HOUSEHOLD HEALTH AND SOCIO-ECONOMIC SURVEY …faculty.som.yale.edu/mushfiqmobarak/ongoingprojects/bangladesh/... · household health and socio-economic survey 2009 ... spouse questionnaire

X:\Inputs for webpage\garments\final Bangla version\Spouse_BNG.doc 1

HOUSEHOLD HEALTH AND SOCIO-ECONOMIC SURVEY 2009

SPOUSE/FEMALE HEAD QUESTIONNAIRE

(Centre for Research and Consultancy) 2/17 Iqbal Road, Mohammadpur, Dhaka-1207, Bangladesh

Tel: 880-2-8118065/9115503, Email: [email protected], Fax: 880-2-9126806


SPOUSE QUESTIONNAIRE

STARTING TIME: .

BARI No.: HH ID No.

CONTACT INFORMATION

CVR1 Name and line number of the head of the household:

CVR2 Name of the wife of household head & Line No.

CVR3 Para name:

CVR4 Village/mohalla name:

CVR5 Union/Ward Name:

CVR6 Name of Respondent and Line No.

INTERVIEWER INFORMATION:

CVR7 Interviewer name and Code no.:

CVR8 Supervisor name and Code no.:

DATE OF INTERVIEW: DDMMYY

CVR9 Date 1:

CVR10 Date 2:

CVR11 Status of interviews Completed 1 Incompleted 2 CVR12 Reason for not interviewing:


m¤§wZ cÎ

Avm& mvjvgy AvjvBKzg/Av`ve,

Avgvi bvg .................................................................................|

Avgiv wgÎ GÛ G‡mvwm‡qU&m bv‡gi GKwU cÖvB‡fU M‡elYv cÖwZôvb †_‡K G‡mwQ| Gi cÖavb Kvh©vjq XvKvq Aew ’Z|

Avgv‡ì †`‡ki Av_©-mvgvwRK AeKvVv‡gvi Dbœqbg~jK Kg©m~wPi mwVK ev —evq‡b mvnvh¨ Kivi R‡b¨ Avgv‡ì cÖwZôvb

wewfbœ Rwic Kv‡R mv¶vrKvi MÖnY K‡i _v‡K| eZ©gv‡b Avgiv Household Health and Socio-economic Survey

cwiPvjbv KiwQ| Gi D‡Ïk¨ n‡jv, cwiev‡ii Av_©-mvgvwRK Ae ’v I Rxeb hvÎvi gvb g~j¨vqb Kiv| GB mv¶vrKv‡ii

R‡b¨ 1:00 N›Uv cÖ‡qvRb n‡e| Avcbvi cÖ Ë Z_¨ m¤ú~Y©fv‡e †Mvcb ivLv n‡e Ges Ab¨ KvD‡K †`Lv‡bv n‡e bv|

GB Rwi‡c Ask MÖnY m¤ú~Y©fv‡e Avcbvi B”Qvi Ici wbf©i Ki‡Q Ges Avcwb B”Qv Ki‡j †Kv‡bv GKwU cÖ‡kœi ev m¤ú~Y©

cÖ‡kœi DËi bv-I w`‡Z cv‡ib| Zvi ciI Avkv Ki‡ev, Avcwb GB Rwi‡c Ask MÖnY Ki‡eb| †Kbbv Avcbvi gZvgZ GB

Rwi‡ci R‡b¨ AZ¨š— ¸i“Z¡c~Y©|

GLb Avcwb Rwic m¤ú‡K© wKQy Rvb‡Z PvB‡j Avgv‡K wR‡Ám Ki‡Z cv‡ib|

Avwg wK GLb mv¶vrKvi †bqv ïi“ Ki‡Z cvwi?

mv¶vrKvi MÖnYKvixi ^v¶i.................................... ZvwiL ............................... DËi`vZv DËi w`‡Z ivRx n‡q‡Qb.....................................1

DËi`vZv DËi w`‡Z ivRx nbwb ............................... 2 END


SECTION 1: MAR: COUPLE’S MARITAL LIFE

WMAR1a. mv¶vrKvi MÖnYKvix, wb‡Pi cÖkœ ‡jv Kivi mgq wK Zvi ¯vgx Dcw ’Z wQ‡jb?

nu v..................................................... 1 bv...................................................... 2

WMAR1b. mv¶vrKvi MÖnYKvix, ¯^vgxi cwiev‡ii †KD wK Dcw¯’Z wQ‡jb? (†hgb k¦vïwo)

nu v..................................................... 1 bv...................................................... 2

WMAR2 ‡Kvb& mv‡j Avcbv‡ì we‡q nq? mvj ............................... Rvwbbv ...........................................9998

WMAR3 Avcbvi (cÖ_g) we‡qi mgq Avcbvi eqm KZ wQj? eqm c~Y© eQ‡i............................

WMAR4 Avcbvi ¯vgxi eqm IB mgq KZ wQj? eqm c~Y© eQ‡i............................

WMAR5 Avcbvi ¯vgxi wK GKB mg‡q KL‡bv GKvwaK ¿x wQj? bv...................................................... 0 nu v, 2 ¯¿x ............................................ 2 nu v, 3 ¯¿x............................................. 3 nu v, 4 ¯¿x............................................. 4

WMAR6 we‡qi ci †_‡K Avcbvi ¯vgx K‡Zv Nb Nb Avcbv‡K bZzb Rvgv-Kvco wK‡b w`‡q‡Qb?

cÖvq KL‡bv bv .............................................0 eQ‡i GKevi (†hgb GK C‡`) .....................1 eQ‡i yB evi (†hgb yB C‡`).......................2 eQ‡i 3-4 evi .............................................3 eQ‡i 5-10 evi ...........................................4 gv‡m GKevi ...............................................5

WMAR7 Avcbvi †Q‡j‡g‡qiv †QvU _vK‡Z w`‡b Kq †ejv Lvevi †L‡Zv?

w`‡b yB †ejv..............................................1 w`‡b wZb †ejv.............................................2 cÖ‡hvR¨ bq..................................................8

WMAR8 Avcbvi †Q‡j‡g‡qiv hLb †QvU wQj ZLb K‡Zv Nb Nb Mi“/QvMj/gyiwMi gvsm †L‡Z †c‡q‡Q?

KLbI bv ..................................................00 †KejgvÎ C‡` ...........................................01 eQ‡i 3-5 evi ...........................................02 gv‡m Aš—Z GKevi.....................................03 gv‡m Aš—Z `yB evi ....................................04 mßv‡n GK evi ..........................................05 mßv‡n Aš—Z `yB evi ..................................06 mßv‡n 3-4 evi .........................................07 cÖwZw`bB ..................................................08 cÖ‡hvR¨ bq................................................98

WMAR9 Avcbvi †Q‡j‡g‡qiv hLb †QvU wQj ZLb K‡Zv Nb Nb gvQ †L‡Z †c‡q‡Q?

KLbI bv ..................................................00 †KejgvÎ C‡` ...........................................01 eQ‡i 3-5 evi ...........................................02 gv‡m Aš—Z GKevi.....................................03 gv‡m Aš—Z `yB evi ....................................04 mßv‡n GK evi ..........................................05 mßv‡n Aš—Z `yB evi ..................................06 mßv‡n 3-4 evi .........................................07 cÖwZw`bB ..................................................08 cÖ‡hvR¨ bq................................................98

WMAR10 Avcbvi ¯vgxi mv‡_ Avcbvi Kx iKg m¤úK© Av‡Q/wQj? fvj ................................................... 1 †gvUvgywU.............................................. 2 Lvivc ................................................. 3

WMAR11 Avcbvi k¦ï‡ii mv‡_ Avcbvi Kx iKg m¤úK© Av‡Q/wQj? fvj ................................................... 1 †gvUvgywU.............................................. 2 Lvivc ................................................. 3 cÖ‡hvR¨ bq (we‡qi c~‡e© k¦ïi gviv †M‡Q)........7


WMAR12 Avcbvi k¦vïoxi mv‡_ Avcbvi Kx iKg m¤úK© Av‡Q/wQj? fvj ................................................... 1 †gvUvgywU.............................................. 2 Lvivc ................................................. 3 cÖ‡hvR¨ bq (we‡qi c~‡e© k¦vïox gviv †M‡Q)......7

WMAR13 Avcwb wK g‡b K‡ib ¿x‡K KL‡bv gviai Kivi AwaKvi †Kv‡bv ¯vgxi i‡q‡Q?

nu v..................................................... 1 bv...................................................... 2 Rvwbbv ................................................ 7

WMAR14 nu¨v n‡j, †Kvb& †Kvb& cwiw ’wZ‡Z? (GKvwaK DËi n‡Z cv‡i)

†hŠZz‡Ki R‡b¨ ............................................ A ¯vgxi K_v bv ïbv ........................................ B Lvivc Pwi‡Îi Rb¨ ....................................... C Av`k© gvZv bq ‡m Rb¨ .................................. D k¦ïi-k¦vïwo/¯vgxi fvB‡evb‡ì cÖwZ ye© envi K‡i ........................................................... E cvwievwiK Kv‡R e¨_©/fvj bv n‡j ......................F ¯^vgx‡K cQ›` K‡i bv/Ab¨ cyi“l/gwnjv‡K cQ›` ...G †Kvb †`vl QvovB gviai K‡i ........................... H Ab¨vb¨ ___________________________ Z

