Questionnaire Text

Questionnaire form view entire document:  text  image
Section D: Questions about the Population
Enumerator: Ask questions to all of the people listed in Section C.

[Question 6 through 36 were asked to the residents]

10. What has caused the disability?

[] 1 Birth
[] 2 Disease
[] 3 Landmines/ War
[] 4 Military Service
[] 5 Labor accident
[] 6 Car accident
[] 7 Other
Questionnaire instructions view entire document:  text  image
P10. What has caused the disability?

For all persons who, in the previous question, have marked any kind of disability you should ask what the causes of the disability were. We intend to know how that person acquired a certain kind of disability. For example, if an individual has an amputated arm and says that he lost his arm while working, you should mark an X in box number 5 (labor accident).

Be aware that this question also admits more than one response. If, for example, in the previous question an individual had two kinds of disability, for this question they should indicate the cause for each type of disability.