive or deceased?
How old was your mother when she died? AGE
Would you say she was older or younger than 50 when she died?
How old is she?
Is/was she literate?
What is the highest level of education she achieved?
Please remind me, is your father alive or deceased?
How old was your father when he died?
Would you say he was older or younger than 50 when he died?
How old is he?
Is/was he literate?
What is the highest level of education he/she achieved?
CP: Is the respondent a woman aged 14 to 50 or a widower aged 14 to 55?
How many children do you have?
CP: Is the respondent a woman?
Did you ever have any STILLBIRTHS?
How many STILLBIRTHS did you have?
Did you ever have any SPONTANEOUS ABORTIONS?
How many SPONTANEOUS ABORTIONS did you have?
Did you ever have any INDUCED ABORTIONS?
How many INDUCED ABORTIONS did you have?
Have you had any children who have died after birth...?
CP: Does/did the respondent have any children?
How many children have you given birth to?
What name was given to your baby?
Was he/she part of a twin pair?
Is/was this child a boy or a girl?
Is this child still alive?
Is this child a member of the household?
INTERVIEWER: RECORD CHILD NUMBER FROM BOARD
Where does this child live? CITY
Where does this child live? DISTRICT
Where does this child live? TOWN
Where does this child live? VILLAGE
How old was this child when he/she died? NUMBER
How old was this child when he/she died? UNITS
How long ago did he/she die? NUMBER
How long ago did he/she die? UNITS
What was the cause of his/her death?
What was the cause of his/her death? OTHER, SPECIFY
If he/she died due to illness: which illness was it?
What is his/her age? NUMBER
What is his/her age? UNITS
Is/was he/she literate?
What is/was this child's marital status? MARRIED, LIVING WITH SPOUSE
What is/was this child's marital status? MARRIED, NOT LIVING WITH SPOUSE YET
What is/was this child's marital status? SEPARATED/DIVORCED
What is/was this child's marital status? SPOUSE/PARTNER DIED
What is/was this child's marital status? NATA
What is/was this child's marital status? NEVER MARRIED/DONE NATA
Did respondent have a stillbirth, spontaneous abortion, or induced abortion?
Did you have STILLBIRTHS between birth of this child and previous?
How many STILLBIRTHS between birth of this child and previous?
Did you have SPONTANEOUS ABORTIONS between birth of this child and previous?
How many SPONTANEOUS ABORTIONS between birth of this child and previous?
Did you have INDUCED ABORTIONS between birth of this child and previous?
How many INDUCED ABORTIONS between birth of this child and previous?
Was any child born afteR this child?
Are you pregnant?
Did you earn income from REGULAR SALARY JOB in last year?
How much did you earn from REGULAR SALARY JOB in last year?
What was the REGULAR SALARY JOB?
Did you earn any INDIVIDUAL INCOME FROM NON-FARM BUSINESS in last year?
How much INDIVIDUAL INCOME FROM NON-FARM BUSINESS did you earn in last year?
What was the NON-FARM BUSINESS?
Earn income WORKING ON SOMEONE ELSE'S FARM/BUSINESS THROUGHOUT THE YEAR?
How much from WORKING ON SOMEONE ELSE'S FARM/BUSINESS THROUGHOUT THE YEAR?
Earn income WORKING ON SOMEONE ELSE'S FARM/BUSINESS SEASONALLY OR CONTRACTUALLY?
How much from WORKING ON SOMEONE ELSE'S FARM/BUSINESS SEASONALLY OR CONTRACTUALL
Earn income WORKING ON SOMEONE ELSE'S FARM/BUSINESS AS A DAY LABORER last year?
How much from WORKING ON SOMEONE ELSE'S FARM/BUSINESS AS A DAY LABORER last year
Earn income WORKING ON EGS (JRY, EGS, JRSY, JFM, SM WORK...) in last year?
How much from WORKING ON EGS (JRY, EGS, JRSY, JFM, SM WORK...) last year?
Earn from PERSONAL INCOME FROM LAND, HOUSE OR OTHER PROPERTY in last year?
How much from PERSONAL INCOME FROM LAND, HOUSE OR OTHER PROPERTY in last year?
Earn INTEREST FROM BANK ACCOUNT/SAVINGS GROUP/OTHER MONEY HOLDER in last year?
How much from INTEREST FROM BANK ACCOUNT/SAVINGS GROUP/OTHER MONEY HOLDER last y
Did you earn any income from OLD AGE PENSION in last year?
How much did you earn from OLD AGE PENSION in last year?