(wbw ©ó Ki“b) cÖ‡hvR¨ bq .................................................. X

WMAR15 Avcbvi ¯vgx wK KL‡bv Avcbv‡K gviai K‡i‡Qb? bv...................................................... 0 nu v, GKevi .......................................... 1 nu¨v, GKvwaKevi .................................... 2 nu¨v, wbqwgZ.......................................... 3

WMAR16 nu v n‡j, gvia‡ii KviY Kx wQj? (GKvwaK DËi n‡Z cv‡i)

†hŠZz‡Ki R‡b¨ ............................................ A ¯vgxi K_v bv ïbv ........................................ B Lvivc Pwi‡Îi Rb¨ ....................................... C Av`k© gvZv bq ‡m Rb¨ .................................. D k¦ïi-k¦vïwo/¯vgxi fvB‡evb‡ì cÖwZ ye© envi K‡i ........................................................... E cvwievwiK Kv‡R e¨_©/fvj bv n‡j ......................F ¯^vgx‡K cQ›` K‡i bv/Ab¨ cyi“l/gwnjv‡K cQ›` ...G †Kvb †`vl QvovB gviai K‡i ........................... H †Kv‡bv DËi †`bwb .......................................... I Ab¨vb¨ ___________________________ Z

(wbw ©ó Ki“b) cÖ‡hvR¨ bq .................................................. X

WMAR17 Avcbvi ¯vgxi ev ¯vgxi cwiev‡ii GB ai‡bi Lvivc AvPi‡Yi wei“‡× Avcbvi †Kv‡bv AvZ¥xq wK cÖwZev` K‡iwQ‡jb?

bv...................................................... 0 nu v, GKevi .......................................... 1 nu¨v, GKvwaKevi .................................... 2 nu¨v, wbqwgZ.......................................... 3 cÖ‡hvR¨ bq .......................................... 8

Section 2: MOBILITY AND DECISIONS MAKING

WMD1 Avcwb K‡Zv Nb Nb evwoi evB‡i hvb (†hgb †`vKv‡b, Kv‡R hvIqv BZ¨vw`)?

cÖvq KL‡bv bv ............................................ 0 eQ‡i GKevi (†hgb GK C‡`) .................... 1 eQ‡i yB evi (†hgb Dfq C‡`).................... 2 eQ‡i 3-4 evi ............................................ 3 eQ‡i 5-10 evi .......................................... 4 gv‡m GKevi ............................................... 5 cÖwZ mßv‡n ................................................. 6 cÖvq cÖwZw`b................................................ 7


WMD2 AvZ¥xq- ^Rb, eÜz-evÜe‡K †`L‡Z Avcwb K‡Zv Nb Nb

evwoi evB‡i †eov‡Z hvb? cÖvq KL‡bv bv ............................................ 0 eQ‡i GKevi (†hgb GK C‡`) .................... 1 eQ‡i yB evi (†hgb Dfq C‡`).................... 2 eQ‡i 3-4 evi ............................................ 3 eQ‡i 5-10 evi .......................................... 4 gv‡m GKevi ............................................... 5 cÖwZ mßv‡n ................................................. 6 cÖvq cÖwZw`b................................................ 7

WMD3 Lvbvi †Kv‡bv wm×vš— wb‡Z Avcbvi ^vgx wK Avcbvi mv‡_ civgk© K‡ib?

KL‡bv bv .............................................0 KL‡bv KL‡bv ........................................1 cÖvq mgq .............................................2

me mgq ..............................................3 eZ©gv‡b weevwnZ bb ................................4

WMD4. Avcwb hw` 100 UvKvi Kg cwigvY A_© LiP Ki‡Z Pvb, Zv‡Z wK Avcbvi ¯^vgxi AbygwZi cÖ‡qvRb nq?

nu¨v .....................................................1 bv ......................................................2 eZ©gv‡b weevwnZ bb ................................3

WMD5. Avcwb hw` 300 UvKvi †ewk LiP Ki‡Z Pvb, Zv‡Z wK Avcbvi ¯vgxi AbygwZi cÖ‡qvRb nq?


WMD6. Avcbvi wb‡Ri Rb¨ hw` wKQy wKb‡Z Pvb Zvn‡j wK Avcbvi ¯vgxi AbygwZi cÖ‡qvRb nq? (†hgb, Pzwo, bvwi‡Kj †Zj, mvevb BZ¨vw`)


wm×vš— †bqvi e¨vcv‡i †K †K RwoZ, Ges wb‡Pi welq¸‡jv m¤ú‡K© †K P~ovš— wm×vš— †bb:

wm×vš— A. ‡K †K RwoZ (†KvW †`Lyb) GKvwaK DËi n‡Z cv‡i

B. P~ovš— wm×vš— Kvi (†KvW †`Lyb)

WMD7. Avcbvi DcvR©b Kxfv‡e e¨q Ki‡eb A B C D E F G H I J 1 2 3 4 5 6 7 8

WMD8. Avcbvi ¯^vgxi DcvR©b Kxfv‡e e¨q Ki‡eb A B C D E F G H I J 1 2 3 4 5 6 7 8

WMD9. ev”Pv‡ì KLb Wv³vi †`Lv‡eb A B C D E F G H I X 1 2 3 4 5 6 7 9

WMD10. ev”Pv‡ì we`¨vj‡q cvVv‡eb wKbv A B C D E F G H I X 1 2 3 4 5 6 7 9

WMD11. ev”Pv‡ì R‡b¨ Kvco-‡Pvco †Kbv A B C D E F G H I X 1 2 3 4 5 6 7 9

WMD12. Avcbvi R‡b¨ Kvco-‡Pvco †Kbv A B C D E F G H I 1 2 3 4 5 6 7

‡K †K RwoZ (†KvW †`Lyb) (WMD 7-12A) P~ovš— wm×vš— Kvi (WMD 7-12B) A= ¯^vgx B= ¯¿x/wb‡RB C= eo †Q‡j D= Ab¨vb¨ †Q‡j E= eo †g‡q F= Ab¨vb¨ †g‡q G= ¯^vgxi wcZvgvZv H= ¯vgxi Ab¨vb¨ AvZ¥xq I= ¿xi Ab¨vb¨ AvZ¥xq J= DcvR©b bvB X= cÖ‡hvR¨ bq

1= ¯vgx 2= ¿x/wb‡RB 3= ¯vgx ¿xi †hŠ_ P~ovš— wm×vš— 4= ev”Pviv 5= ¯^vgx I ev”Pv‡ì †hŠ_ P~ovš— wm×vš— 6= ¯¿x I ev”Pv‡ì †hŠ_ P~ovš— wm×vš— 7= cwiev‡ii mevi wm×vš— 8= DcvR©b bvB 9= cÖ‡hvR¨ bq


WMD13 Avcbvi ¯vgxi evwo †_‡K evevi evwo †h‡Z KZ¶Y mgq

jv‡M? N›Uv..........................................

wgwbU ........................................ WMD14 we‡qi ci K‡Zv Nb Nb Avcwb wbR cwievi‡K †`L‡Z

†h‡Z †c‡i‡Qb?

cÖvq KL‡bv bv ............................................ 0 eQ‡i GKevi (†hgb GK C‡`)...................... 1 eQ‡i yB evi (†hgb Dfq C‡`) .................. 2 eQ‡i 3-4 evi ............................................ 3 eQ‡i 5-10 evi .......................................... 4 gv‡m GKevi ............................................... 5 cÖwZ mßv‡n ................................................. 6 cÖvq cÖwZw`b................................................ 7

Section 3: DOWRY

WD1 we‡qi mgq Avcbvi ¯^vgxi cwievi‡K †hŠZzK wn‡m‡e †Kv‡bv wKQy †`qv n‡qwQj?

nu v .....................................................1 bv ......................................................2 Rvwbbv.................................................7

WD2 nu¨v n‡j, GB UvKv cwi‡kva KivUv Avcbvi cwiev‡ii R‡b¨ mnR bv Kómva¨ wQj?

mnR...................................................1 Kómva¨ ...............................................2 Rvwbbv.................................................7 cÖ‡hvR¨ bq ............................................8

WD3 we‡qi mgq †hŠZzK eve` K‡Zv UvKv w`‡qwQj? UvKv ................... cÖ‡hvR¨ bq ..................................999998

WD4 KZ w`b ci GB UvKv cwi‡kva Kiv n‡qwQj? gvm .......................................... eQi.......................................... cÖ‡hvR¨ bq .....................................9998

WD5 Avcbvi ¯vgx ev Zvi cwievi wK we‡qi ci AviI †hŠZzK †P‡q‡Qb?

nu¨v .....................................................1 bv ......................................................2 Rvwbbv.................................................7

WD6 Avcbvi cwievi wK we‡qi ci AviI †hŠZzK w`‡q‡Qb? nu¨v .....................................................1 bv ......................................................2 Rvwbbv.................................................7 cÖ‡hvR¨ bq ............................................8

WD7 we‡qi mgq Avcbv‡K ev Avcbvi ¯vgx‡K (†hŠZzK Qvov) me©‡gvU KZ UvKvi Dcnvi mvgMÖx w`‡qwQ‡jb?

