Health, care and household conditions
The health questions cover reported illness, treatment, access to care, traditional medicine, disability, nutrition and hygiene. The questions for health practitioners and agencies form a separate respondent section within this material.
Project questionnaire · Indonesia/Maluku · Survey design
Design use
Identify who supplied each response and its recall period. Keep reported symptoms and treatment histories distinct from diagnoses or facility statistics, and specify the population denominator before using agency records to calculate a rate.
Instrument review
The source repeats question number 343 and retains qX/qY routing placeholders. Review disease terminology, disability wording and bilingual equivalence with appropriate specialists before selecting questions.
Household health & treatment behavior
| Item | Question / field | Response options and notes |
|---|---|---|
| 302 | What is your perception of the health of your household? | |
| 303 | Has any member of your household been sick in the last 30 days? | |
| 304 | Which of the following sickness / illness / condition have members of the households suffered in the last year? Bahasa IndonesiaSelama 12 bulan, apakah ada anggota keluarga bapak/ibu yang mengalami penyakit di bawah ini? | |
| 305 | Did sick member seek treatment? | |
| 306 | If yes, from whom was treatment sought? | |
| 307 | How much did you / your family pay to get the health services? | |
| 308 | How far was it to the treatment/health facility? Bahasa IndonesiaBerapa jauh jarak dari rumah bapak/ibu ke tempat pengobatan? | |
| 309 | How did you / your family member get there? | |
| 310 | How much does it cost to get there, if any? | |
| 311 | If you did not seek treatment, what was your reason? | |
| 312 | If did not seek treatment, what did you do in order to recover? | |
| 313 | If a member of your household were to become ill in the future, where would you most likely take them for diagnosis and treatment? Bahasa IndonesiaJika bapak/ibu dan atau anggota keluarganya sakit, dimana biasanya mereka dibawa berobat? | |
| 314 | If a member of your household were to become ill in the future, how would you pay for it? Bahasa IndonesiaBagaimana bapak/ibu membayar pengobatan penyakit? | |
| 315 | What health facilities exist in the area? | |
| 316 | How far away is the nearest treatment/health facility? Bahasa IndonesiaBerapa jauh jarak dari rumah bapak/ibu ke tempat pengobatan? | kilometers: |
| 317 | How would you get to a treatment facility? | |
| 318 | How much do you estimate transportation would cost to each facility? Bahasa IndonesiaBerapa biaya yang dikeluarkan untuk menuju ke tempat pengobatan? | rupiah: |
| 319 | How many qualified health professionals are there for each facility? | |
| 320 | How many traditional healers are there in the area? | |
| 321 | What pharmacies exist in the area? | |
| 322 | What personal, social, economic, institutional and environmental factors do you feel affect public health in this area? | |
| 323 | What traditional knowledge, attitudes and beliefs exist in the area? | |
| 324 | What are the prevalence rates for non-communicable diseases (hypertension, diabetes cardiovascular disorders, cancer) in the area? |
Use of traditional medicine
| Item | Question / field | Response options and notes |
|---|---|---|
| 325 | How important is the use of traditional medicine to your or members of your household? | |
| 326 | Is there a traditional / natural healer in this village? | |
| 327 | Have you ever used traditional medicine? | |
| 328 | Do you know many natural / traditional remedies? | |
| 329 | Where did you get traditional medicines? Bahasa IndonesiaDimana bapak/ibu mendapatkan tanaman obat tradisional tersebut? | |
| 330 | What kind of plants / animals / ingredients are commonly used to make medicine? | |
| 331 | Is there a particular person in the community who collects ingredients for traditional medicine? | |
| 332 | Do you, or members of your household, collect any ingredients for traditional medicine locally (herbs, etc)? | |
| 333 | What natural resources / species are targeted? | |
| 334 | What are they used for? | |
| 335 | Are pythons or bats or any other species caught for medicinal purposes? | |
| 336 | Did you find it difficult to find / gather / obtain the ingredients for traditional medicines? If so, why? Bahasa IndonesiaApakah bapak/ibu memiliki kesulitan mendapatkan tanaman obat tradisional tersebut? Jika ya, kenapa? | |
| 337 | Have you noticed any trends in the availability of natural medicines? | |
