2016 WHO Verbal Autopsy Form 1.5.3Preset HIV-Malaria mortality and season.(Id10002) [Is this a region of high HIV/AIDS mortality?]Should be completed by the central office.HIGH corresponds to more than 1% of deaths due to HIV/AIDS, LOW around 0.1%, VERY LOW less than 0.01%. Filling in during the interview is not mandatory. Usually the value is predetermined for the region.HighLowVery low(Id10003) [Is this a region of high malaria mortality?]Should be completed by the central office.HIGH corresponds to more than 1% of deaths due to malaria, LOW around 0.1%, VERY LOW less than 0.01%. Filling in during the interview is not mandatory. Usually the value is predetermined for the region.HighLowVery low(Id10004) [During which season did (s)he die?]WetDryDoesn't knowInformation on the respondent and background about interview(Id10007) [What is the name of VA respondent?](Id10007a) [What is the sex of VA respondent?]FemaleMaleAmbiguous/Intersex(Id10008) What is your/the respondent's relationship to the deceased?First verify if the respondent is a family member, and only if it is not a family member choose the other categories like health worker or public official.ParentChildOther family memberFriendSpouseHealth workerPublic officialAnother relationshipRefused to answer(Id10009) Did you/the respondent live with the deceased in the period leading to her/his death?YesNoDoesn't knowRefused to answer(Id10010) [Name of VA interviewer](Id10010a) [Age of VA interviewer](Id10010b) [Sex of VA interviewer]FemaleMaleAmbiguous/Intersex(Id10010c) [ID of VA interviewer](Id10012)(Id10013) [Did the respondent give consent?]YesNoSkip to end if not consentedInformation about the deceased and vital registrationInformation on the Deceased(Id10017) What was the first or given name(s) of the deceased?(Id10018) What was the surname (or family name) of the deceased?(Id10019) What was the sex of the deceased?FemaleMaleAmbiguous/Intersex(Id10020) Is the date of birth known?YesNoRefused to answer(Id10021) When was the deceased born?To select previous years, click or tap the month name, then click or tap the year.(Id10022) Is the date of death known?YesNoRefused to answer(Id10023_a) When did (s)he die?If the deceased was a stillborn baby, enter the date of delivery as the date of death.(Id10023_b) When did (s)he die?(Id10023) When did (s)he die?Year of Death can not be in the future(Id10024) Please indicate the year of death.NEONATE was days old.Please verify that the age is correct, before you proceed. You will now be filling in the questionnaire for a NEONATE.CHILD was years months and days old.Please verify that the age is correct, before you proceed. You will now be filling in the questionnaire for a CHILD.ADULT was years old.Please verify that the age is correct, before you proceed. You will now be filling in the questionnaire for an ADULT.Age group is not compatible with date of birth and year of death indicated. Please review the selection or correct the data previously entered.[What age group corresponds to the deceased?](1) Neonatal 0-27 completed days; (2) Child 28 days - through 11 years; (3) Adult - above 12 yearsNeonateChildAdultNeonatal age is 0 to 27 days only!How many days old was the baby? [Enter neonate's age in days:]Neonatal age is under 28 days, or 0 to 27 completed days. If less than 1 day or 24 hours, enter 0 days. A response is required for this question. If the exact age is unknown, enter the best estimate.How old was the child? [Enter child's age in:]Child age is between 28 days through 11 years. A response is required for this question. If the exact age is unknown, enter the best estimate.DaysMonthsYearsDoesn't knowRefused to answerChild's age is above 28 days; If response was greater than 60 days, ask respondent to report time in another unit.[Enter child's age in days:]Number entered is not likely. If response was greater than 59 months, ask respondent to report time in years.[Enter child's age in months:]Child's age is between 28 days and 11 years only![Enter child's age in years:]Adult age is above 11 years; an age above 120 years is unlikely.[Enter adult's age in years:]A response is required for this question. If the exact age is unknown, enter the best estimate.(Id10008_check) It is not possible to select that the respondent is the child of the deceased and enter that the deceased is a neonate or child. Please go back and correct the selection.