Questionnaire Text

Questionnaire form view entire document:  text  image
B. All persons
[Questions 1-19 were asked of all persons.]

Disability

11A. Other disabilities

Does [the respondent] have any other disability among the following? Read all types of disabilities / difficulties to respondent.

If answer is no, go to question 12
[]Yes
[]No
Multiple response is allowed
[] 1 Cleft palete
[] 2 Spinal befida
[] 3 Spinal cord injuries
[] 4 Mental health
[] 5 Psoriasis
Questionnaire instructions view entire document:  text  image
Questions 6 to 11 aim to get information on the disability status of people in the communities.
Is [the respondent] an albino, or has difficulty seeing, hearing, walking or climbing stairs, remembering or concentrating, caring for him/herself such as washing or dressing, has a cleft palate, has spinal befida, has spinal cord injuries, mental illness, or psoriasis?

Questions description
These questions aim to obtain information about disability status in the communities.
Answers on these questions will enable the nation understand how many people have disabilities and types of disabilities, and thus allow the nation develop sustainable programs for this special group in the community.