Questionnaire Text

Questionnaire form view entire document:  text  image
11. Type of disability
[] 00 No handicap
[] 01 Cerebral motor infirmity

Motor:
[] 02 Amputated
[] 03 Paralyzed

Visual:
[] 04 Amblyopic (visually impaired)
[] 05 Blind

Auditory/Verbal:
[] 06 Hard of hearing
[] 07 Deaf
[] 08 Mute

Intellectual:
[] 09 With Down syndrome
[] 10 Autistic
[] 11 Mentally impaired or retarded

Mental
[] 12 Mentally ill

Write down the codes for the three main declared disabilities

_ _ 1st
_ _ 2nd
_ _ 3rd
Questionnaire instructions view entire document:  text  image
Section 2: Individual characteristics of household members

Questions 1 [order number] to 12 [residency status] apply to all persons to count in the household.

11. Type of Handicap

A handicap is defined as a limitation of physical and/or mental abilities of a person, due to a deficiency that is congenital or acquired during one's existence. In other terms, it is a disadvantage of which a person suffers following an infirmity or incapacity and that prohibits them for totally or partially fulfilling a task that is otherwise normal given their age, sex, and different cultural factors. Any person incapable of fulfilling alone all or some necessities of a normal individual or social life, as a result of a deficiency, congenital or not, of their physical or mental capacities is considered handicapped.

Below is the list of elementary handicaps that the 4th GPHC of Benin has retained:

[] 00. No handicap

Mental handicap
[] 12. Mentally ill - A person suffering from an illness characterized by the presence of delirious ideas and/or hallucinations during which the patient is not conscious of their personality troubles.

Ask the following question:

Q: "Does [the respondent] exhibit one [or some] physical or mental handicap[s], apparent or non-apparent?"

NB: when the handicap is manifestly visible, note it down and go to the following question;
At most three main declared handicaps can be registered for a person suffering from several infirmities.

[] Write down in the 1st, then the 2nd, then the 3rd grid corresponding to the registration order number of the counted person, respectively the 1st, then potentially the 2nd, then potentially the 3rd handicap.

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If the counted person does not suffer from any handicap

Write down "00" in the boxes of the first grid, "00" in the boxes of the second grid, and "00" in the boxes of the third grid.

If the counted person suffers from one handicap:

Note the code corresponding to the modality of the 1st handicap in the boxes of the first grid;
Then write down "00" in the boxes of the second grid and "00" in the boxes of the third grid.