(Id10058) Where did the deceased die?HospitalOther health facilityHomeOn route to hospital or facilityOtherDoesn't knowRefused to answer(Id10487) In the two weeks before death, did (s)he live with, visit, or care for someone who had any COVID-19 symptoms or a positive COVID-19 test?COVID-19 symptoms include fever, difficulty breathing, cough, extreme fatigue, and changes in sense of smell or taste. In case of neonates or young children, please omit "care for".YesNoDoesn't knowRefused to answer(Id10488) In the two weeks before death, did (s)he travel to an area where COVID-19 is known to be present?Based on self-report of the respondent. If there is doubt, note the location in the narrative and check with the respective supervisor.YesNoDoesn't knowRefused to answer(Id10051) [Is there a need to collect additional demographic data on the deceased?]If you choose 'No', this question allows to skip asking details about place of residence, education, and family. The question on marriage status will always be asked for adults.YesNo(Id10052) What was her/his citizenship/nationality?Citizen at birthNaturalized citizenForeign nationalDoesn't knowRefused to answer(Id10053) What was her/his ethnicity?Enter a "-" if this information is not available.(Id10054) What was her/his place of birth?Specify here village and district. A question on the facility and circumstances will be asked later. Enter a "-" if this information is not available.(Id10055) What was her/his place of usual residence? (the place where the person lived most of the year)For perinatal cases, just ask for the address of the health facility or if released and at home, the home address.(Id10057) Where did the death occur? (specify country, province, district, village)(Id10059) What was her/his marital status?Life partner is defined here as living with someone for a long time without ever having married.SingleMarriedLife partnerDivorcedWidowedToo young to be marriedDoesn't knowRefused to answer(Id10060_check) [Is the date of marriage available?]YesNo(Id10060) What was the date of marriage?(Id10061) What was the name of the father?(Id10062) What was the name of the mother?(Id10063) What was her/his highest level of schooling?No formal educationPrimary schoolSecondary schoolHigher than secondary schoolDoesn't knowRefused to answer(Id10064) Was (s)he able to read and/or write?select 'yes' also if only one of either reading or writing is known to the respondentYesNoDoesn't knowRefused to answer(Id10065) What was her/his economic activity status in year prior to death?The deceased might have had several activities. Choose the one that was probabaly true for most of the year preceding illness and deathMainly unemployedMainly employedHome-makerPensionerStudentOtherDoesn't knowRefused to answer(Id10066) What was her/his occupation, that is, what kind of work did (s)he mainly do?Civil registration numbers(Id10069) [Is there a need to collect civil registration numbers on the deceased?]YesNo(Id10069_a) Do you have a Death Certificate from the Civil Registry?YesNo(Id10070) [Death registration number/certificate]Enter a "-" if this information is not available.(Id10071_check) [Is the date of registration available?]YesNo(Id10071) [Date of registration](Id10072) [Place of registration]Enter a "-" if this information is not available.(Id10073) [National identification number of deceased]Record the National Identification Number. For newborns that have no ID number, use the mother's ID. If the mother's ID is not available, use the father's ID. If this information is unknown or not available, enter "-". Note whose ID was entered in the blank after the ID has been recorded.Verification of possible stillbirth(Id10104) Did the baby ever cry?YesNoDoesn't knowRefused to answer(Id10105) Did the baby cry immediately after birth, even if only a little bit?YesNoDoesn't knowRefused to answerEnter a number between 1 and 60. If the respondent says the baby never cried, go back and enter "No," the baby did not ever cry.(Id10106) How many minutes after birth did the baby first cry?For don't know, enter "99." For refused, enter "88." If the respondent says the baby never cried, go back and enter "No" to Id10104, "Did the baby ever cry?"(Id10107) Did the baby stop being able to cry?YesNoDoesn't knowRefused to answerPlease enter a value between 0 and 99. If response was greater than 98 hours, confirm the response and enter 98.(Id10108) How many hours before death did the baby stop crying?Less than 60 minutes = 0 hours. Enter "99" for "don't know." Enter "88" for "refuse.(Id10109) Did the baby ever move?YesNoDoesn't knowRefused to answer(Id10110) Did the baby ever breathe?YesNoDoesn't knowRefused to answer(Id10111) Did the baby breathe immediately after birth, even a little?YesNoDoesn't knowRefused to answer(Id10112) Did the baby have a breathing problem?YesNoDoesn't knowRefused to answer(Id10113) Was the baby given assistance to breathe at birth?YesNoDoesn't knowRefused to answer(Id10114) If the baby didn't show any sign of life, was it born dead?This question serves to finally determine if the baby was born alive or dead.YesNoDoesn't knowRefused to answer(Id10115) Were there any bruises or signs of injury on baby's body after the birth?YesNoDoesn't knowRefused to answer(Id10116) Was the baby's body soft, pulpy and discoloured and the skin peeling away?Macerated means the body was pulpy. This indicates that the baby has been dead inside the mother for some time.YesNoDoesn't knowRefused to answerHistory of