Questionnaire Text

Questionnaire form view entire document:  text  image
Section P: Characteristics of population

[Questions 7-13 were asked of all usual residents.]

12. Does the respondent have any difficulty or problem as listed below? If yes, what were the causes?

[Respondent can answer up to 5 disability/ cause pairs.]

Type of disability _
Cause of disability _

If none, write 0 in "Types of disability" and go to Question 13.
Types of disability
1. Seeing
2. Hearing
3. Speaking
4. Walking/ Climbing
5. Learning/ Concentrating
6. Other____
Causes of disability
1. Congenital
2. Disease/ Illness
3. Injury/ Accident
4. War/ Mines
5. Genocide
6. Now known
7. Other ____

[Table omitted.]

Questionnaire instructions view entire document:  text  image
P12: Type and cause of major disability
Ask: Does [the person] have any difficulty or problem as listed below? If yes, what were the causes?

A person is called disabled if during birth or after birth his/her body part or his/her mental is damaged, lack of body part or congenital malformation and fails to do activities that other persons who have no such problems could do.

The possible disabilities and their causes are follows:

Type of disability [D]
1 - Seeing
2 - Hearing
3 - Speaking
4 - Walking/Climbing
5 - Learning/Concentrating
6 - Other
Causes [C]
1 - Congenital
2 - Disease/Illness
3 - Injury/Accident
4 - War/Mines
5 - Genocide
6 - Not known
7 - Other