Did you earn any income from DISABILITY PENSION in last year?
How much did you earn from DISABILITY PENSION in last year?
Did you earn any income from WIDOW'S PENSION in last year?
How much did you earn from WIDOW'S PENSION in last year?
Did you earn any income from ANY OTHER WELFARE SCHEME in last year?
How much did you earn from ANY OTHER WELFARE SCHEME in last year?
Did you earn any income from REMITTANCES in last year?
How much did you earn from REMITTANCES in last year?
Did you earn any income from ANY OTHER SOURCE in last year?
How much did you earn from ANY OTHER SOURCE in last year?
What was the OTHER SOURCE?
Do you have an outstanding loan from a commercial bank?
For how much money is this commercial bank loan?
Have you had any loan from a commercial bank in the past that you have repaid?
Do you participate in a savings group or SHG?
How much did you contribute to the savings group or SHG in the last 30 days?
Do you have an outstanding loan from the savings group or SHG?
For how much money is the savings group or SHG loan?
Are you a member of a Bisi?
How much did you contribute to the Bisi in the last 30 days?
Do you have an outstanding loan from a Bisi?
For how much money is the Bisi loan?
Do you have life insurance?
Do you ever deposit money in any other institution or savings group?
How much did you deposit in other institution or savings group in last 30 days?
How would you classify your health these days? (10- BEST, 1- WORST)
Which level of difficulty is DRESSING alone now?
Which level of difficulty is BATHING alone now?
Which level of difficulty is EATING alone now?
Which level of difficulty is TOILETING alone now?
Which level of difficulty is DOING_LIGHT_WORK_IN_OR_AROUND_HOUSE alone now?
Which level of difficulty is CLIMBING_A_SMALL_HILL alone now?
Which level of difficulty is LIFTING/CARRYING_HEAVY_OBJECTS_(5KG) alone now?
Which level of difficulty is WALKING_200_TO_300_METERS alone now?
Which level of difficulty is WALKING_5_KM alone now?
Which level of difficulty is BOW_SQUAT_OR_KNEEL alone now?
Which level of difficulty is DRAW_WATER_FROM_A_WELL alone now?
Which level of difficulty is STAND_UP_FROM_SITTING_ON_THE_FLOOR alone now?
Which level of difficulty is WORK_IN_A_FIELD_FOR_ONE_DAY alone now?
Which level of difficulty is MANAGING_MONEY alone now?
Which level of difficulty is TAKE_A_BUS_TRAIN_OR_TAXI alone now?
Have you experienced COLD_SYMPTOMS in the last 30 days?
Was it (COLD_SYMPTOMS) serious?
Have you experienced DRY_COUGH in the last 30 days?
Was it (DRY_COUGH) serious?
Have you experienced PRODUCTIVE_COUGH in the last 30 days?
Was it (PRODUCTIVE_COUGH) serious?
Have you experienced COUGH_WITH_BLOOD in the last 30 days?
Was it (COUGH_WITH_BLOOD) serious?
Have you experienced BLOOD_IN_SPIT in the last 30 days?
Was it (BLOOD_IN_SPIT) serious?
Have you experienced HOT_FEVER in the last 30 days?
Was it (HOT_FEVER) serious?
Have you experienced DIARRHEA in the last 30 days?
Was it (DIARRHEA) serious?
Have you experienced BODY_ACHE in the last 30 days?
Was it (BODY_ACHE) serious?
Have you experienced WEAKNESS/FATIGUE in the last 30 days?
Was it (WEAKNESS/FATIGUE) serious?
Have you experienced PROBLEMS_WITH_VISION in the last 30 days?
Was it (PROBLEMS_WITH_VISION) serious?
Have you experienced HEADACHE in the last 30 days?
Was it (HEADACHE) serious?
Have you experienced BACK_ACHE in the last 30 days?
Was it (BACK_ACHE) serious?
Have you experienced VOMITING in the last 30 days?
Was it (VOMITING) serious?
Have you experienced WORMS_IN_STOOL in the last 30 days?
Was it (WORMS_IN_STOOL) serious?
Have you experienced TROUBLE_BREATHING in the last 30 days?
Was it (TROUBLE_BREATHING) serious?
Have you experienced PAIN_IN_UPPER_ABDOMEN in the last 30 days?
Was it (PAIN_IN_UPPER_ABDOMEN) serious?
Have you experienced PAIN_IN_LOWER_ABDOMEN in the last 30 days?
Was it (PAIN_IN_LOWER_ABDOMEN) serious?
Have you experienced GENITAL_ULCERS in the last 30 days?