injuries/accidents(Id10077) Did (s)he suffer from any injury or accident that led to her/his death?YesNoDoesn't knowRefused to answerInjuries and accidents detail(Id10079) Was it a road traffic accident?YesNoDoesn't knowRefused to answer(Id10080) What was her/his role in the road traffic accident?PedestrianDriver or passenger in car or light vehicleDriver or passenger in bus or heavy vehicleDriver or passenger on a motorcycleDriver or passenger on a pedal cycleOtherDoesn't knowRefused to answer(Id10081) What was the counterpart that was hit during the road traffic accident?PedestrianStationary objectCar or light vehicleBus or heavy vehicleMotorcyclePedal cycleOtherDoesn't knowRefused to answer(Id10082) Was (s)he injured in a non-road transport accident?YesNoDoesn't knowRefused to answer(Id10083) Was (s)he injured in a fall?This includes accidents and cases where it is unknown if it was an accident or whether there was intentional violence.YesNoDoesn't knowRefused to answer(Id10084) Was there any poisoning?This includes accidents and cases where it is unknown if it was an accident or whether there was intentional violence.YesNoDoesn't knowRefused to answer(Id10085) Did (s)he die of drowning?This includes accidents and cases where it is unknown if it was an accident or whether there was intentional violence.YesNoDoesn't knowRefused to answer(Id10086) Was (s)he injured by a bite or sting by venomous animal?This includes accidents and cases where it is unknown if it was an accident or whether there was intentional violence.YesNoDoesn't knowRefused to answer(Id10087) Was (s)he injured by an animal or insect (non-venomous)?YesNoDoesn't knowRefused to answer(Id10088) What was the animal/insect?DogSnakeInsect or scorpionOtherDoesn't knowRefused to answer(Id10089) Was (s)he injured by burns/fire?YesNoDoesn't knowRefused to answer(Id10090) Was (s)he subject to violence (suicide, homicide, abuse)?(don't say suicide for under-12-year olds)YesNoDoesn't knowRefused to answer(Id10091) Was (s)he injured by a firearm?YesNoDoesn't knowRefused to answer(Id10092) Was (s)he stabbed, cut or pierced?YesNoDoesn't knowRefused to answer(Id10093) Was (s)he strangled?YesNoDoesn't knowRefused to answer(Id10094) Was (s)he injured by a blunt force?YesNoDoesn't knowRefused to answer(Id10095) Was (s)he injured by a force of nature?YesNoDoesn't knowRefused to answer(Id10096) Was it electrocution?This includes accidents and cases where it is unknown if it was an accident or whether there was intentional violence.YesNoDoesn't knowRefused to answer(Id10097) Did (s)he encounter any other injury?YesNoDoesn't knowRefused to answer(Id10098) Was the injury accidental?YesNoDoesn't knowRefused to answer(Id10099) Was the injury self-inflicted?YesNoDoesn't knowRefused to answer(Id10100) Was the injury intentionally inflicted by someone else?YesNoDoesn't knowRefused to answerHealth historyPlease enter a value less than the age in days at death.(Id10351) How many days old was the baby when the fatal illness started?Maximum number of days for neonates is 27 days. The answer could be given in another unit, but for data entry use days. Less than 24 hours=0 days; 1 week=7 days. Enter "99" for "don't know." Enter "88" for "refuse."(Id10408) Before the illness that led to death, was the baby/the child growing normally?YesNoDoesn't knowRefused to answerDuration of illnessPlease enter a value less then neonatal age in days at death.(Id10120_0) For how many days was (s)he ill before death?If less than 1 day or 24 hours, enter 0 days. For don't know, enter "99." For refused, enter "88."(id10120_unit) For how long was (s)he ill before death?DaysMonthsYearsDoesn't knowRefused to answerIf response was greater than 11 months, ask respondent to report time in years.(Id10121) MonthsDuration entered exceeds age at death.(Id10122) YearsIf response was greater than 30 days, ask respondent to report time in another unit.(Id10120_1) DaysLess than 24 hours = 0 days.(Id10120) Calculated number of Days with illness(Id10123) Did (s)he die suddenly?Suddenly means died unexpectedly within 24 hours of being in regular health.YesNoDoesn't knowRefused to answerMedical history associated with final illness(Id10125) Was there any diagnosis by a health professional of tuberculosis?Remind the respondent that we are asking for the diagnosis assessed by a doctor, health worker, or other health professional during the final illness.YesNoDoesn't knowRefused to answer(Id10126) Was an HIV test ever positive?YesNoDoesn't knowRefused to answer(Id10127) Was there any diagnosis by a health professional of AIDS?Remind the respondent that we are asking for the diagnosis assessed by a doctor, health worker, or other health professional during the final illness.YesNoDoesn't knowRefused to answer(Id10128) Did (s)he have a recent positive test by a health professional for malaria?Remind the respondent that we are asking for the diagnosis assessed by a doctor, health worker, or other health