UvKv ................... cÖ‡hvR¨ bq ..................................999998

WD8 Avcbvi we‡q‡Z Avcbvi wcZv-gvZv me©‡gvU KZ UvKv LiP K‡iwQ‡jb?

UvKv ................... cÖ‡hvR¨ bq ..................................999998

WD9 Avcbvi evevi cwiev‡ii Zzjbvq Avcbvi ^vgxi cwiev‡ii m¤ú‡ì cwigvY †Kgb?

A‡bK †ewk abx .....................................1 †ewk abx..............................................2 cÖvq mgvb.............................................3 Kg Avw_©K m½wZ....................................4 A‡bK Kg Avw_©K m½wZ ...........................5

WD10 Avcbvi we‡qi mgq Avcbvi ¯vgxi cwiev‡ii wK cwigvY Rwg (mKj cÖKvi Rwg) wQj?

Rwgi cwigvY ’vbxq gv‡ci GKK ..........

’vbxq gv‡ci GKK = kZvsk ..........

................................ . GKi kZvsk Rvwbbv ...........................................9998


Section 4: KINSHIP (GB †mKk‡b DËi`vZv me© v gwnjv Lvbv cÖavb/Lvbv cÖav‡bi ¿x)| WKIN1 Avcwb wK g‡b K‡ib AvZ¥xq-¯R‡bi

g‡a¨ we‡q n‡j Rb¥ †bqv ev”Pv‡ì mvaviY ^v‡ ’ i Ici Gi ¶wZKi cÖfve co‡e, bvwK G‡Z †Kv‡bv cÖfveB co‡e bv?

†ewk ¶wZ ......................................1Kg ¶wZ ........................................2†Kv‡bv cÖfve †bB .............................3Rvwbbv...........................................4m„wó KZv©i B”Qv ................................8

WKIN2 Avcwb wK g‡b K‡ib AvZ¥xq- ^R‡bi g‡a¨ we‡q n‡j ^vgx- ¿xi g‡a¨ ewbebv fvj nq bv Lvivc nq, bvwK G‡Z †Kv‡bv cÖfveB c‡o bv?

fvj ......................................... 1 Lvivc....................................... 2 †Kv‡bv cÖfve †bB ........................ 3 Rvwbbv...................................... 4 m„wó KZv©i B”Qv ........................... 8

WKIN3 Avcwb wK g‡b K‡ib AvZ¥xq-¯R‡bi g‡a¨ we‡q n‡j Rb¥ †bqv wkï‡ì eyw×gËvi Ici ¶wZKi cÖfve co‡e, bvwK G‡Z †Kv‡bv cÖfveB co‡e bv?

†ewk eyw×gvvb ..................................1Kg eyw×gvb.....................................2†Kv‡bv cÖfve †bB .............................3Rvwbbv...........................................4m„wó KZv©i B”Qv ................................8

WKIN4 Avcwb wK g‡b K‡ib, AvZ¥xq-¯^R‡bi g‡a¨ we‡q Ki‡j k¦ïi c¶‡ì mv‡_ m¤ú‡K©i Dbœqb nq?

fvj ......................................... 1 Lvivc....................................... 2 †Kv‡bv cÖfve †bB ........................ 3 Rvwbbv...................................... 4 m„wó KZv©i B”Qv ........................... 8

WKIN5 Avcbvi g‡Z Avcb AvZ¥xq ¯Rb‡ì g‡a¨ we‡q n‡j BwZevPK cÖfve/fvj w`K¸‡jv Kx Kx?

Rvwbbv/g‡b Ki‡Z cviwQ bv.................0†hŠZzK Kg jv‡M ............................. ADËivwaKvi my‡Î cÖvß m¤úwË fvM Ki‡Z nq bv .................................. Bwkï `v`v`v`x-bvbvbvbxi Kv‡Q †_‡K AwaKZi hZœ cvq ............................ CAb¨vb¨ ..........................................Z

WKIN6 AvZ¥xq-¯R‡bi g‡a¨ we‡q Kivi Ab¨vb¨ †bwZevPK cÖfve/Lvivc w`K¸‡jv Kx Kx? (cÖ‡hvR¨ mKj †KvW e„ËvwqZ Ki“b)|

0 = Rvwbbv ev g‡b Ki‡Z cviwQ bv A = †ewki fvM mgq ev”Pviv Amy ’ _v‡K B = mvgvb¨ K_v‡Z SMov nq C = AvZ¥xqZv ev‡o bv D = m¤§vb cvIqv hvq bv E = †hŠZzK/Ab¨vb¨ wRwbm †ewk w`‡Z nq F = ¯^vgx/ ¿xi g‡a¨ m¤úK© fv‡jv nq bv Z = Ab¨vb¨ wbw ©ó Ki“b

eZ©gv‡b weevwnZ wKš‘ †Kv‡bv KvwR‡bi mv‡_ we‡q bv n‡j WKIN7 hvb (HR11 †`Lyb, hw` †KvW 01-06 bv nq): WKIN7 Avcbvi wcZvgvZv wK Avcbv‡K †Kv‡bv

AvZ¥x‡qi mv‡_ we‡q †`qvi K_v we‡ePbv K‡iwQ‡jb?

nu¨v ...............................................1bv ................................................2Rvwbbv...........................................4

WKIN8 bv n‡j, †Kb bq? (cÖ‡hvR¨ mKj †KvW e„ËvwqZ Ki“b)|

A = mwVK eq‡mi KvwRb cvBwb B = mwVK eq‡mi KvwRb‡ì B‡Zvg‡a¨ we‡q n‡q wM‡qwQj C = Avgvi KvwR‡bi cwievi †hŠZz‡Ki A_© w`‡Z A¶g wQj D = Avgvi AvZ¥x‡qi evB‡i Dchy³ cvÎx cvIqv wM‡qwQj X = Rvwbbv Z = Ab¨vb¨ wbw ©ó Ki“b


eskMZ ^v ’ mgm¨vi †Kv‡bv BwZnvm Av‡Q wK? ( ^ZtdzZ¡ DË‡ii mKj †KvW e„ËvwqZ Ki“b) WKIN9 Avcbvi evevi w`‡Ki cvwievwiK Kx Kx

¯^v¯’¨ mgm¨v Av‡Q AbyMÖn K‡i ejyb? 0= Rvwbbv/†Kv‡bv mgm¨v nq wb A= Wvqv‡ewUK B= nv‡U©i †ivM C= K¨vÝvi D= G¨vRgv ev k¦vmbvjx (k¦vmKó, k¦ k¦ kã Kiv, †QvU †QvU I AwbqwgZ wbtk¦vm) E= Pg©‡ivM F= h²v X= cÖ‡hvR¨ bq Z= Ab¨vb¨ (wbw`©ó Ki“b)

WKIN10 Avcbvi gv‡qi w`‡Ki cvwievwiK Kx Kx ^v ’ mgm¨v Av‡Q AbyMÖn K‡i ejyb?

0= Rvwbbv/†Kv‡bv mgm¨v nq wb A= Wvqv‡ewUK B= nv‡U©i †ivM C= K¨vÝvi D= G¨vRgv ev k¦vmbvjx (k¦vmKó, k¦ k¦ kã Kiv, †QvU †QvU I AwbqwgZ wbtk¦vm) E= Pg©‡ivM F= h²v X= cÖ‡hvR¨ bq Z= Ab¨vb¨ (wbw ©ó Ki“b)

WKIN11 evevi w`‡Ki KZRb GB mgm¨v¸wji m¤§yLxb n‡q‡Qb?

WKIN12 gv‡qi w`‡Ki KZRb GB mgm¨v¸wji m¤§yLxb n‡q‡Qb?