Was it (GENITAL_ULCERS) serious?
Have you experienced PAINFUL_URINATION in the last 30 days?
Was it (PAINFUL_URINATION) serious?
Have you experienced SWELLING_ANKLES in the last 30 days?
Was it (SWELLING_ANKLES) serious?
Have you experienced HEARING_PROBLEMS in the last 30 days?
Was it (HEARING_PROBLEMS) serious?
Have you experienced SKIN_PROBLEMS in the last 30 days?
Was it (SKIN_PROBLEMS) serious?
Have you experienced CHEST_PAIN in the last 30 days?
Was it (CHEST_PAIN) serious?
Have you experienced MEMORY_LOSS in the last 30 days?
Have you experienced FULL_PARALYSIS in the last 30 days?
Have you experienced PARTIAL_PARALYSIS in the last 30 days?
Have you experienced NIGHT_SWEATS in the last 30 days?
Was it (NIGHT_SWEATS) serious?
Have you experienced WEIGHT_LOSS in the last 30 days?
Was it (WEIGHT_LOSS) serious?
Have you experienced OTHER_(SPECIFY) in the last 30 days?
Was it (OTHER_(SPECIFY)) serious?
If you have experienced OTHER SYMPTOMS in the last 30 days: SPECIFY
Have you experienced MENSTRUAL_PROBLEMS in the last 30 days?
Was it (MENSTRUAL_PROBLEMS) serious?
Have you experienced WHITE_DISCHARGE in the last 30 days?
Was it (WHITE_DISCHARGE) serious?
Was there any condition checked in E3.0?
Did you consult anyone about any of these conditions in the last 30 days?
How many times did you consult someone about these conditions in last 30 days?
Which type of facility did you visit?
Which type of facility did you visit? OTHER, SPECIFY
Was this facility/health provider private or public?
What is the name of the facility or health provider?
Where is this facility located? TEHSIL
Where is this facility located? DISTRICT
Where is this facility located? STATE
How long ago was this consultation? NUMBER OF DAYS
Was this consultation more than 30 days ago?
Was anyone from this household with you during this consultation?
Who was with you?
For which conditions did you make this consultation?
Was this consultation a consultation to a bhopa?
Did you get CONSULTATION?
Did you have to pay for CONSULTATION?
How much did you have to pay for CONSULTATION?
Did you get MEDICATION_GIVEN_IN_FACILITY?
Did you have to pay for MEDICATION_GIVEN_IN_FACILITY?
How much did you have to pay for MEDICATION_GIVEN_IN_FACILITY?
Did you get MEDICATION_BOUGHT_OUTSIDE_FACILITY?
Did you have to pay for MEDICATION_BOUGHT_OUTSIDE_FACILITY?
How much did you have to pay for MEDICATION_BOUGHT_OUTSIDE_FACILITY?
Did you get INJECTION?
Did you have to pay for INJECTION?
How much did you have to pay for INJECTION?
Did you get DRIP?
Did you have to pay for DRIP?
How much did you have to pay for DRIP?
Did you get OPERATION?
Did you have to pay for OPERATION?
How much did you have to pay for OPERATION?
Did you get LAB_TEST?
Did you have to pay for LAB_TEST?
How much did you have to pay for LAB_TEST?
Did you get OTHER_TREATMENT?
Did you have to pay for OTHER_TREATMENT?
How much did you have to pay for OTHER_TREATMENT?
Did you get TRANSPORTATION_(ROUND_TRIP)?
Did you have to pay for TRANSPORTATION_(ROUND_TRIP)?
How much did you have to pay for TRANSPORTATION_(ROUND_TRIP)?
TOTAL E1PENSE INCURRED for this visit
Did you  get any jalibuti or any other treatment from the bhopa?
How much did this consultation to the bhopa cost you in total?
After this consultation, did you feel better?
Was any medication or treatment received or prescribed at this consultation?
Did you finish this medication/treatment?
Why did you interrupt this medication/treatment?
Did the respondent have any other consultation in the last 30 days?
Facility code
TOTAL E2PENSE INCURRED for this visit
TOTAL E3PENSE INCURRED for this visit
TOTAL E4PENSE INCURRED for this visit
TOTAL E5PENSE INCURRED for this visit
TOTAL E6PENSE INCURRED for this visit
TOTAL E7PENSE INCURRED for this visit
TOTAL E8PENSE INCURRED for this visit
Are there conditions checked in E3.0 for which you did not make a consultation?
Why did you not seek consultation for those conditions?
Did you undergo treatment for any conditions without consulting anyone first?