professional during the final illness.YesNoDoesn't knowRefused to answer(Id10129) Did (s)he have a recent negative test by a health professional for malaria?Remind the respondent that we are asking for the diagnosis assessed by a doctor, health worker, or other health professional during the final illness.YesNoDoesn't knowRefused to answer(Id10130) Was there any diagnosis by a health professional of dengue fever?Remind the respondent that we are asking for the diagnosis assessed by a doctor, health worker, or other health professional during the final illness.YesNoDoesn't knowRefused to answer(Id10131) Was there any diagnosis by a health professional of measles?Remind the respondent that we are asking for the diagnosis assessed by a doctor, health worker, or other health professional during the final illness.YesNoDoesn't knowRefused to answer(Id10132) Was there any diagnosis by a health professional of high blood pressure?Remind the respondent that we are asking for the diagnosis assessed by a doctor, health worker, or other health professional during the final illness.YesNoDoesn't knowRefused to answer(Id10133) Was there any diagnosis by a health professional of heart disease?Remind the respondent that we are asking for the diagnosis assessed by a doctor, health worker, or other health professional during the final illness.YesNoDoesn't knowRefused to answer(Id10134) Was there any diagnosis by a health professional of diabetes?Remind the respondent that we are asking for the diagnosis assessed by a doctor, health worker, or other health professional during the final illness.YesNoDoesn't knowRefused to answer(Id10135) Was there any diagnosis by a health professional of asthma?Remind the respondent that we are asking for the diagnosis assessed by a doctor, health worker, or other health professional during the final illness.YesNoDoesn't knowRefused to answer(Id10136) Was there any diagnosis by a health professional of epilepsy?Remind the respondent that we are asking for the diagnosis assessed by a doctor, health worker, or other health professional during the final illness.YesNoDoesn't knowRefused to answer(Id10137) Was there any diagnosis by a health professional of cancer?Remind the respondent that we are asking for the diagnosis assessed by a doctor, health worker, or other health professional during the final illness.YesNoDoesn't knowRefused to answer(Id10138) Was there any diagnosis by a health professional of Chronic Obstructive Pulmonary Disease (COPD)?Remind the respondent that we are asking for the diagnosis assessed by a doctor, health worker, or other health professional during the final illness.YesNoDoesn't knowRefused to answer(Id10139) Was there any diagnosis by a health professional of dementia?Remind the respondent that we are asking for the diagnosis assessed by a doctor, health worker, or other health professional during the final illness.YesNoDoesn't knowRefused to answer(Id10140) Was there any diagnosis by a health professional of depression?Remind the respondent that we are asking for the diagnosis assessed by a doctor, health worker, or other health professional during the final illness.YesNoDoesn't knowRefused to answer(Id10141) Was there any diagnosis by a health professional of stroke?Remind the respondent that we are asking for the diagnosis assessed by a doctor, health worker, or other health professional during the final illness.YesNoDoesn't knowRefused to answer(Id10142) Was there any diagnosis by a health professional of sickle cell disease?Remind the respondent that we are asking for the diagnosis assessed by a doctor, health worker, or other health professional during the final illness.YesNoDoesn't knowRefused to answer(Id10143) Was there any diagnosis by a health professional of kidney disease?Remind the respondent that we are asking for the diagnosis assessed by a doctor, health worker, or other health professional during the final illness.YesNoDoesn't knowRefused to answer(Id10144) Was there any diagnosis by a health professional of liver disease?Remind the respondent that we are asking for the diagnosis assessed by a doctor, health worker, or other health professional during the final illness.YesNoDoesn't knowRefused to answer(Id10482) Was there any diagnosis by a health professional of COVID-19?YesNoDoesn't knowRefused to answer(Id10483) Did s(h)e have a recent test by a health professional for COVID-19?YesNoDoesn't knowRefused to answer(Id10484) What was the result?Prompt for the result of the most recent test in case the deceased had more than 1 test performedPositiveNegativeUnclearDon't knowRefused to answerGeneral signs and symptoms associated with final illness(Id10147) Did (s)he have a fever?YesNoDoesn't knowRefused to answerPlease enter a value less then neonatal age in days at death.(Id10148_a) How many days did the fever last?If less than 1 day or 24 hours, enter 0 days. Use 1 week = 7 days to determine number of days. For don't know, enter "99." For refused, enter "88."