WKIN13 Avcwb wK KL‡bv Avcbvi †Q‡j‡K Zvi

Avcb PvPvZ/dzdvZ/gvgvZ/LvjvZ (dv÷© KvwRb) †evb‡ì mv‡_ we‡qi e¨vcv‡i AbygwZ †`‡eb?

nu¨v.....................................................1 bv......................................................2 Rvwbbv ................................................7 cÖ‡hvR¨ bq...........................................8 me †Q‡ji Av‡MB we‡q n‡q †M‡Q................9

WKIN14 Avcwb wK KL‡bv Avcbvi †Q‡j‡K Zvi Avcb PvPvZ/dzdvZ/gvgvZ/LvjvZ †evb‡ì Qvov Ab¨vb¨ AvZ¥xq ¯^R‡bi A_©vr †m‡KÛ KvwR‡bi mv‡_ we‡qi e¨vcv‡i AbygwZ †`‡eb?

nu v ........................................1 bv .........................................2 Rvwbbv ...................................7 cÖ‡hvR¨ bq ..............................8 me †Q‡ji Av‡MB we‡q n‡q †M‡Q ...9

WKIN15 Avcwb wK KL‡bv Avcbvi †g‡q‡K Zvi Avcb PvPvZ/dzdvZ/gvgvZ/LvjvZ (dv÷© KvwRb) fvB‡ì mv‡_ we‡qi e¨vcv‡i AbygwZ †`‡eb?

nu¨v.....................................................1 bv......................................................2 Rvwbbv ................................................7 cÖ‡hvR¨ bq...........................................8 me †g‡qi Av‡MB we‡q n‡q †M‡Q................9

WKIN16 Avcwb wK KL‡bv Avcbvi †g‡q‡K Zvi Avcb PvPvZ/dzdvZ/gvgvZ/LvjvZ fvB‡ì Qvov Ab¨vb¨ AvZ¥xq ¯^R‡bi A_©vr †m‡KÛ KvwR‡bi mv‡_ we‡qi e¨vcv‡i AbygwZ †`‡eb?

nu v ........................................1 bv .........................................2 Rvwbbv ...................................7 cÖ‡hvR¨ bq ..............................8 me †g‡qi Av‡MB we‡q n‡q †M‡Q ...9


SECTION 5: PREGNANCY HISTORY Respondent Name __________________ Line # _________ HH # ___________ Bari serial # ____________ WPH1a. RxweZ †Q‡j mš—v‡bi msL¨v WPH1b. RxweZ Rb¥ wb‡q gviv †M‡Q Ggb †Q‡j mš—v‡bi msL¨v

WPH1c. RxweZ †g‡q mš—v‡bi msL¨v WPH1d. RxweZ Rb¥ wb‡q gviv †M‡Q Ggb †g‡q mš—v‡bi msL¨v

WPH1e. Mf©cvZ/Mf©b‡ói msL¨v (Miscarriage/abortion) WPH1f. g„Z mš—vb R‡b¥i msL¨v

WPH1g. hw` eZ©gv‡b Mf©eZ©x nq Zvn‡j e‡· 1 wjLyb

WPH1h. †gvU M‡f©i msL¨v

WPH2 WPH3 WPH4 WPH5 WPH6 WPH7 WPH8 WPH9 WPH10 WPH11 WPH12a WPH12b WPH12c M‡f©i msL¨v (me©‡kl Mf© w`‡q ïi“ Ki“b)

(me©‡kl Mf© w`‡q ïi“ Ki“b) wkïi bvg hw` cÖ‡hvR¨ nq

Mf©Kvjxb mg‡q Avcwb wK Amy¯’ wQ‡jb ev we‡kl †Kv‡bv Amy¯’Zv †eva K‡iwQ‡jb? 1= nu¨v 2= bv

GB Mf©Kvjxb mg‡q Avcwb wK aygcvb K‡iwQ‡jb? 1= nu v 2= bv

M‡f©i djvdj wK wQj 1= RxweZ Rb¥ --> WPH8 2= g„Z Rb¥--> WPH8 3= Mf©bó/ Mf©cvZ 4= eZ©gv‡b Mf©eZx (cieZ©x jvB‡b hvb)

Mf© bó/Mf©cvZ n‡j 1= Mf© ïi“‡Z 2= gaëZx© mg‡q 3= ‡kl mg‡q (cieZ©x jvB‡b hvb)

†Kvbv mv‡ji †Kvb& gv‡m Rb¥ MÖnY K‡iwQj? (g„Z Rb¥ n‡j cieZ©x jvB‡b hvb) gvm mvj

†Q‡j bv †g‡h 1= ‡Q‡j 2= ‡g‡q

†Wwjfvwii mgq Kx ai‡bi ¯^v¯’¨ †mev`vZv Dcw¯’Z wQ‡jb? (†KvW †`Lyb) GKvwaK DËi n‡Z cv‡i

beRvZ‡Ki ¯^v¯’¨ mgm¨v (R‡b¥i 11 gvm ev Zvi wb‡P) (†KvW †`Lyb) GKvwaK DËi n‡Z cv‡i

(bvg) wK eZ©gv‡b RxweZ? 1= nu v 2= bv--> WPH12c

(bvg ) Gi eZ©gvb eqm K‡Zv? (eQ‡i) --> WPH13

g„Z n‡j, g„Zz i ZvwiL wjLyb (cieZ©x jvB‡b hvb) gvm mvj

01 1 2 1 2 1 2 3 4 1 2 3 1 2 1 2 02 1 2 1 2 1 2 3 4 1 2 3 1 2 1 2 03 1 2 1 2 1 2 3 4 1 2 3 1 2 1 2 04 1 2 1 2 1 2 3 4 1 2 3 1 2 1 2 05 1 2 1 2 1 2 3 4 1 2 3 1 2 1 2 06 1 2 1 2 1 2 3 4 1 2 3 1 2 1 2 07 1 2 1 2 1 2 3 4 1 2 3 1 2 1 2 1 eQ‡ii wkï‡ì ¯v ’¨ mgm¨vi †KvW: (WPH11) GKvwaK DËi n‡Z cv‡i †Wwjfvwii mgq ¯^v¯’¨ †mev`vZvi Dcw¯’wZ (WPH10) 0= †Kv‡bv mgm¨v bvB A= A¯^vfvweK †QvU ev”Pv B= i³k~Y¨Zv (wkïwU wK d¨vKv‡k wQj?) C= wXjwX‡j ev”Pv (`ye©j †ckx) D= wkïwU me©¶b KvbœvKvwU KiZ (AwZ weiw³fve)

E= wkïwU Aw ’i wQj F= wkïwU R‡b¥i mgqB wKQy †¶‡Î kvixwiK A¶gZv

G= †c‡Ui/A‡š¿i cxov (nvZ-cv Qyov) (baby throws up?) H= k¦vmbvjx (k¦vmKó, k¦ k¦ kã Kiv, †QvU †QvU I AwbqwgZ wbtk¦vm) I= `yN©Ubv (†hgb Wy‡e hvIqv) J= Zxeª R¡i

K= Wvqwiqv L= nvg M= wLPzwb/abyósKvi N= h²v X= cÖ‡hvR¨ bq Z= Ab¨vb¨ (wbw ©ó Ki“b)

0= ‡KD bv A= MÖv‡gi eq¯‹ gwnjv B= mbvZb `vB C= cÖwk¶YcÖvß `vB D= cÖwk¶YcÖvß bvm© E= Wv³vi (GgweweGm)

F= cvk bv Kiv Wv³vi G= FWV/SACMO/ PARAMEDICS Z= Ab¨vb¨ (wbw ©ó Ki“b)


WPH2 WPH3 WPH4 WPH5 WPH6 WPH7 WPH8 WPH9 WPH10 WPH11 WPH12a WPH12b WPH12c M‡f©i msL¨v (me©‡kl Mf© w`‡q ïi“ Ki“b)

(me©‡kl Mf© w`‡q ïi“ Ki“b) wkïi bvg hw` cÖ‡hvR¨ nq

Mf©Kvjxb mg‡q Avcwb wK Amy¯’ wQ‡jb ev we‡kl †Kv‡bv Amy¯’Zv †eva K‡iwQ‡jb? 1= nu¨v 2= bv

GB Mf©Kvjxb mg‡q Avcwb wK aygcvb K‡iwQ‡jb? 1= nu v 2= bv

M‡f©i djvdj wK wQj 1= RxweZ Rb¥ --> WPH8 2= g„Z Rb¥--> WPH8 3= Mf©bó/ Mf©cvZ 4= eZ©gv‡b Mf©eZx (cieZ©x jvB‡b hvb)

Mf© bó/Mf©cvZ n‡j 1= Mf© ïi“‡Z 2= gaëZx© mg‡q 3= ‡kl mg‡q (cieZ©x jvB‡b hvb)

†Kvbv mv‡ji †Kvb& gv‡m Rb¥ MÖnY K‡iwQj? (g„Z Rb¥ n‡j cieZ©x jvB‡b hvb) gvm mvj

†Q‡j bv †g‡h 1= ‡Q‡j 2= ‡g‡q

†Wwjfvwii mgq Kx ai‡bi ¯^v¯’¨ †mev`vZv Dcw¯’Z wQ‡jb? (†KvW †`Lyb) GKvwaK DËi n‡Z cv‡i

beRvZ‡Ki ¯^v¯’¨ mgm¨v (R‡b¥i 11 gvm ev Zvi wb‡P) (†KvW †`Lyb) GKvwaK DËi n‡Z cv‡i

