C1. List all members of this household (from questions A1 or B1) ____
C2. Serial number (from questions A2 or B2) _ _
C3. Does any person(s) listed in A1 or B1 suffer from any of the following disabilities?
[] 11 Defect of seeing in 1 eye
[] 12 Defect of seeing in 2 eyes
[] 13 Blindness in 1 eye
[] 14 Blindness in 2 eyes
[] 21 Defect of hearing in 1 ear
[] 22 Defect of hearing in 2 ears
[] 23 Deafness in 1 ear
[] 24 Deafness in 2 ears
[] 31 Defect of speech
[] 32 Inability to speak
[] 41 Inability to use 1 leg
[] 42 Inability to use 2 legs
[] 51 Inability to use 1 arm
[] 52 Inability to use 2 arms
[] 61 Moderate retardation
[] 62 Severe retardation
[] 63 Mental cases
131.
Columns C1/C2/C3: Disability
Q: Does any person(s) listed in A1 or B1 suffer from any of the following disabilities?
[] 11 Defect of seeing in 1 eye
[] 12 Defect of seeing in 2 eyes
[] 13 Blindness in 1 eye
[] 14 Blindness in 2 eyes
[] 21 Defect of hearing in 1 ear
[] 22 Defect of hearing in 2 ears
[] 23 Deafness in 1 ear
[] 24 Deafness in 2 ears
[] 31 Defect of speech
[] 32 Inability to speak
[] 41 Inability to use 1 leg
[] 42 Inability to use 2 legs
[] 51 Inability to use 1 arm
[] 52 Inability to use 2 arms
[] 52 Inability to use 2 arms
[] 62 Severe retardation
[] 63 Mental illness
You should read out the list of disabilities to the respondent as a reminder to him or her of the types of disabilities to which we are referring. Be very tactful in asking these questions so as not to cause offence or embarrassment.
If anyone does have a disability, enter the person's first name in column C1, then enter in column C2 the same serial number that you assigned to this person in column A2 or B2. A person from Part A will have serial numbers 01, 02 or 03, etc., whilst Part B will have serial numbers 91, 92 or 93, etc.
A disabled person has incapacities as a result of physical or mental deficiencies such as bodily abnormalities, defects and impairments. Impairments are defects of structure or functions of the body which give rise to personal inabilities to perform necessary activities. The defects and impairments might occur from birth, or may be brought about by disease, injury or just old age.
Defect of Seeing: A person wearing glasses will not usually be defined as having a defect of seeing. Only if, when wearing glasses, the person cannot count the fingers of a hand from a distance of 3 metres will you record him as having a seeing defect. If the defect is in one eye, code 11, and, if the defect is in both eyes, code 12. If there is complete blindness in one eye enter 13; if there is blindness in both eyes enter 14.
Defect of Hearing: If a person cannot hear a whisper at a distance of 2 metres, that person is said to have a defect of hearing. If the defect is in one ear enter code 21, if both ears are affected, enter code 22. If there is complete deafness in one ear enter 23; if the deafness is in both ears enter 24.
Defect of Speech: A person who makes unintelligible speech, stammers or speaks with an abnormal voice is said to have a defect of speech. If this defect applies, enter code 31.
Inability to Speak: For a person who cannot speak at all (i.e. is completely dumb or mute), enter 32.
Inability to Use One or Both Legs: For a person who has one leg lame or a leg or foot missing enter 41; if both legs are lame or both feet/legs are missing, enter 42.
Inability to Use One or Both Arms: For a person who has one arm lame or a hand or arm missing enter 51; if both arms are lame or both hands/arms are missing, code 52.
Mental Retardation: A person who is capable of taking care of himself/herself but who cannot adjust to a situation needing ordinary skills consistent with age is said to be moderately retarded, and the code should be 61.
A person who, despite good physical condition, is incapable of doing normal daily self-care activities consistent with age is said to be severely mentally retarded. For this condition enter 62.
If a person suffers from a combination of any of the listed disabilities, enter the applicable codes, e.g. if there is a defect of hearing in two ears and a defect of speech enter 2231. After you have recorded the disability code(s) for a particular person, fill the remaining boxes with dashes.
Mental Case: This situation must not be confused with retardation, as this is abnormal perceptions associated with delusional misinterpretation of events; or it could be said to be thinking so disordered as to prevent the patient making a reasonable appraisal of his situation or having reasonable communication with others (as defined in http://www.hyperguide.co.uk/mha/contents).
The relevant portion of the sample questionnaire is shown below.
Example: Itumeleng does not hear at all in one ear, hence his name and serial number in C1 and C2. The type of disability, which is not hearing in one ear, is shown by code 21.