| 338 | Are there alternative locations where medicinal herbs could be collected and, if so, where are these located? | |
| 339 | Are there any restrictions on the collection of plants for medicinal purposes (e.g. permits / licenses required)? | |
| 340 | Is there any collection of natural medicines (herbs, etc) in the project area? | |
| 341 | What are they used for? | |
| 342 | Are there alternative locations where medicinal herbs could be collected and, if so, where are these located? | |
| 343 | Are there any restrictions on the collection of plants for medicinal purposes (e.g. permits / licenses required)? | |
| 343 | Are pythons or bats or any other species caught for medicinal purposes? |
Targeted questions for medical practitioners / health agencies
| Item | Question / field |
|---|---|
| 344 | What are the most common diseases amongst local communities living within or immediately around the project area? |
| 345 | Are any of these waterborne or could they be attributed to environmental factors (e.g. transmission by birds/mammals, standing water, vegetation clearance)? |
| 346 | What vector related diseases (malaria, schistosomiasis, dengue, onchocerciasis etc) are present in the area? |
| 347 | What is the prevalence of soil and water borne disease (giardiasis, worms, water access & quality, sanitation) in the area? |
| 348 | What is the prevalence and incidence of respiratory issues (acute respiratory infections [bacterial & viral], pneumonia, tuberculosis) from housing conditions, overcrowding and house inflation? |
| 349 | What is the prevalence of zootonic issues (Brucellosis, rabies, bovine TB, bird flu etc.) in the area? |
| 350 | What is the prevalence of sexually transmitted disease in the area? |
| 351 | Are there any food and nutrition issues [stunting, wasting, micronutrient diseases, gastroenteritis (bacterial and viral)] that are especially prevalent in the area? |
| 352 | What personal, social, economic, institutional and environmental factors determine the status of population health in the area? |
Mortality and morbidity
| Item | Question / field | Response options and notes |
|---|---|---|
| 353 | Was any member of the family born in the past 12 months? | |
| 354 | How is the baby's' health assessed at birth (according to which diagnostic criteria)? | |
| 355 | Did any member of the household die in the past 12 months? Bahasa IndonesiaApakah bapak/ibu memiliki anggota keluarga yang meninggal selama 12 bulan terakhir? | |
| 356 | Please indicate the cause of death. |
Disability
| Item | Question / field | Response options and notes |
|---|---|---|
| 357 | Does any member of the household have any disabilities? | |
| 358 | Please indicate the type of disability | |
| 359 | Does the disabled person receive any forms of support/ or assistance? |
Health behaviour
| Item | Question / field | Response options and notes |
|---|---|---|
| 360 | Do you smoke? | |
| 361 | If yes, do you smoke inside the house and near children? | |
| 362 | Do you consume alcohol? | |
| 363 | How often do you drink alcohol? | |
| 364 | Are you influenced after drinking alcohol? |
Nutrition
NUTRISI
| Item | Question / field | Response options and notes |
|---|---|---|
| 365 | Do you eat regular meals? Bahasa IndonesiaBerapa kali bapak/ibu dan anggota keluarga makan setiap hari? | |
| 366 | Are there any types of food that you prefer over others? | |
| 367 | Are there any types of food that are difficult to maintain? | |
| 368 | Are there any types of food that are considered "prestigious"? | |
| 369 | Are there any types of food that you eat mostly / only for ceremonial occasions? | |
| 370 | Have you experienced any food shortages during the past 12 months? Bahasa IndonesiaApakah bapak/ibu pernah mengalami kekurangan makanan selama 12 bulan terakhir? | |
| 371 | If so, in what month? Bahasa IndonesiaJika pernah, di bulan apa? | |
| 372 | Do you find alternates for the food? |
Sanitation and personal hygene
| Item | Question / field | Response options and notes |
|---|---|---|
| 373 | Do you have access to hygienic facilities for bathing, washing and waste water? Bahasa IndonesiaApakah bapak/ibu memiliki fasilitas higienis untuk mandi, cuci dan buang air? | |
| 374 | If you do not have access to hygienic facilities, where to you go to attend to personal hygiene? Bahasa IndonesiaJika tidak punya, dimana bapak/ibu biasanya melakukan kegiatan higienis? | |
| 375 | Do you wash hands before eating or after defecating? | |
| 376 | Do you take regular bath? |
Source
Questionnaire working file in the versioned project survey collection.