For which conditions did you undergo treatment without consulting anyone first?
What kind of treatment did you do without consultation?
What kind of treatment did you undertake without consulting first? OTHER, SP
Why undertake treatment w/out consulting first? ADVISED_BY_FAMILY_MEMBER
Why undertake treatment w/out consulting first? ADVISED_BY_NEIGHBOR/FRIEND
Why undertake treatment w/out consulting first? PAST_EXPERIENCE
Why undertake treatment w/out consulting first? OTHER
Why undertake treatment w/out consulting first? OTHER, SPECIFY
How much did you pay for treatment undertaken w/out consulting first?
Have you ever been tested for Tuberculosis (TB)?
Have you ever been diagnosed with Tuberculosis (TB)?
When was the first time that you were told you had TB?
In the past 12 months, have you received any medication or treatment for TB...?
Has the respondent suffered from cough in last 30 days?
If yes, are you still suffering from cough?
If yes, has the cough been continuing for more than the past two weeks?
Have you ever been to health facility or consulted a health provider?
LAST VISIT: How_much_time_ago_was_it?_NUMBER
LAST VISIT: How_much_time_ago_was_it?_UNITS
LAST VISIT: When_was_the_respondent’s_last_visit_to_a_health_facility?
LAST VISIT: For_whose_condition_did_you_visit_health_facility?_OWN
LAST VISIT: For_whose_condition_did_you_visit_health_facility?_SPOUSE
LAST VISIT: For_whose_condition_did_you_visit_health_facility?_CHILD
LAST VISIT: For_whose_condition_did_you_visit_health_facility?_PARENT
LAST VISIT: For_whose_condition_did_you_visit_health_facility?_OTHER_RELATIVE
LAST VISIT: For_whose_condition_did_you_visit_health_facility?_NEIGHBOR
LAST VISIT: For_whose_condition_did_you_visit_health_facility?_OTHER
LAST VISIT: For_whose_condition_did_you_visit_health_facility?_OTHER_SPECIFY
LAST VISIT: Was_anyone_from_this_household_with_you_during_this_visit/consultati
LAST VISIT: Who was with you?
LAST VISIT: Why_did_you_visit_a_health_facility_or_consult_a_health_provider?
LAST VISIT: Which_type_of_facility_did_you_visit?
LAST VISIT: Which_type_of_facility_did_you_visit?_OTHER_SPECIFY
LAST VISIT: Was_this_facility/health_provider_public_or_private?
LAST VISIT: What_is_the_name_of_the_facility_or_health_provider?
LAST VISIT: Was_this_consultation_with_a_health_provider_in_your_own_home?
LAST VISIT: Where_is_this_health_provider_based?_FACILITY_NAME
LAST VISIT: Where_is_this_health_provider_based?_VILLAGE
LAST VISIT: Where_is_this_health_provider_based?_TEHSIL
LAST VISIT: Where_is_this_health_provider_based?_DISTRICT
LAST VISIT: Where_is_this_health_provider_based?_STATE
LAST VISIT: Where_is_this_facility_located?_VILLAGE
LAST VISIT: Where_is_this_facility_located?_TEHSIL
LAST VISIT: Where_is_this_facility_located?_DISTRICT
LAST VISIT: Where_is_this_facility_located?_STATE
LAST VISIT: Was_this_consultation_a_visit_to_a_public_facility?
LAST VISIT: At_your_last_visit_to_a_public_health_facility_was_any_health_provid
LAST VISIT: At_your_last_visit_to_public_facility_how_long_did_you_have_to_wait.
LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_GOVERNMENT_DOCTOR/
LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_COMPOUNDER_OR_MALE
LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_PHARMACIST
LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_MPW
LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_ANM
LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_STAFF_NURSE
LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_LHV
LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_LAB_TECHNICIAN
LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_RADIOGRAPHER
LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_CLERK
LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_PRIVATE_QUALIFIED_
LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_PRIVATE_COMPOUNDER
LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_PRIVATE_PHARMACIST
LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_BENGALI_DOCTOR
LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_TBA/DAI
LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_VHW/CHW
LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_HRW
LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_BHOPA/TRADITIONAL_
LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_OTHER
LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_OTHER_SPECIFY
LAST VISIT: Would_you_ever_go_back_to_this_facility_again_if_necessary?
LAST VISIT: Why_would_you_not_go_back_to_this_facility?
LAST VISIT: Was_this_consultation_a_visit_to_a_bhopa?
LAST VISIT: Did you get CONSULTATION?
