1 | IDNO Surname First Name | |
2 | Date of interview | |
3 | Age in years | |
4 | Sex | |
5 | Religion (Moslem = 1, Christian = 2, Other = 3 and specify No response = 9) | |
6 | Married status (Married = 1, Single = 2, Divorced = 3, Widowed = 4, No response = 9) | |
7 | Occupation | |
8 | Highest level of education (No formal education = 1, Madrassa = 2, Primary = 3, Secondary = 4, Technical = 5, University = 6, No response = 9) | |
9 | Address Do you live permanently at the above address? (Yes = 1, No = 2, No response = 9) | |
10 | Have you ever smoked tobacco? (Yes = 1, No = 2, Not Applicable = 8, No Response = 9) If Yes: Still a smoker = 1, Stopped less than 6 months ago = 2, Stopped less than 1 year ago = 3,Stopped less than 5 years ago = 4, Stopped greater than 5 years ago = 5 How many years have you smoked in total? How often do you smoke? (Not every day = 1, 1 - 10 times/day = 2, 11 - 20 times/day = 3, Over 20/day = 4) Do you smoke: (Cigarette = 1, Pipe = 2, Snuff = 3, Other = 4) | |
11 | Receiving treatment for hypertension? Yes = 1, No = 2, Don’t Know = 3, 8 = Not applicable, 9 = No Response If yes, name/dosage | |
12 | Receiving other medicatios? Yes = 1, No = 2, Don’t Know = 3, 8 = Not applicable, 9 = No Response If yes, name/dosage | |
13 | Has the doctor ever diagnosed 13a. = Hypertension, 13b. = Obesity, 13c. = Diabetes, 13d. = Heart attack, 13e. = Stroke Yes = 1, No = 2, Don’t Know = 3, 8 = Not applicable, 9 = No Response | |
14 | Family history of 14a. = Hypertension, 14b. = Obesity, 14c. = Diabetes, 14d. = Heart attack, 14e. = Stroke Yes = 1, No = 2, Don’t Know = 3, 8 = Not applicable, 9 = No Response | |
15 | Do you have excessive thirst? Yes = 1, No = 2, Don’t Know = 3, 8 = Not applicable, 9 = No Response Do you produce a lot of urine? Yes = 1, No = 2, Don’t Know = 3, 8 = Not applicable, 9 = No Response | |
16 | Have you ever experienced severe pain across the front of your chest lasting > ½ hour? Yes = 1, No = 2, Don’t Know = 3, 8 = Not applicable, 9 = No Response |