Terms

Definition of variable

Modality

IDENTIFICATION OF PARTICIPANT

Age (year)

Age of participant in last year (it will be categorical)

Sex

Biological sex

Male

Female

I. SOCIO-DEMOGRAPHIC CARACTERISTICS

Marital situation

Marital situation

Single

Cohabitation

Separated

Married

Divorced

Widow (er)

Type of household

Type of household

1. Monogamic household

2. Polygamic household

Number of dependent people

Number of dependent people

Educated level

Educated level

0. Uneducated

1. Primary

2. Secondary

3. Higher

4. Alphabetized

Professional status

Professional status

0. Unemployed

1. Working

2. Retiree

SOCIO-ECONOMIC CHARACTÉRISTICS

Monthly income (FCFA)

Declarative: monthly income taking into account salaries and parallel activities

No income

Less than 52,000

≥52,000

BEHAVIORAL FACTORS

TOBACCO CONSUMPTION

Do you smoke currently product from tobacco such as cigarettes, cigares of pipes?

Recent smoker

Yes/no

In average, how many times per day do you consume the following products?

Average consumption

Tobacco to snuff (oral canal) |__|__||__|

Tobacco to chew (oral canal) |__|__||__|

Tobacco to masticate |__|__||__|

Other (specify |_______|) |__|__||__|

ASSESSMENT OF TOBACCO-DEPENDENCE: TEST OF FAGERSTRÖM

On morning, how many times after waking up, do you smoke your first cigarette?

On morning, how many times after waking up, does the survey smoke his/her first cigarette?

5 minutes

6 - 30 minutes

31 - 60 minutes

More than 60 minutes

Do you find that it is difficult to not smoke in space where it is forbidden? (Ex.: cinemas, libraries)

Measurement of dependence level

Yes/no

From which cigarettes would you give up hardly?

Type of cigarettes

Manufactured cigarettes = 1

Rolled cigarettes = 2

Pipes = 3

Cigares, cigarillos = 4

Others = 5

How many cigarettes do you smoke per day in average?

Average of sticks

10 or less

11 to 20

21 to 30

31 or more

Do you smoke more in closed intervalls during early hours of the morning than in the rest of the day?

Progression of dependence in day

No

Yes

Do you smoke when you feel sick and obliged to be laid almost the day?

Assessment of absolute dependence

No

Yes

Interpretation

Between 0 et 2: no dependence

Between 3 et 4: low dependence

Between 5 et 6: medium dependence

Between 7 et 10: high or very high dependence

A. ALCOHOL CONSUMPTION

Did you consume an alcoholic drink such as beer, wine, liqueur, cider or local alcoholic drinks these later twelve months?

Assessment of alcohol consumption

Yes/no

AUDIT (ALCOHOL USE DISORDERS IDENTIFICATION TEST): Assessment of Alcoolo-dependence

To which frequency do you consume alcoholic drinks?

Assessment scale

Never

At least 1 time per month

2 to 4 times per month

2 to 3 times per week

4 times or more per week

How many standard glasses of alcohol do you drink in a week?

Assessment scale

1 or 2

3 or 4

5 or 6

7 or 8

9 or 10

At the same period, how many times do you drink six standard glasses of alcohol or more?

Assessment scale

Never

Less than 1 time per month

1 time per month

1 time per week

Always or almost

During the later twelve months, how many times did you observe that you were not ever able to stop drinking after starting?

Assessment scale

Never

Less than 1 time per month

1 time per month

1 time per week

Always or almost

During the later twelve months, how many times drinking alcohol inhibited you to do what you were supposed to do?

Assessment scale

Never

Less than 1 time per month

1 time per month

1 time per week

Always or almost

During the later twelve months, how many times did you feel guilty or had regrets after drinking alcohol?

Assessment scale

Never

Less than 1 time per month

1 time per month

1 time per week

Always or almost

During the later twelve months, how many times were you unable to remind about previous night because you drunk alcohol?

Assessment scale

Never

Less than 1 time per month

1 time per month

1 time per week

Always or almost

Were you hurt or did you hurt someone because you had drunk?

Assessment scale

No

Yes, but not last year

Yes, last year

Was a parent, a friend or another health worker concerned about your alcohol consumption and advised you to reduce it?

Assessment scale

No

Yes, but not last year

Yes, last year

Interpretation (AUDIT) : Sum of quotation from A2-A11

Interpretation of assessment scale

Low risk (if score <6)

Risk of harm (if score between 6 - 12)

Alcoolo-dependence (if score >12)

FOOD HYGIENE [77]

Usually how many days per week do you consume fruits?

Days number of fruits consumption per day

|__|__| if no day, go to D3

How many fruits portions do you consume in a day?

Number of fruits portions per day

|__|__|

Usually, how many days per week do you consume vegetables?

Days number of vegetables consumption per day

|__|__| if no day, go to D5

How many vegetables portions do you consume in a day?

Number of vegetables portions per day

|__|__|

Do you add sometimes salt or salted sauce such as soya sauce before or during eating?