LAST VISIT: Did you have to pay for CONSULTATION?
LAST VISIT: Did you pay for CONSULTATION?
LAST VISIT: Did you get MEDICATION_GIVEN_IN_FACILITY?
LAST VISIT: Did you have to pay for MEDICATION_GIVEN_IN_FACILITY?
LAST VISIT: Did you pay for MEDICATION_GIVEN_IN_FACILITY?
LAST VISIT: Did you get MEDICATION_BOUGHT_OUTSIDE_FACILITY?
LAST VISIT: Did you have to pay for MEDICATION_BOUGHT_OUTSIDE_FACILITY?
LAST VISIT: Did you pay for MEDICATION_BOUGHT_OUTSIDE_FACILITY?
LAST VISIT: Did you get INJECTION?
LAST VISIT: Did you have to pay for INJECTION?
LAST VISIT: Did you pay for INJECTION?
LAST VISIT: Did you get DRIP?
LAST VISIT: Did you have to pay for DRIP?
LAST VISIT: Did you pay for DRIP?
LAST VISIT: Did you get OPERATION?
LAST VISIT: Did you have to pay for OPERATION?
LAST VISIT: Did you pay for OPERATION?
LAST VISIT: Did you get LAB_TEST?
LAST VISIT: Did you have to pay for LAB_TEST?
LAST VISIT: Did you pay for LAB_TEST?
LAST VISIT: Did you get OTHER_TREATMENT?
LAST VISIT: Did you have to pay for OTHER_TREATMENT?
LAST VISIT: Did you pay for OTHER_TREATMENT?
LAST VISIT: Did you get TRANSPORTATION_(ROUND_TRIP)?
LAST VISIT: Did you have to pay for TRANSPORTATION_(ROUND_TRIP)?
LAST VISIT: Did you pay for TRANSPORTATION_(ROUND_TRIP)?
LAST VISIT: TOTAL_EXPENSE_INCURRED_for_this_visit
LAST VISIT: How_much_did_this_visit_to_the_bhopa_cost_in_total?
LAST VISIT: At_this_visit,_were_you_referred_to_another_health_facility?
LAST VISIT: To_which_type_of_health_facility_were_you_referred?
LAST VISIT: To_which_type_of_health_facility_were_you_referred?_OTHER_SPECIFY
LAST VISIT: Did_you_go_to_this_facility_where_you_were_referred?
LAST VISIT: CP:_Have_you_asked_about_the_next_to_last_visit_to_a_health_facility
LAST VISIT: Facility_code
NEXT-TO-LAST VISIT: How_much_time_ago_was_it?_NUMBER
NEXT-TO-LAST VISIT: How_much_time_ago_was_it?_UNITS
NEXT-TO-LAST VISIT: When_was_the_respondent’s_last_visit_to_a_health_facility?
NEXT-TO-LAST VISIT: For_whose_condition_did_you_visit_health_facility?_OWN
NEXT-TO-LAST VISIT: For_whose_condition_did_you_visit_health_facility?_SPOUSE
NEXT-TO-LAST VISIT: For_whose_condition_did_you_visit_health_facility?_CHILD
NEXT-TO-LAST VISIT: For_whose_condition_did_you_visit_health_facility?_PARENT
NEXT-TO-LAST VISIT: For_whose_condition_did_you_visit_health_facility?_OTHER_REL
NEXT-TO-LAST VISIT: For_whose_condition_did_you_visit_health_facility?_NEIGHBOR
NEXT-TO-LAST VISIT: For_whose_condition_did_you_visit_health_facility?_OTHER
NEXT-TO-LAST VISIT: For_whose_condition_did_you_visit_health_facility?_OTHER_SPE
NEXT-TO-LAST VISIT: Was_anyone_from_this_household_with_you_during_this_visit/co
NE1T-TO-LAST VISIT: Who was with you?
NE2T-TO-LAST VISIT: Who was with you?
NE3T-TO-LAST VISIT: Who was with you?
NE4T-TO-LAST VISIT: Who was with you?
NE5T-TO-LAST VISIT: Who was with you?
NE6T-TO-LAST VISIT: Who was with you?
NE7T-TO-LAST VISIT: Who was with you?
NE8T-TO-LAST VISIT: Who was with you?
NE9T-TO-LAST VISIT: Who was with you?
NE10T-TO-LAST VISIT: Who was with you?
NE11T-TO-LAST VISIT: Who was with you?
NE12T-TO-LAST VISIT: Who was with you?