(bvg) wK eZ©gv‡b RxweZ? 1= nu v 2= bv--> WPH12c

(bvg ) Gi eZ©gvb eqm K‡Zv? (eQ‡i) --> WPH13

g„Z n‡j, g„Zz i ZvwiL wjLyb (cieZ©x jvB‡b hvb) gvm mvj

08 1 2 1 2 1 2 3 4 1 2 3 1 2 1 2 09 1 2 1 2 1 2 3 4 1 2 3 1 2 1 2 10 1 2 1 2 1 2 3 4 1 2 3 1 2 1 2 11 1 2 1 2 1 2 3 4 1 2 3 1 2 1 2 12 1 2 1 2 1 2 3 4 1 2 3 1 2 1 2 13 1 2 1 2 1 2 3 4 1 2 3 1 2 1 2 14 1 2 1 2 1 2 3 4 1 2 3 1 2 1 2 15 1 2 1 2 1 2 3 4 1 2 3 1 2 1 2 16 1 2 1 2 1 2 3 4 1 2 3 1 2 1 2 1 eQ‡ii wkï‡ì ¯v ’¨ mgm¨vi †KvW: (WPH11) GKvwaK DËi n‡Z cv‡i †Wwjfvwii mgq ¯^v¯’¨ †mev`vZvi Dcw¯’wZ (WPH10) 0= †Kv‡bv mgm¨v bvB A= A¯^vfvweK †QvU ev”Pv B= i³k~Y¨Zv (wkïwU wK d¨vKv‡k wQj?) C= wXjwX‡j ev”Pv (`ye©j †ckx) D= wkïwU me©¶b KvbœvKvwU KiZ (AwZ weiw³fve)

E= wkïwU Aw ’i wQj F= wkïwU R‡b¥i mgqB wKQy †¶‡Î kvixwiK A¶gZv

G= †c‡Ui/A‡š¿i cxov (nvZ-cv Qyov) (baby throws up?) H= k¦vmbvjx (k¦vmKó, k¦ k¦ kã Kiv, †QvU †QvU I AwbqwgZ wbtk¦vm) I= `yN©Ubv (†hgb Wy‡e hvIqv) J= Zxeª R¡i

K= Wvqwiqv L= nvg M= wLPzwb/abyósKvi N= h²v X= cÖ‡hvR¨ bq Z= Ab¨vb¨ (wbw ©ó Ki“b)

0= ‡KD bv A= MÖv‡gi eq¯‹ gwnjv B= mbvZb `vB C= cÖwk¶YcÖvß `vB D= cÖwk¶YcÖvß bvm© E= Wv³vi (GgweweGm)

F= cvk bv Kiv Wv³vi G= FWV/SACMO/ PARAMEDICS Z= Ab¨vb¨ (wbw ©ó Ki“b)


WPH2 WPH13 WPH14a WPH14b WPH15 WPH16 WPH17 WPH18a WPH18b WPH19 WPH20 †Kvb& eq‡m ‡Q‡o w`‡qwQj Ges †Kvb& eq‡m cybivq ¯‹z‡j wM‡qwQj?

†Kvb& gva¨wgK ¯‹z‡j

(bvg) cÖ_g hvIqv ïi“

K‡ib?

M‡f©i msL¨v/bvg me©‡kl Mf© w`‡q ïi“ Ki“b

GB wkï‡K wK †ivM cÖwZ‡laK wUKv w`‡q‡Qb? 1= nu v 2= bv 8= cÖ‡hvR¨ bq

WPH12b †`Lyb: (hw` eqm 5 eQi ev Zvi †ewk nq) (bvg)

wK eZ©gv‡b ¯‹z‡j hvq? 1= nu v--> WPH15 2= bv

(bvg) wK

KLbI we`¨vj‡q wM‡qwQj? 1= nu v 2= bv--> WPH25

(bvg) hLb

¯‹z‡j hvIqv ïi“ K‡i ZLb eqm KZ wQj?

we`¨vj‡q cÖ_g hvevi R‡b¨ wkïwU wK bZzb Rvgv Kvco, RyZv †c‡qwQj? 1= nu v 2= bv

Ggb †Kv‡bv mgq wQj wK hLb

(bvg) ¯‹z‡j hvIqv

†Q‡o w`‡qwQj Ges cybivq ¯‹z‡j wM‡qwQj? 1= nu v 2= bv -->WPH19

Qvovi eqm (eQ‡i)

cybivq hvIqvi eqm (eQ‡i)

(bvg) m‡e©v”P †Kvb& K¬vk cvk K‡i‡Qb?

00= ¯‹z‡j wM‡qwQj wKš‘ †Kv‡bv K¬vk cvk K‡iwb 01-09= ‡kªYx ch©š— c‡o‡Qb 10= GmGmwm 12= GBPGmwm 14= weG/weGmwm/ weKg 16= øvZ‡KvËi 17= Wv³vi/BwÄwbqvi/ DwKj (hw` gva¨wgK we`¨vj‡q bv hvq Z‡e --> WPH25 hvb)

¯‹z‡ji †KvW ev hw` ZvwjKvq bv _v‡K Zvn‡j ¯‹z‡ji bvg wjLyb

01 1 2 8 1 2 1 2 1 2 1 2

02 1 2 8 1 2 1 2 1 2 1 2

03 1 2 8 1 2 1 2 1 2 1 2

04 1 2 8 1 2 1 2 1 2 1 2

05 1 2 8 1 2 1 2 1 2 1 2

06 1 2 8 1 2 1 2 1 2 1 2

07 1 2 8 1 2 1 2 1 2 1 2

08 1 2 8 1 2 1 2 1 2 1 2

09 1 2 8 1 2 1 2 1 2 1 2

10 1 2 8 1 2 1 2 1 2 1 2

11 1 2 8 1 2 1 2 1 2 1 2

12 1 2 8 1 2 1 2 1 2 1 2

13 1 2 8 1 2 1 2 1 2 1 2

14 1 2 8 1 2 1 2 1 2 1 2

15 1 2 8 1 2 1 2 1 2 1 2

16 1 2 8 1 2 1 2 1 2 1 2


WPH2 WPH21a WPH21b WPH22a WPH22b WPH23 WPH24 WPH25 WPH26 WPH27 WPH28 me©‡kl Mf© w`‡q ïi“ Ki“b bvg

cyivZb c×wZ‡Z cix¶vq AskMÖnY Ki‡j (bvg)

GmGmwm‡Z †Kvb wWwfkb †c‡q‡Qb 1 = 1g wefvM 2 = 2q wefvM 3 = 3q wefvM 7 = ‡dj K‡i‡Q 8 = Rvwbbv 9 = cÖ‡hvR¨ bq

bZzb c×wZ‡Z cix¶vq AskMÖnY Ki‡j

(bvg)

GmGmwm‡Z †Kvb †MÖW †c‡q‡Qb 8 = Rvwbbv 9 = cÖ‡hvR¨ bq

cyivZb c×wZ‡Z cix¶vq AskMÖnY Ki‡j (bvg)

GBPGmwm‡Z †Kvb wWwfkb †c‡q‡Qb 1 = 1g wefvM 2 = 2q wefvM 3 = 3q wefvM 7 = ‡dj K‡i‡Q 8 = Rvwbbv 9 = cÖ‡hvR¨ bq


(bvg)

GBPGmwm‡Z †Kvb †MÖW †c‡q‡Qb 8 = Rvwbbv 9 = cÖ‡hvR¨ bq

(ïaygvÎ †g‡q‡ì Rb¨)

(bvg) wK

†g‡q‡ì gva¨wgK we`¨vj‡q Dce„wË †c‡q‡Qb 1 = nu v 2 = bv --> WPH25

(ïaygvÎ †g‡q‡ì Rb¨) we`¨vj‡qi †Kvb& †kªYx‡Z covi mgq cÖ_g Dce„wË †c‡q‡Qb

WPH12b †`Lyb: (hw` eqm 8 eQi ev Zvi †ewk nq)

(bvg) †QvU

_vK‡Z †Kv‡bv KvR Ki‡Zv 1 = nu v 2 = bv--> WPH28 9 = cÖ‡hvR¨ bq --> WPH28

(hw` eqm 8 eQi ev Zvi †ewk nq) ev”Pv †QvU _vK‡Z Kx ai‡bi KvR Ki‡Zv? (GKvwaK DËi n‡Z cv‡i) A = evwoi wfZ‡i KvR (cwi®‹vi cwi”Qbœ BZ¨vw`) B= cwiev‡ii Lvgv‡i KvR C = †QvU fvB‡evb‡ì †`Lvïbv D = ivbœv evbv E = evwoi evwn‡i Lvgv‡i UvKvi wewbg‡q KvR F = evwoi evwn‡i UvKvi wewbg‡q Ab¨ KvR

GB KvRwU wK (bvg)

wbqwgZ Ki‡Zv bv gv‡Sgv‡S Ki‡Zv 1 = wbqwgZ2 = gv‡Sgv‡S

(bvg) eZ©gv‡b †Kv_vq emevm

K‡ib? 1= GB evwo/Lvbvq 2= Ab¨ evwo wKš‘ GKB MÖvg 3= Ab¨ MÖvg wKš‘ GKB _vbv 4= Ab¨ _vbv, GKB ‡Rjv (XvKv bMix e¨wZwi‡K) 5= XvKv bMix 6= wfbœ †Rjv wKš‘ GKB †`k 7= Ab¨ †`k