Assessment of salt supplement in need to satisfy appetite

Never

Always

Often

Sometimes

Rarely

According to you, which quantity of salt or salted sauce do you consume?

Assessment of salt consumption

Quantity needed

A bite

Too little

Too much

Very too much

Which kind of fat do you use frequently to cook meals at home?

Assessment of lipids consumption

None particularly

Vegetable oil

Bacon or fat

Butter

Margarine

Other (specify)

B. PHYSICAL ACTIVITY (Assessment of usual level of physical activity with the questionnaire Ricci et Gagnon)

SEDENTARY BEHAVIORS

How many times do you spend sat per day (hobbies, television, computer, work, etc.)?

Assessment of sedentariness

<2 h

2 to 3 h

3 to 4 h

4 to 5 h

≥5 h

DAILY ACTIVITIES

Which intensity of physical activity does your work require?

Assessment of daily sportive activities

Light

Moderate

Medium

Intense

Very intense

Apart your work, how many hours do you spend a week for light tasks: DIY, gardening, housework, etc…?

Assessment of daily sportive activities

<2 h

3 to 4 h

5 to 6 h

7 to 9 h

≥10 h

How many minutes per day do you spend to walk?

Assessment of daily sportive activities

<15'

16 to 30'

31 to 45'

45 to 60'

≥61'

How many floors, in average, do you go up per day?

Assessment of daily sportive activities

<2

3 to 5

6 to 10

11 to 15

≥16

ACTIVITES SPORTIVES ET RECREATIVES

Do you practise regularly one or more physical or recreational activities?

Daily assessment of recreational and sportive activity

No

Yes

To which frequency do you practise all these physical activities?

Daily assessment of recreational and sportive activity

1 to 2/month

2/week

3/week

≥4/week

How minutes do you spend in average to each section of physical activity?

Daily assessment of recreational and sportive activity

<15'

31 to 45'

45 to 60'

≥61'

Usually, how do you perceive your effort?

Daily assessment of recreational and sportive activity

Very easy

Easy

Less easy

Difficult

Interpretation

Interpretation of recreational and sportive activities

Less than 18: inactive

Between 18 et 35: active

More than 35: very active

PHYSICAL MEASURES

SBP1

Systolic blood pressure

DBP1

Diastolic blood pressure

SBP2

Systolic blood pressure

DBP2

Diastolic blood pressure

Size

Measure of size in meter

Weight

Taking of weight in kilogramme

Brachial circumference

Brachial circumference

|__|__|__| cm

Abdominal circumference

Abdominal circumference

|__|__|__| cm

Taking time of capillary glycemia

Completion time of capillary glycemia

Hours Minutes

Capillary glycemia

Value

|__|.|__|__| g/l

Venous glycemia

Value

|__|.|__|__| g/l

II. CLINICAL AND THERAPEUTIC CHARACTERISTICS

A. HISTORY OF HIGH BLOOD PRESSURE

Did a doctor or another health worker already measure your blood pressure?

Confirmation of HBP status

No (if no, go to H7)

Yes

Did a doctor or another health worker already tell you that you had a high blood pressure or you were suffering hypertension?

Confirmation of HBP status

Non (if no, go to H7)

Yes

Did they tell you these later 12 months?

Confirmation of HBP status

No

Yes

Since how many time are you known hypertensive?

Confirmation of HBP status

Less than 1 year

1 to 05 years

5 to 10 years

More than 10 years

Do not know

Are you currently under a medical treatment?

Confirmation of HBP status

No

Yes

If yes, which one?

Confirmation of HBP status

Do not know

Specify the name

During later 2 weeks, did you take drugs prescribed by a doctor or another health worker for your high blood pressure?

Confirmation of HBP status

No

Yes

Did you already consult a traditional healer for your high blood pressure?

Confirmation of HBP status

No

Yes

Do you currently take a traditional drug or herbal drug for you high blood pressure?

Confirmation of HBP status

No

Yes

B. HISTORY OF DIABETES

Did a doctor or another health worker already measure your glycemia?

Confirmation of diabetes

No (if no, go to M1)

Yes

Did a doctor or another health worker already tell you had diabetes?

Confirmation of diabetes

No (if no, go to M1)

Yes

Did they tell you late 12 months?

Confirmation of diabetes

No

Yes

Since how many time are you known diabetic?

Confirmation of diabetes

Less than 1 year

1 to 05 years

5 to 10 years

More than 10 years

Do not know

Are you currently under a medical treatment?

Confirmation of diabetes

No

Yes

If yes, which one?

Confirmation of diabetes

Do not know

Specify the name

During later 2 weeks, did you take drugs prescribed by a doctor or another health worker for your diabetes?

Confirmation of diabetes

No

Yes

Did you already consult a traditional healer for your diabetes?

Confirmation of diabetes

No

Yes

Do you currently take a traditional drug or herbal drug for you diabetes?

Confirmation of diabetes

No

Yes