NEXT-TO-LAST VISIT: Why_did_you_visit_a_health_facility_or_consult_a_health_prov
NEXT-TO-LAST VISIT: Which_type_of_facility_did_you_visit?
NEXT-TO-LAST VISIT: Which_type_of_facility_did_you_visit?_OTHER_SPECIFY
NEXT-TO-LAST VISIT: Was_this_facility/health_provider_public_or_private?
NEXT-TO-LAST VISIT: What_is_the_name_of_the_facility_or_health_provider?
NEXT-TO-LAST VISIT: Was_this_consultation_with_a_health_provider_in_your_own_hom
NEXT-TO-LAST VISIT: Where_is_this_health_provider_based?_FACILITY_NAME
NEXT-TO-LAST VISIT: Where_is_this_health_provider_based?_VILLAGE
NEXT-TO-LAST VISIT: Where_is_this_health_provider_based?_TEHSIL
NEXT-TO-LAST VISIT: Where_is_this_health_provider_based?_DISTRICT
NEXT-TO-LAST VISIT: Where_is_this_health_provider_based?_STATE
NEXT-TO-LAST VISIT: Where_is_this_facility_located?_VILLAGE
NEXT-TO-LAST VISIT: Where_is_this_facility_located?_TEHSIL
NEXT-TO-LAST VISIT: Where_is_this_facility_located?_DISTRICT
NEXT-TO-LAST VISIT: Where_is_this_facility_located?_STATE
NEXT-TO-LAST VISIT: Was_this_consultation_a_visit_to_a_public_facility?
NEXT-TO-LAST VISIT: At_your_last_visit_to_a_public_health_facility_was_any_healt
NEXT-TO-LAST VISIT: At_your_last_visit_to_public_facility_how_long_did_you_have_
NEXT-TO-LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_GOVERNMENT
NEXT-TO-LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_COMPOUNDER
NEXT-TO-LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_PHARMACIST
NEXT-TO-LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_MPW
NEXT-TO-LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_ANM
NEXT-TO-LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_STAFF_NURS
NEXT-TO-LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_LHV
NEXT-TO-LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_LAB_TECHNI
NEXT-TO-LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_RADIOGRAPH
NEXT-TO-LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_CLERK
NEXT-TO-LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_PRIVATE_QU
NEXT-TO-LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_PRIVATE_CO
NEXT-TO-LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_PRIVATE_PH
NEXT-TO-LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_BENGALI_DO
NEXT-TO-LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_TBA/DAI
NEXT-TO-LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_VHW/CHW
NEXT-TO-LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_HRW
NEXT-TO-LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_BHOPA/TRAD
NEXT-TO-LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_OTHER
NEXT-TO-LAST VISIT: Who_did_you_see_at_your_last_visit_to_a_facility?_OTHER_SPEC
NEXT-TO-LAST VISIT: Would_you_ever_go_back_to_this_facility_again_if_necessary?
NEXT-TO-LAST VISIT: Why_would_you_not_go_back_to_this_facility?
NEXT-TO-LAST VISIT: Was_this_consultation_a_visit_to_a_bhopa?
NEXT-TO-LAST VISIT: Did you get CONSULTATION?
NEXT-TO-LAST VISIT: Did you have to pay for CONSULTATION?
NEXT-TO-LAST VISIT: Did you pay for CONSULTATION?
NEXT-TO-LAST VISIT: Did you get MEDICATION_GIVEN_IN_FACILITY?
NEXT-TO-LAST VISIT: Did you have to pay for MEDICATION_GIVEN_IN_FACILITY?
NEXT-TO-LAST VISIT: Did you pay for MEDICATION_GIVEN_IN_FACILITY?
NEXT-TO-LAST VISIT: Did you get MEDICATION_BOUGHT_OUTSIDE_FACILITY?
NEXT-TO-LAST VISIT: Did you have to pay for MEDICATION_BOUGHT_OUTSIDE_FACILITY?
NEXT-TO-LAST VISIT: Did you pay for MEDICATION_BOUGHT_OUTSIDE_FACILITY?
NEXT-TO-LAST VISIT: Did you get INJECTION?
NEXT-TO-LAST VISIT: Did you have to pay for INJECTION?
NEXT-TO-LAST VISIT: Did you pay for INJECTION?
NEXT-TO-LAST VISIT: Did you get DRIP?
NEXT-TO-LAST VISIT: Did you have to pay for DRIP?
NEXT-TO-LAST VISIT: Did you pay for DRIP?
NEXT-TO-LAST VISIT: Did you get OPERATION?
NEXT-TO-LAST VISIT: Did you have to pay for OPERATION?