01 1 2 1 2 9 A B C D E F 1 2 1 2 3 4 5 6 7

02 1 2 1 2 9 A B C D E F 1 2 1 2 3 4 5 6 7

03 1 2 1 2 9 A B C D E F 1 2 1 2 3 4 5 6 7

04 1 2 1 2 9 A B C D E F 1 2 1 2 3 4 5 6 7

05 1 2 1 2 9 A B C D E F 1 2 1 2 3 4 5 6 7

06 1 2 1 2 9 A B C D E F 1 2 1 2 3 4 5 6 7

07 1 2 1 2 9 A B C D E F 1 2 1 2 3 4 5 6 7

08 1 2 1 2 9 A B C D E F 1 2 1 2 3 4 5 6 7

09 1 2 1 2 9 A B C D E F 1 2 1 2 3 4 5 6 7

10 1 2 1 2 9 A B C D E F 1 2 1 2 3 4 5 6 7

11 1 2 1 2 9 A B C D E F 1 2 1 2 3 4 5 6 7

12 1 2 1 2 9 A B C D E F 1 2 1 2 3 4 5 6 7

13 1 2 1 2 9 A B C D E F 1 2 1 2 3 4 5 6 7

14 1 2 1 2 9 A B C D E F 1 2 1 2 3 4 5 6 7

15 1 2 1 2 9 A B C D E F 1 2 1 2 3 4 5 6 7

16 1 2 1 2 9 A B C D E F 1 2 1 2 3 4 5 6 7


WPH2 WPH29 WPH30a WPH31b WPH32 WPH33 WPH34 WPH35 WPH36

(bvg) Gi we‡q K‡e

n‡qwQj?

me©‡kl Mf© w`‡q ïi“ Ki“b bvg

WPH12b †`Lyb: (eqm 10 eQi ev Zvi †ewk n‡j) (bvg) Gi êevwnK

Ae¯’v? 1= KLbI we‡q nqwb --> (cieZ©x jvBb) 2= eZ©gv‡b weevwnZ 3= ZvjvKcÖvß 4= weaev/wecZœxK 5= wew”Qbœv

gvm eQi

we‡qi mgq Avcwb ev Avcbvi ¯vgx (bvg) †K

†h Dcnvi mvgMÖx w`‡qwQ‡jb Zvi g~j¨ K‡Zv?

(bvg) wK i‡³i m¤ú‡K©i †Kv‡bv

AvZ¥xq‡K we‡q K‡iwQj? 01= Avcb PvPv‡Zv fvB/†evb 02= Avcb dzdv‡Zv/gvgv‡Zv fvB/†evb 03= Avcb gvgv‡Zv/dzdv‡Zv fvB/†evb 04= Avcb Lvjv‡Zv fvB/†evb 05= Second Cousin 06= Ab¨vb¨ AvZ¥xq (wbw ©ó Ki“b) 07= AvZ¥xq bq 97= Rvwbbv

(bvg) Gi ^vgx/ ¿xi

wk¶v? 00= cov‡jLv K‡ibwb 01-09= ‡kªYx ch©š— c‡o‡Qb 10= GmGmwm 12= GBPGmwm 14= weG/weGmwm /weKg 16= øvZ‡KvËi 17= Wv³vi/ BwÄwbqvi/DwKj

(bvg) Gi

¯^vgx/¯¿x wK Zvi †P‡q eq‡m eo bvwK †QvU bvwK GKB eq‡mi 1= eo 2= †QvU 3= GKB eqm --> WPH37

(bvg) Gi KZ

eQ‡ii †QvU ev eo

01 1 2 3 4 5 1 2 3

02 1 2 3 4 5 1 2 3

03 1 2 3 4 5 1 2 3

04 1 2 3 4 5 1 2 3

05 1 2 3 4 5 1 2 3

06 1 2 3 4 5 1 2 3

07 1 2 3 4 5 1 2 3

08 1 2 3 4 5 1 2 3

09 1 2 3 4 5 1 2 3

10 1 2 3 4 5 1 2 3

11 1 2 3 4 5 1 2 3

12 1 2 3 4 5 1 2 3

13 1 2 3 4 5 1 2 3 14 1 2 3 4 5 1 2 3 15 1 2 3 4 5 1 2 3 16 1 2 3 4 5 1 2 3


WPH2 WPH37 WPH38 WPH39 WPH40 WPH41 WPH42 me©‡kl Mf© w`‡q ïi“ Ki“b bvg

wcZvgvZv (bvg) †K †Kvb UvKv cqmv

†`b?

1= wKQyB †`q bv 2= wbqwgZ LiP †`q 3= eo ai‡bi Avw_©K 4= msmvi Pvjv‡bvi wbqwgZ LiP 6= Ab¨vb¨ (wbw ©ó Ki“b)

wcZvgvZv (bvg) †K ev Zvi

¯^vgx/ ¿x‡K cwiev‡ii eëmv/K…wlKv‡R wb‡qvwRZ K‡i _v‡Kb? 1= nu v 2= bv

wcZvgvZv (bvg) †K ev Zvi

¯vgx/ ¿x‡K †Kv‡bv eëmv ïi“i R‡b¨ mvnvh¨ K‡iwQ‡jb?

1= nu v 2= bv

(bvg) wK Avcbv‡ì‡K (wcZvgvZv)

†Kv‡bv UvKv cqmv ‡`b?

1= wKQyB †`q bv 2= wbqwgZ LiP †`q 3= eo ai‡bi Avw_©K mnvqZv 4= msmvi Pvjv‡bvi wbqwgZ LiP 6= Ab¨vb¨ (wbw`©ó Ki“b)

(bvg) Gi KqwU mš—vb

i‡q‡Q? (0 n‡j cieZ©x jvB‡b hvb)

cÖ_g ev”Pv Rb¥ MÖn‡Yi mgq (bvg) Gi eqm

K‡Zv wQj?

01 1 2 3 4 6 1 2 1 2 1 2 3 4 6

02 1 2 3 4 6 1 2 1 2 1 2 3 4 6

03 1 2 3 4 6 1 2 1 2 1 2 3 4 6

04 1 2 3 4 6 1 2 1 2 1 2 3 4 6

05 1 2 3 4 6 1 2 1 2 1 2 3 4 6

06 1 2 3 4 6 1 2 1 2 1 2 3 4 6

07 1 2 3 4 6 1 2 1 2 1 2 3 4 6

08 1 2 3 4 6 1 2 1 2 1 2 3 4 6

09 1 2 3 4 6 1 2 1 2 1 2 3 4 6

10 1 2 3 4 6 1 2 1 2 1 2 3 4 6

11 1 2 3 4 6 1 2 1 2 1 2 3 4 6

12 1 2 3 4 6 1 2 1 2 1 2 3 4 6

13 1 2 3 4 6 1 2 1 2 1 2 3 4 6

14 1 2 3 4 6 1 2 1 2 1 2 3 4 6

15 1 2 3 4 6 1 2 1 2 1 2 3 4 6

16 1 2 3 4 6 1 2 1 2 1 2 3 4 6


Section 6: ¿xi Avcb PvPv‡Zv/dzdv‡Zv/gvgv‡Zv/Lvjv‡Zv fvB‡evb (HFC1a †_‡K HFC10b cÖkœ ‡jv ¿xi wcZvi w`‡Ki m¤úwK©Z Ges HFC11a †_‡K HFC20b cÖkœ ‡jv DËi`vZv gv‡qi w`‡Ki m¤úwK©Z Avcbvi evevi Kq Rb Avcb fvB‡evb Av‡Qb/wQ‡jb? HFC1a. fvB ________ HFC1b. ‡evb ________

HFC2a HFC3a HFC4a HFC5a PvPvi bvg GB PvPvi ‡g‡q‡ì msL¨v

88= Rvwbbv --> cieZx© jvB‡b hvb

Avcbvi eq‡mi 8 eQ‡ii g‡a¨ GB PvPvi †g‡q‡ì msL¨v

GB PvPvi †Q‡j‡ì msL¨v Avcbvi eq‡mi 8 eQ‡ii g‡a¨ GB PvPvi †Q‡j‡ì msL¨v (hw` PvPv‡Zv fvB‡K we‡q K‡i _v‡Kb Zvn‡j ¯vgxmn)

1. __________________________

2. __________________________

3. __________________________

4. __________________________

5. __________________________

6. __________________________

7. __________________________

HFC2b HFC3b HFC4b HFC5b dzdzi bvg GB dzdzi †g‡q‡ì msL¨v


Avcbvi eq‡mi 8 eQ‡ii g‡a¨ GB dzdzi †g‡q‡ì msL¨v

GB dzdzi †Q‡j‡ì msL¨v Avcbvi eq‡mi 8 eQ‡ii g‡a¨ GB dzdzi †Q‡j‡ì msL¨v (hw` dzdv‡Zv fvB‡K we‡q K‡i _v‡Kb Zvn‡j ¯vgxmn)

1. __________________________

2. __________________________

3. __________________________

4. __________________________

5. __________________________

6. __________________________

7. __________________________


HFC6a HFC7a HFC8a HFC9a HFC10a HFC5a -†Z wPwýZ Avcbvi eq‡mi 8 eQ‡ii g‡a¨ PvPv‡Zv fvB‡ì bvg (Avcbvi ¯^vgxmn, hw` wZwb Avcbvi PvPv‡Zv fvB nb)

(bvg) wK Avcbvi

†P‡q eq‡m eo, bv †QvU? eo=1 †QvU=2 mg eqmx=3

KZ eQ‡ii eo/†QvU?

