Health Questionnaire

This questionnaire aims to collect information about the health and general well-being of households. Please read each question carefully and select the option that best fits your situation.

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What is your age? (Please mark only one option)

In general, how would you rate your current health status?

At this moment, are you or any member of your household experiencing an illness or health condition (physical or mental)?

Have you or any adult in your household been diagnosed with any chronic illness or condition (long-lasting)? (E.g. Diabetes, Hypertension, Asthma, Depression, etc.)

In the last 3 months, which of the following health problems have most affected the children in your household? (Please mark up to 3, or 'None')

If you or a family member became ill, how easy is it to get medical care in your community?