NEXT-TO-LAST VISIT: Did you pay for OPERATION?
NEXT-TO-LAST VISIT: Did you get LAB_TEST?
NEXT-TO-LAST VISIT: Did you have to pay for LAB_TEST?
NEXT-TO-LAST VISIT: Did you pay for LAB_TEST?
NEXT-TO-LAST VISIT: Did you get OTHER_TREATMENT?
NEXT-TO-LAST VISIT: Did you have to pay for OTHER_TREATMENT?
NEXT-TO-LAST VISIT: Did you pay for OTHER_TREATMENT?
NEXT-TO-LAST VISIT: Did you get TRANSPORTATION_(ROUND_TRIP)?
NEXT-TO-LAST VISIT: Did you have to pay for TRANSPORTATION_(ROUND_TRIP)?
NEXT-TO-LAST VISIT: Did you pay for TRANSPORTATION_(ROUND_TRIP)?
NEXT-TO-LAST VISIT: TOTAL_EXPENSE_INCURRED_for_this_visit
NEXT-TO-LAST VISIT: How_much_did_this_visit_to_the_bhopa_cost_in_total?
NEXT-TO-LAST VISIT: At_this_visit,_were_you_referred_to_another_health_facility?
NEXT-TO-LAST VISIT: To_which_type_of_health_facility_were_you_referred?
NEXT-TO-LAST VISIT: To_which_type_of_health_facility_were_you_referred?_OTHER_SP
NEXT-TO-LAST VISIT: Did_you_go_to_this_facility_where_you_were_referred?
NEXT-TO-LAST VISIT: CP:_Have_you_asked_about_the_next_to_last_visit_to_a_health_
NEXT-TO-LAST VISIT: Facility_code
CP: Is one of last two visits a visit to a private facility (excluding bhopas)?
When was your last visit to private facility (for own health or someone else’s)?
CP: Is one of the last two visits a visit to a public health facility?
When was your last visit to public facility (for own health or someone else’s)?
Why don’t you go to public health facilities?
CP: Is one of the last two visits a visit to a bhopa?
When was your last visit to a bhopa (for own health or someone else’s)?
Why have you never been to a health facility or consulted a health provider?
How satisfied are you with your life right now? (FACES: 1 (SAD) TO 5 (HAPPY))
How often have you FELT SAD in the last week?
How often have you CRIED A LOT in the last week?
How often have you NOT FELT LIKE EATING in the last week?
How often have you NOT FELT LIKE DOING YOUR WORK in the last week?
How often has your SLEEP BEEN RESTLESS in the last week?
Last year, did you have a period lasting >=1 month when you felt worried...?
What was the source of these worries or tensions?
Has that period ended or is it still going on?
How much did these worries interfere with ability to do normal activities?
Last year, did you visit a health facility for reasons related to your worries?
Which type of facility did you visit? CHC/PHC
Which type of facility did you visit? GOVERNMENT_REFERRAL_HOSPITAL
Which type of facility did you visit? PRIVATE_HOSPITAL
Which type of facility did you visit? ARYUVEDIC_HOSPITAL
Which type of facility did you visit? T.B._HOSPITAL
Which type of facility did you visit? DISPENSARY
Which type of facility did you visit? AIDPOST/SUBCENTRE
Which type of facility did you visit? ANGANWADI
Which type of facility did you visit? HEALTH_CAMP
Which type of facility did you visit? NGO_CLINIC
Which type of facility did you visit? PRIVATE_QUALIFIED_DOCTOR
Which type of facility did you visit? PRIVATE_COMPOUNDER/NURSE
Which type of facility did you visit? PRIVATE_PHARMACIST
Which type of facility did you visit? BENGALI_DOCTOR
Which type of facility did you visit? GOVERNMENT_DOCTOR,_PRIVATE_PRACTICE
Which type of facility did you visit? OTHER_GOVERNMENT_PRACTITIONER,_PRIVATE
Which type of facility did you visit? TBA/DAI
Which type of facility did you visit? VHW/CHW
Which type of facility did you visit? HRW
Which type of facility did you visit? BHOPA/TRADITIONAL_HEALER
Which type of facility did you visit? OTHER_SPECIFY
Which type of health facility did you visit? OTHER, SPECIFY
What are the issues that sometimes are reasons of concern for you?
Do you expect life to get better for you and your family in the next few years?
Why expect life to get worse/why can’t you say whether it will get better?
Do you have plans to do things to make life better for you and your family?
If YES, what are these plans?
Do you currently smoke cigarettes or bidis, use paan, hukka, or chew tobacco?