Avcbvi we‡qi Av‡M bv c‡i Zvi we‡q n‡qwQj? c~‡e© = 1 c‡i = 2 AweevwnZ = 3 GKB w`b = 4

wZwb wK Ggb †Kv‡bv AvZ¥xq‡K we‡q K‡i‡Qb hvi mv‡_ AvcbviI AvZ¥xqZvi m¤úK© Av‡Q? nu v = 1 bv = 2 cÖ‡hvR¨ bq = 3

A1. _____________________

A2. _____________________

A3. _____________________

A4. _____________________

A5. _____________________

1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

A6. _____________________

A7. _____________________

A8. _____________________

A9. _____________________

A10. ____________________

1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

HFC6b HFC7b HFC8b HFC9b HFC10b HFC5b-†Z wPwýZ Avcbvi eq‡mi 8 eQ‡ii g‡a¨ dzdv‡Zv fvB‡ì bvg (Avcbvi ¯^vgxmn, hw` wZwb Avcbvi dzdv‡Zv fvB nb)

(bvg) wK Avcbvi





A1. _____________________

A2. _____________________

A3. _____________________

A4. _____________________

A5. _____________________

1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

A6. _____________________

A7. _____________________

A8. _____________________

A9. _____________________

A10. ____________________

1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

QHFC10a Ges QHFC10b Gi †¶‡Î mv¶vrKvi MÖnYKvix‡ì cÖwZ wb‡ ©kbv: mKj KvwR‡bi †ejvq GwU cÖ‡hvR¨ (cÖ_g KvwRb ev `~i m¤úKx©q AvZ¥xq), Z‡e KvwR‡bi ¯^vgx/¯¿x‡KI mv¶vrKvi`vbKvix e¨w³i mv‡_ AvZ¥xqZvi m¤úK© _vK‡Z n‡e|


Avcbvi gv‡qi Kq Rb Avcb fvB‡evb Av‡Qb/wQ‡jb? HFC11a. fvB ________ HFC11b. ‡evb ________

HFC12a HFC13a HFC14a HFC15a gvgvi bvg GB gvgvi †g‡q‡ì msL¨v


Avcbvi eq‡mi 8 eQ‡ii g‡a¨ GB gvgvi †g‡q‡ì msL¨v

GB gvgvi †Q‡j‡ì msL¨v Avcbvi eq‡mi 8 eQ‡ii g‡a¨ GB gvgvi †Q‡j‡ì msL¨v (Avcbvi ¯^vgxmn, hw` wZwb Avcbvi gvgv‡Zv fvB nb)

1. ___________________________

2. ___________________________

3. ___________________________

4. ___________________________

5. ___________________________

6. ___________________________

7. ___________________________

HFC12b HFC13b HFC14b HFC15b Lvjvi bvg GB Lvjvi †g‡q‡ì msL¨v


Avcbvi eq‡mi 8 eQ‡ii g‡a¨ GB Lvjvi †g‡q‡ì msL¨v

GB Lvjvi †Q‡j‡ì msL¨v Avcbvi eq‡mi 8 eQ‡ii g‡a¨ GB Lvjvi †Q‡j‡ì msL¨v (Avcbvi ¯^vgxmn, hw` wZwb Avcbvi Lvjv‡Zv fvB nb)

1. ___________________________

2. ___________________________

3. ___________________________

4. ___________________________

5. ___________________________

6. ___________________________

7. ___________________________


HFC16a HFC17a HFC18a HFC19a HFC20a HFC15a -‡Z wPwýZ Avcbvi eq‡mi 8 eQ‡ii g‡a¨ gvgv‡Zv fvB‡ì bvg (Avcbvi ¯^vgxmn, hw` wZwb Avcbvi gvgv‡Zv fvB nb)

(bvg) wK Avcbvi





A1. ___________________

A2. ___________________

A3. ___________________

A4. ___________________

A5. ___________________

1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

A6. ___________________

A7. ___________________

A8. ___________________

A9. ___________________

A10. __________________

1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

HFC16b HFC17b HFC18b HFC19b HFC20b HFC15b-†Z wPwýZ Avcbvi eq‡mi 8 eQ‡ii g‡a¨ Lvjv‡Zv fvB‡ì bvg (Avcbvi ¯vgxmn, hw` wZwb Avcbvi Lvjv‡Zv fvB nb)

(bvg) wK Avcbvi





A1. __________________

A2.___________________

A3.___________________

A4.___________________

A5.___________________

1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

A6. __________________

A7.___________________

A8.___________________

A9.___________________

A10.__________________

1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

QHFC20a Ges QHFC20b Gi †¶‡Î mv¶vrKvi MÖnYKvix‡ì cÖwZ wb‡ ©kbv: mKj KvwR‡bi †ejvq GwU cÖ‡hvR¨ (cÖ_g KvwRb ev `~i m¤úKx©q AvZ¥xq), Z‡e KvwR‡bi ¯vgx/ ¿x‡KI mv¶vrKvi`vbKvix e¨w³i mv‡_ AvZ¥xqZvi m¤úK© _vK‡Z n‡e|


7. SISTERS INFORMATION Respondent Name __________________ Line # _________ HH # ___________ Bari serial # ____________ DËi`vÎxi eqm hw` 50 Gi wb‡P nq Z‡e GB †mKkb cyiY Ki“b Avi hw` 50 Gi †ewk nq Zvn‡j †mKkb 7 I 8 wRÁvmv Kivi ìKvi †bB| S0: Avcbvi eZ©gv‡b RxweZ KqRb †evb Av‡Qb? (mv¶vrKvi MÖnYKvix: eZ©gv‡b RxweZ me †evb‡ì bvg wb‡Pi 2q Kjv‡g ZvwjKve× Ki“b †QvU †evb w`‡q ïi“ Ki“b)

S1 S2 S3 S4 S5 S6 S7 S8 S9 S10 S11 S12 S13a S13b

(bvg) eZ©gv‡b RxweZ

n‡j (bvg) haÑj¡−e

S£¢ha e¡ q−m †Kvb& eq‡m ‡Q‡o w`‡qwQj Ges †Kvb& eq‡m cybivq ¯‹z‡j wM‡qwQj?

†evb bvg

†Kv_vq emevm Ki‡Qb (wb‡Pi †KvW †`Lyb)

eqm (10 eQ‡ii Kg n‡j cieZ©x jvB‡b hvb)

R‡b¥i mvj

g„Zy i mgq eqm (10 eQ‡ii Kg

n‡j cieZ©x

jvB‡b hvb)

(bvg)

hLb ¯‹z‡j hvIqv ïi“ K‡i ZLb Zvi eqm K‡Zv wQj? 88= KL‡bv ¯‹z‡j hvqwb 98= Rvwbbv

Ggb †Kv‡bv mgq wQj wK hLb

(bvg) ¯‹z‡j

hvIqv †Q‡o w`‡qwQj Ges cybivq ¯‹z‡j wM‡qwQj? 1= nu v 2= bv --> (S10-G hvb) 98= Rvwbbv--> (S10-G hvb)

Qvovi eqm

cybivq hvIqvi eqm

(bvg)

m‡ev©”P †Kvb& †kªYx cvk K‡i‡Qb? (hw` †KvW 9 ev Zvi Kg nq Zvn‡j S15 †Z hvb) (wb‡Pi †KvW †`Lyb)

(bvg) wK

†g‡q‡ì gva¨wgK we`¨vj‡q Dce„wË †c‡q‡Qb? 1= nu v 2= bv --> (S13a-G hvb) 98= Rvwbbv --> (S13a-G hvb)

(bvg)

†Kvb& K¬v‡k me© cÖ_g Dce„wË †c‡q‡Qb?

cyivZb c×wZ‡Z cix¶vq AskMÖnY Ki‡j

(bvg) GmGmwm‡Z

†Kvb wWwfkb †c‡q‡Qb 1 = 1g wefvM 2 = 2q wefvM 3 = 3q wefvM 7 = ‡dj K‡i‡Q 8 = Rvwbbv 9 = cÖ‡hvR¨ bq


(bvg)

GmGmwm‡Z †Kvb †MÖW †c‡q‡Qb 8 = Rvwbbv 9 = cÖ‡hvR¨ bq

01

02

03

04

05

06

07

08

09

10

evwoi †KvW (S3) DËi`vZvi eZ©gvb MÖv‡gi mv‡_ Zzjbv Ki“b wk¶vi †KvW (S10) ‰eevwnK Ae¯’v (S15) 1= Ab¨ evwo wKš‘ GKB MÖvg 2= Ab¨ MÖvg wKš‘ GKB _vbv 3= Ab¨ _vbv, GKB ‡Rjv (XvKv bMix e¨wZwi‡K) 4= XvKv bMix 5= wfbœ †Rjv wKš‘ GKB †`k 6= Ab¨ †`k

00= ¯‹z‡j wM‡qwQj wKš‘ †Kv‡bv K¬vk cvk K‡iwb 01-09= †kªYx ch©š— c‡o‡Qb 10= GmGmwm 12= GBPGmwm

14= weG/weGmwm /weKg 16= øvZ‡KvËi 17= Wv³vi/BwÄwbqvi/DwKj 98= KL‡bv ¯‹z‡j hvqwb

1= KLbI we‡q nqwb 2= eZ©gv‡b weevwnZ 3= ZvjvKcÖvß 4= weaev/wecZœxK 5= wew”Qbœv


S14a S14b S15 S16 S17 S18 S19 S20 S21 S22 S23

®h¡e cyivZb c×wZ‡Z cix¶vq AskMÖnY Ki‡j

(bvg) GBPGmwm‡Z

†Kvb wWwfkb †c‡q‡Qb 1 = 1g wefvM 2 = 2q wefvM 3 = 3q wefvM 7 = †dj K‡i‡Q 8 = Rvwbbv 9 = cÖ‡hvR¨ bq


(bvg)

GBPGmwm‡Z †Kvb †MÖW †c‡q‡Qb 8 = Rvwbbv 9 = cÖ‡hvR¨ bq

(bvg) Gi êevwnK

Ae ’v 1 = KL‡bv we‡q nqwb --> S26 2 = eZ©gv‡b weevwnZ 3 = ZvjvKcÖvß 4 = weaev/wecZ¥xK 5 = wew”Qbœv

¯^vgx †Kvb& †kªYx ch©š— c‡o‡Qb?

(wb‡Pi †KvW †`Lyb)

(bvg) Gi

KZ eQi hver we‡q n‡q‡Q?

DK=88

(bvg) Gi ¯vgx

wK Zvi †P‡q eq‡m eo bvwK †QvU bvwK GKB eq‡mi 1= eo 2= †QvU 3= GKB eqm --> S20

(bvg) Gi

KZ eQ‡ii †QvU ev eo (eQi) 98 = Rvwbbv

(bvg) Gi

we‡q‡Z KZ UvKv †hŠZyK †`qv n‡qwQj? (hw` bv nq

Z‡e ‘0’ wjLyb ev Rvwbbvi Rb¨

‘DK’ wjLyb)

Avcbvi evev-gv

(bvg) Gi we‡qi

mgq Zv‡K Ges Zvi ¯vgx‡K K‡Zv UvKvv Dcnvi mvgMÖx w`‡qwQ‡jb? (hw` bv nq Z‡e

‘0’ wjLyb ev Rvwbbvi Rb¨

‘DK’ wjLyb)

(bvg) Gi

we‡q‡Z me©‡gvU K‡Zv UvKv LiP n‡qwQj? (hw` bv nq Z‡e

‘0’ wjLyb ev Rvwbbvi Rb¨

‘DK’ wjLyb)

¯vgxi cwiev‡ii gvwjKvbvaxb Rwgi cwigvY? Rvwbbvi Rb¨

‘DK’ wjLyb) kZvs‡k wjLyb

01

02

03

04

05

06

07

08

09

10

wk¶vi †KvW (S16) 00= ¯‹z‡j wM‡qwQj wKš‘ †Kv‡bv K¬vk cvk K‡iwb 01-09= †kªYx ch©š— c‡o‡Qb 10= GmGmwm 12= GBPGmwm

14= weG/weGmwm /weKg 16= øvZ‡KvËi 17= Wv³vi/BwÄwbqvi/DwKj 98= KL‡bv ¯‹z‡j hvqwb DK= Rvwbbv


S24 S25 S26 S27 S28 S29 S30 S31 S32 S33 S34

†evb Avcbvi wcZvi cwiev‡ii Zzjbvq

(bvg) ¯vgxi cwiev‡ii

m¤ú‡ì cwigvY †Kgb? (see codes below)

(bvg) ¯^vgx wK

Avcbv‡ì i‡³i m¤ú‡K©i AvZ¥xq? (see codes below)

(bvg) wK KL‡bv

evwoi evB‡i KvR K‡i‡Qb? 1 = nu v 2 = bv (>> S33)

(bvg) hLb

evwoi evwn‡i KvR Avi¤¢ K‡iwQ‡jb ZLb Zvi eqm KZ wQj? (eqm)

(bvg) wK

eZ©gv‡b evwoi evB‡i KvR Ki‡Qb? 1 = nu¨v (>>S30) 2 = bv

†Kvb& eq‡m evwoi evB‡i KvR Kiv †Q‡o w`‡q‡Qb? (eqm)

Gevi Avgiv Avcbvi ‡ev‡bi& cÖavb KvR m¤ú‡K© Avjvc Ki‡ev, †h Kv‡R Avcbvi †ev‡bi †ewki fvM mgq e¨q n‡q‡Q| GUv wK Mv‡g©›Um&-G PvKwi? 1 = nu v (>> S32) 2 = bv

Avcbvi †evb Kx ai‡bi cÖwZôv‡b KvR Ki‡Zb ev K‡ib? (wb‡Pi †KvW †`Lyb)

Avcbvi †ev‡bi gvwmK †eZb K‡Zv, hw` GLb Avi KvR bv K‡ib Zvn‡j KvR Qvovi Av‡M gvwmK †eZb KZ wQj? DK= Rvwbbv

Avcbvi †ev‡bi ev”Pv KqRb? (0 n‡j cieZx© jvB‡b hvb)

cÖ_g ev”Pv nIqvi mgq

(bvg) Gi eqm

K‡Zv wQj? cieZ©x jvB‡b hvb

01

02

03

04

05

06

07

08

09

10

m¤ú‡ì Zzjbv (S24) AvZ¥xqZvi ai‡bi †KvW (S25) ‡ckvi †KvW (S31) 1 = A‡bK †ewk abx 2 = †ewk abx 3 = cÖvq mgvb 4 = Kg Avw_©K m½wZ 5 = A‡bK Kg Avw_©K m½wZ 8= Rvwbbv

^vgx. . . . . 01= PvPv‡Zv fvB 02= dzdv‡Zv/gvgv‡Zv fvB 03= gvgv‡Zv/dzdv‡Zv fvB 04= Lvjv‡Zv fvB

05= Second Cousin 06= Ab¨vb¨ AvZ¥xq (wbw`©ó Ki“b) 07= AvZ¥xq bq 08= Reve †`bwb 97= Rvwbbv

A= K…wl gRyi B= wk¶KZv C= ¯^v¯’¨ †mevv D= M„n¯’vjx KvR E= Ab¨vb¨ †mevg~jK wkí F= wi·v/f¨vb PvjK

G= Drcv`bkxj wkí (Mv‡g©›Um& bq) H= LyPiv we‡µZv Z= Ab¨vb¨ (wbw ©ó Ki“b)


8. BROTHER INFORMATION Respondent Name __________________ Line # _________ HH # ___________ Bari serial # ____________ BO. Avcbvi me©‡gvU KZRb RxweZ fvB Av‡Q (†QvU fvB w`‡q ïi“ Ki“b)| ......................................

B1 B2 B3 B4 B5 B6 B7 B8 B9 B10 eZ©gv‡b RxweZ bv n‡j fvB bvg eZ©gv‡b

RxweZ n‡j eqm

R‡b¥i mvj g„Zz i mgq eqm

(bvg) Gi êevwnK Ae ’v

1= KLbI we‡q nqwb --> (cieZ©x jvBb) 2= eZ©gv‡b weevwnZ 3= ZvjvKcÖvß 4= weaev/wecZœxK 5= wew”Qbœv

we‡qi mgq eqm 98= Rvwbbv

¯^vgx I ¿xi g‡a¨ †Kv‡bv AvZ¥xqZvi m¤úK© wQj wK? 01= PvPv‡Zv fvB 02= dzdv‡Zv/gvgv‡Zv fvB 03= gvgv‡Zv/dzdv‡Zv fvB 04= Lvjv‡Zv fvB 05= Second Cousin 06= Ab¨vb¨ AvZ¥xq (wbw`©ó Ki“b) 07= AvZ¥xq bq 08= Reve †`bwb 97= Rvwbbv

(bvg) †h †hŠZzK

†c‡q‡Qb Zvi ¿xi cwiev‡ii KvQ †_‡K Zvi g~j¨? (UvKvq) (hw` bv nq Z‡e

‘0’ wjLyb ev

Rvwbbvi Rb¨ ‘DK’ wjLyb)

(bvg) Zvi ¿xi

cwiev‡ii KvQ †_‡K Ab¨vb¨ †h Dcnvi †c‡q‡Qb Zvi g~j¨? (UvKvq) (hw` bv nq Z‡e

‘0’ wjLyb ev

Rvwbbvi Rb¨ ‘DK’ wjLyb)

01

02

03

04

05

06

07

08

09

10

Ending Time: .

Documents

HOUSEHOLD HEALTH AND SOCIO-ECONOMIC SURVEY …faculty.som.yale.edu/mushfiqmobarak/ongoingprojects/bangladesh/... · household health and socio-economic survey 2009 ... spouse questionnaire