What do you smoke/chew use? CIGARETTES
What do you smoke/chew use? BIDIS
What do you smoke/chew use? PAAN
What do you smoke/chew use? HUKKA
What do you smoke/chew use? CHEW_TOBACCO
What do you smoke/chew use? OTHER_SPECIFY
What do you smoke/chew/use? OTHER, SPECIFY
If ‘YES’ to any above, how much do you use in a day?
Have you used cig., bidi, or tobacco/paan products on daily basis in past?
Do you ever drink alcohol or toddy?
Have you ever drunk alcohol or toddy in the past?
Do you think anyone in this household drinks too much?
What problems does it cause?
Are you a member of TRADITIONAL_VILLAGE_COMMITTEE?
How often do you participate in TRADITIONAL_VILLAGE_COMMITTEE activities?
Are you a member of CASTE_COMMITTEE?
How often do you participate in CASTE_COMMITTEE activities?
Are you a member of CHURCH_TEMPLE_MOSQUE_DEVRA_SECT_OR_GURU?
How often do you participate in CHURCH_TEMPLE_MOSQUE_DEVRA_SECT_OR_GURU activiti
Are you a member of SEVA_MANDIR?
How often do you participate in SEVA_MANDIR activities?
Are you a member of NON_SM_JOINT_FOREST_MANAGEMENT_COMMITTEE?
How often do you participate in NON_SM_JOINT_FOREST_MANAGEMENT_COMMITTEE activit
Are you a member of NON_SM_WOMEN'S_ORG/COOP,_SAVINGS_GROUP,_OR_INCOME_GEN_GROUP?
How often do you participate in NON_SM_WOMEN'S_ORG/COOP,_SAVINGS_GROUP,_OR_INCOM
Are you a member of ANY_GROUPS_OR_ACTIVITIES_WITH_ANOTHER_NGO?
How often do you participate in ANY_GROUPS_OR_ACTIVITIES_WITH_ANOTHER_NGO activi
Are you a member of YOUTH_CLUB,_INCLUDING_NAVYUG_MANDAL?
How often do you participate in YOUTH_CLUB,_INCLUDING_NAVYUG_MANDAL activities?
Are you a member of BHAJAN_MANDAL,_SAT_SONG?
How often do you participate in BHAJAN_MANDAL,_SAT_SONG activities?
Are you a member of POLITICAL_PARTY?
How often do you participate in POLITICAL_PARTY activities?
Are you a member of OTHER?
How often do you participate in OTHER activities?
Is there a group of people (excl. family) with whom you do regular activities?
If yes, how often do you meet?
If yes, what is this regular activity?
Did you attend the last Gram Sabah?
Did you attend the last Ward Sabah?
CP: Is the respondent above 18?
Did you vote in the last panchayat election?
In last year, have you or anyone in your family been the victim of a crime?
If yes, what crimes were committed against you/your family in last 12 months?
Do people in your (close) family respect you?
Do the people in your falla respect you?
Would you say that the people in your falla can be trusted?
What are the major causes of conflict in your phala?
Do you discuss personal issues with anyone outside your close family?
How often do you usually speak to this person?
Ending time of module. HOUR
Ending time of module. MINUTE
Did you have to go back a second time?
When did you go back? DAY
When did you go back? MONTH
When did you go back? YEAR
Starting time of module, visit 2. HOUR
Starting time of module, visit 2. MINUTE
Ending time of module, visit 2. HOUR
Ending time of module, visit 2. MINUTE
Comprehension level of respondent
Cooperation level of respondent
How much did others assist the respondent with his/her answers?
Who was helping the respondent with his/her answers? (CODE FROM BOARD IF IN HH)
Who was helping the respondent with his/her answers? NAME
Date of health measurements. DAY
Date of health measurements. MONTH
Date of health measurements. YEAR
Height of the respondent (cm)
Weight of the respondent (Kg)
Is the respondent wearing any heavy item?
Is the respondent wearing ANKLETS?
Is the respondent wearing NECKLACE?
Is the respondent wearing HEAVY_BRACELETS?
Is the respondent wearing OTHER_HEAVY_ITEM?
Blood pressure 1
Blood pressure 2
Pulse
Hb (g/dl)
Body temperature (Celsius)
How much time does it take the respondent to squat and stand up 5 times? (sec)
Pick flow meter reading 1 (L/min)
Pick flow meter reading 2 (L/min)
Pick flow meter reading 3 (L/min)
Total number of hh members
Household/person weight: strata pop / strata sample pop