(Id10148_units) How long did the fever last?Enter 1 unit only: 0-30 days or 1-60 months. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.DaysMonthsDoesn't knowRefused to answerIf response was greater than 30 days, ask respondent to report time in months.(Id10148_b) [Enter how long the fever lasted in days]:Enter 0-30 days. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.Likely response is under 60 months. If response was greater than 60 months, confirm the response and enter 60.(Id10148_c) [Enter how long the fever lasted in months]:Enter 1-60 months.(Id10148) How many days did the fever last?(Id10149) Did the fever continue until death?YesNoDoesn't knowRefused to answer(Id10150) How severe was the fever?MildModerateSevereDoesn't knowRefused to answer(Id10151) What was the pattern of the fever?ContinuousOn and offOnly at nightDoesn't knowRefused to answer(Id10152) Did (s)he have night sweats?YesNoDoesn't knowRefused to answer(Id10153) Did (s)he have a cough?YesNoDoesn't knowRefused to answer(Id10154_units) For how long did (s)he have a cough?Enter 1 unit only: 0-30 days or 1-60 months. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.DaysMonthsDoesn't knowRefused to answerIf response was greater than 30 days, ask respondent to report time in months.(Id10154_a) [Enter how long (s)he had a cough in days]:Enter 0-30 days. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.Likely response is under 60 months. If response was greater than 60 months, confirm the response and enter 60.(Id10154_b) [Enter how long (s)he had a cough in months]:Enter 1-60 months.(Id10154) For how many days did (s)he have a cough?(Id10155) Was the cough productive, with sputum?YesNoDoesn't knowRefused to answer(Id10156) Was the cough very severe?YesNoDoesn't knowRefused to answer(Id10157) Did (s)he cough up blood?YesNoDoesn't knowRefused to answer(Id10158) Did (s)he make a whooping sound when coughing?YesNoDoesn't knowRefused to answer(Id10159) Did (s)he have any difficulty breathing?YesNoDoesn't knowRefused to answerDuration of breathing difficultyPlease enter a value less then neonatal age in days at death.(Id10161_0) For how many days did the difficulty breathing last?If less than 1 day or 24 hours, enter 0 days. Use 1 week = 7 days to determine the number of days. For don't know, enter "99." For refused, enter "88."(id10161_unit) For how long did the difficult breathing last?Enter 1 unit only: 0-30 days, 1-11 months, or 1 or more years. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.DaysMonthsYearsDoesn't knowRefused to answerIf response was greater than 30 days, ask respondent to report time in another unit.(Id10161_1) [Enter how long the difficult breathing lasted in days]:Enter 0-30 days. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.If response was greater than 11 months, ask respondent to report time in years.(Id10162) [Enter how long the difficult breathing lasted in months]:Enter 1-60 months.Duration entered exceeds age at death.(Id10163) [Enter how long the difficult breathing lasted in years]:Enter number of years less than age at death.(Id10161) Calculated number of Days with illness(Id10165) Was the difficulty continuous or on and off?ContinuousOn and offDoesn't knowRefused to answer(Id10166) During the illness that led to death, did (s)he have fast breathing?YesNoDoesn't knowRefused to answerPlease enter a value less then neonatal age in days at death.(Id10167_a) For how many days did the fast breathing last?If less than 1 day or 24 hours, enter 0 days. Use 1 week = 7 days to determine the number of days. For don't know, enter "99." For refused, enter "88."(Id10167_units) How long did the fast breathing last?Enter 1 unit only: 0-30 days or 1-60 months. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.DaysMonthsDoesn't knowRefused to answerIf response was greater than 30 days, ask respondent to report time in months.(Id10167_b) [Enter how long the fast breathing lasted in days]:Enter 0-30 days. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.Likely response is under 60 months. If response was greater than 60 months, confirm the response and enter 60.(Id10167_c) [Enter how long the fast breathing lasted in months]:Enter 1-60 months.(Id10167) How long did the fast breathing last?(Id10168) Did (s)he have breathlessness?YesNoDoesn't knowRefused to answerPlease enter a value less then neonatal age in days at death.(Id10169_a) For how many days did (s)he have breathlessness?If less than 1 day or 24 hours, enter 0 days. Use 1 week = 7 days to determine the number of days. For don't know, enter "99." For refused, enter "88."(Id10169_units) How long did (s)he have breathlessness?Enter 1 unit only: 0-30 days or 1-60 months. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.DaysMonthsDoesn't knowRefused to answerIf response was greater than 30 days, ask respondent to report time in months.(Id10169_b) [Enter how long (s)he had breathlessness in days]:Enter 0-30 days. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.Likely response is under 60 months. If response was greater than 60 months, confirm the response and enter 60.(Id10169_c) [Enter how long (s)he had breathlessness in months]:Enter 1-60 months.(Id10169) How long did (s)he have breathlessness?(Id10170) Was (s)he unable to carry out daily routines due to breathlessness?YesNoDoesn't knowRefused to answer(Id10171) Was (s)he breathless while lying flat?YesNoDoesn't knowRefused to answer(Id10172) Did you see the lower chest wall/ribs being pulled in as the child breathed in?Ask only for children under the age of 12 years. Show photos if available.YesNoDoesn't knowRefused to answerIt is not possible to select "Don't know" or "refuse" or "no" together with other options. Please go back and correct the selection.(Id10173_nc) During the illness that led to death did his/her breathing sound like any of the following:StridorGruntingWheezingNoDoesn't knowRefused to answer(Id10173_a) During the illness that led to death did (s)he have wheezing?YesNoDoesn't knowRefused to answer(Id10173) During the illness that led to death did his/her breathing sound like any of the following:(Id10174) Did (s)he have chest pain?YesNoDoesn't knowRefused to answer(Id10175) Was the chest pain severe?YesNoDoesn't knowRefused to answerPlease enter a value between 0 and 99. If response was greater than 98 days, confirm the response and enter 98.(Id10176) How many days before death did (s)he have chest pain?Less than 1 day or 24 hours = 0 days; 1 week = 7 days. For don't know, enter "99." For refused, enter "88."Duration of the chest pain(Id10178_unit) How long did the chest pain last?Enter 1 unit only: 0-59 minutes, 1-23 hours, or days less than response for how many days before death did (s)he have chest pain. 1 week = 7 days.MinutesHoursDaysDoesn't knowRefused to answerIf response was greater than 59 minutes, ask respondent to report time in another unit.(Id10178) [Enter how long the chest pain lasted in minutes]:Enter 0-59 minutes.If response was greater than 23 hours, ask respondent to report time in days.(Id10179) [Enter how long the chest pain lasted in hours]:Enter 1-23 hours.Response should be less than the response for ID10176.(Id10179_1) [Enter how long the chest pain lasted in days]:Enter 0-30 days. 1 week = 7 days.(Id10181) Did (s)he have more frequent loose or liquid stools than usual?Ask the respondent about his/her understanding of what is diarrhoea (having more frequent loose or liquid stools than usual); if unclear, explain to the respondent what is diarrhoea .YesNoDoesn't knowRefused to answer(Id10182_units) How long did (s)he have frequent loose or liquid stools?Enter 1 unit only: 0-30 days or 1-60 months. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.DaysMonthsDoesn't knowRefused to answerIf response was greater than 30 days, ask respondent to report time in months.(Id10182_a) [Enter how long (s)he had frequent loose or liquid stools in days]:Enter 0-30 days. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.Likely response is under 60 months. If response was greater than 60 months, confirm the response and enter 60.(Id10182_b) [Enter how long (s)he had frequent loose or liquid stools in months]:Enter 1-60 months.(Id10182) For how many days did (s)he have frequent loose or liquid stools?Please enter a value between 1-20, 88, 99. If the response is more than 20, confirm the response and enter 20.(Id10183) How many stools did the baby or child have on the day that loose liquid stools were most frequent?For don't know, enter "99." For refused, enter "88."Please enter a value less then neonatal age in days at death.(Id10184_a) How many days before death did the frequent loose or liquid stools start?If less than 1 day or 24 hours, enter 0 days. Use 1 week = 7 days to determine the number of days. For don't know, enter "99." For refused, enter "88."(Id10184_units) How long before death did the frequent loose or liquid stools start?Enter 1 unit only: 0-30 days or 1-60 months. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.DaysMonthsDoesn't knowRefused to answerIf response was greater than 30 days, ask respondent to report time in months.(Id10184_b) [Enter how long before death the frequent loose or liquid stools started in days]:Enter 0-30 days. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.Likely response is under 60 months. If response was greater than 60 months, confirm the response and enter 60.(Id10184_c) [Enter how long before death the frequent loose or liquid stools started in months]:Enter 1-60 months.(Id10185) Did the frequent loose or liquid stools continue until death?YesNoDoesn't knowRefused to answer(Id10186) At any time during the final illness was there blood in the stools?YesNoDoesn't knowRefused to answer(Id10187) Was there blood in the stool up until death?YesNoDoesn't knowRefused to answer(Id10188) Did (s)he vomit?YesNoDoesn't knowRefused to answer(Id10189) To clarify: Did (s)he vomit in the week preceding the death?YesNoDoesn't knowRefused to answer(Id10190_units) How long before death did (s)he vomit?Enter 1 unit only: 0-30 days or 1-60 months. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.DaysMonthsDoesn't knowRefused to answerIf response was greater than 30 days, ask respondent to report time in months.(Id10190_a) [Enter how long before death(s)he vomited in days]:Enter 0-30 days. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.Likely response is under 60 months. If response was greater than 60 months, confirm the response and enter 60.(Id10190_b) [Enter how long before death(s)he vomited in months]:Enter 1-60 months.(Id10191) Was there blood in the vomit?YesNoDoesn't knowRefused to answer(Id10192) Was the vomit black?YesNoDoesn't knowRefused to answer(Id10193) Did (s)he have any belly (abdominal) problem?Explain to the respondent that problems could be pain, protruding abdomen or a mass.YesNoDoesn't knowRefused to answer(Id10194) Did (s)he have belly (abdominal) pain?YesNoDoesn't knowRefused to answer(Id10195) Was the belly (abdominal) pain severe?YesNoDoesn't knowRefused to answerBelly pain(id10196_unit) For how long did (s)he have belly (abdominal) pain?Enter 1 unit only: 0-23 hours, 1-30 days, or 1-60 months. 1 week = 7 days.HoursDaysMonthsDoesn't knowRefused to answerIf response was greater than 23 Hours, ask respondent to report time in another unit.(Id10196) [Enter how long (s)he had belly (abdominal) pain in hours]:Enter 1-23 hours.If response was greater than 30 days, ask respondent to report time in months(Id10197_a) [Enter how long (s)he had belly (abdominal) pain in days]:Enter 0-30 days. 1 week = 7 days.Likely response is under 60 months. If response is greater then 60, confirm the response and enter 60.(Id10198) [Enter how long (s)he had belly (abdominal) pain in months]:Enter 1-60 months.(Id10197) Calculated number of Days with belly pain(Id10199) Was the pain in the upper or lower belly (abdomen)?Upper abdomenLower abdomenUpper and lower abdomenDoesn't knowRefused to answer(Id10200) Did (s)he have a more than usually protruding belly (abdomen)?YesNoDoesn't knowRefused to answer(Id10201_unit) For how long before death did (s)he have a more than usually protruding belly (abdomen)?Enter 1 unit only: 0-30 days or 1-60 months. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.DaysMonthsDoesn't knowRefused to answerIf response was greater than 30 days, ask respondent to report time in months(Id10201_a) [Enter how long before death (s)he had a more than usually protruding belly (abdomen) in days]:Enter 0-30 days. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.Likely response is under 60 months. If response is greater then 60, confirm the response and enter 60.(Id10202) [Enter how long before death (s)he had a more than usually protruding belly (abdomen) in months]:Enter 1-60 months.(Id10201) Calculated number of Days with protruding belly (abdomen)(Id10203) How rapidly did (s)he develop the protruding belly (abdomen)?RapidlySlowlyDoesn't knowRefused to answer(Id10204) Did (s)he have any mass in the belly (abdomen)?YesNoDoesn't knowRefused to answer(Id10205_unit) For how long did (s)he have a mass in the belly (abdomen)?Enter 1 unit only: 0-30 days or 1-60 months. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.DaysMonthsDoesn't knowRefused to answerIf response was greater than 30 days, ask respondent to report time in months(Id10205_a) [Enter how long (s)he had a mass in the belly (abdomen) in days]:Enter 0-30 days. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.Likely response is under 60 months. If response is greater then 60, confirm the response and enter 60.(Id10206) [Enter how long (s)he had a mass in the belly (abdomen) in months]:Enter 1-60 months.(Id10205) Calculated number of Days with a mass in the belly (abdomen)(Id10207) Did (s)he have a severe headache?YesNoDoesn't knowRefused to answer(Id10208) Did (s)he have a stiff neck during illness that led to death?YesNoDoesn't knowRefused to answer(Id10209_units) How long before death did (s)he have stiff neck?Enter 1 unit only: 0-30 days or 1-60 months. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.DaysMonthsDoesn't knowRefused to answerIf response was greater than 30 days, ask respondent to report time in months(Id10209_a) [Enter how long before death did (s)he have stiff neck in days]:Enter 0-30 days. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.Likely response is under 60 months. If response is greater then 60, confirm the response and enter 60.(Id10209_b) [Enter how long before death did (s)he have stiff neck in months]:Enter 1-60 months.(Id10209) For how many days before death did (s)he have stiff neck?(Id10210) Did (s)he have a painful neck during the illness that led to death?YesNoDoesn't knowRefused to answer(Id10211_units) How long before death did (s)he have a painful neck?Enter 1 unit only: 0-30 days or 1-60 months. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.DaysMonthsDoesn't knowRefused to answerIf response was greater than 30 days, ask respondent to report time in months(Id10211_a) [Enter how long before death (s)he had a painful neck in days]:Enter 0-30 days. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.Likely response is under 60 months. If response is greater then 60, confirm the response and enter 60.(Id10211_b) [Enter how long before death (s)he had a painful neck in months]:Enter 1-60 months.(Id10211) For how many days before death did (s)he have a painful neck?(Id10212) Did (s)he have mental confusion?YesNoDoesn't knowRefused to answer(Id10213_units) How long did (s)he have mental confusion?Enter 1 unit only: 0-30 days or 1-60 months. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.DaysMonthsDoesn't knowRefused to answerIf response was greater than 30 days, ask respondent to report time in months(Id10213_a) [Enter how long (s)he had mental confusion in days]:Enter 0-30 days. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.Likely response is under 60 months. If response is greater then 60, confirm the response and enter 60.(Id10213_b) [Enter how long (s)he had mental confusion in months]:Enter 1-60 months.(Id10213) For how many months did (s)he have mental confusion?(Id10214) Was (s)he unconscious during the illness that led to death?YesNoDoesn't knowRefused to answer(Id10215) Was (s)he unconscious for more than 24 hours before death?YesNoDoesn't knowRefused to answer(Id10216_units) How long before death did unconsciousness start?Enter 1 unit only: 0-23 hours or 1-99 days. 1 week = 7 days.HoursDaysDoesn't knowRefused to answerIf response was greater than 23 hours, ask respondent to report time in days.(Id10216_a) [Enter how long before death unconsciousness started in hours]?The question needs input in hours but the respondent may not know exactly and so it may be easier to ask 'how long' and then convert the duration in hours. (Less than 1 hour = "0").Likely response is under 99 days. If response was greater than 99 days, confirm the response and enter 99.(Id10216_b) [Enter how long before death unconsciousness started in days]?If more than 99, enter 99.(Id10216) How many hours before death did unconsciousness start?(Id10217) Did the unconsciousness start suddenly, quickly (at least within a single day)?YesNoDoesn't knowRefused to answer(Id10218) Did the unconsciousness continue until death?YesNoDoesn't knowRefused to answer(Id10219) Did (s)he have convulsions?YesNoDoesn't knowRefused to answer(Id10220) Did (s)he experience any generalized convulsions or fits during the illness that led to death?YesNoDoesn't knowRefused to answerPlease enter a value between 0 and 99. If response was greater than 98 minutes, confirm the response and enter 98.(Id10221) For how many minutes did the convulsions last?The answer could be given in another unit, but for data entry use minutes. Less than 1 minute=0; 1 hour=60 minutes. Enter "99" for "don't know." Enter "88" for "refuse."(Id10222) Did (s)he become unconscious immediately after the convulsion?YesNoDoesn't knowRefused to answer(Id10223) Did (s)he have any urine problems?Explain to the respondent that urine problems refer to urinating a lot or not at all, and blood in the urine.YesNoDoesn't knowRefused to answer(Id10225) Did (s)he go to urinate more often than usual?YesNoDoesn't knowRefused to answer(Id10226) During the final illness did (s)he ever pass blood in the urine?YesNoDoesn't knowRefused to answer(Id10224) Did (s)he stop urinating?This means that the deceased stopped urinating.YesNoDoesn't knowRefused to answer(Id10227) Did (s)he have sores or ulcers anywhere on the body?YesNoDoesn't knowRefused to answer(Id10228) Did (s)he have sores?YesNoDoesn't knowRefused to answer(Id10229) Did the sores have clear fluid or pus?YesNoDoesn't knowRefused to answer(Id10230) Did (s)he have an ulcer (pit) on the foot?YesNoDoesn't knowRefused to answer(Id10231) Did the ulcer on the foot ooze pus?YesNoDoesn't knowRefused to answer(Id10232_units) How long did the ulcer on the foot ooze pus?Enter 1 unit only: 0-30 days or 1-60 months. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.DaysMonthsDoesn't knowRefused to answerIf response was greater than 30 days, ask respondent to report time in months(Id10232_a) [Enter how long the ulcer on the foot oozed pus in days]:Enter 0-30 days. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.Likely response is under 60 months.If response is greater then 60, confirm the response and enter 60.(Id10232_b) [Enter how long the ulcer on the foot oozed pus in months]:Enter 1-60 months.(Id10232) For how many days did the ulcer on the foot ooze pus?(Id10233) During the illness that led to death, did (s)he have any skin rash?YesNoDoesn't knowRefused to answerPlease enter a value between 0 and 99. If response was greater than 98 days, confirm the response and enter 98.(Id10234) For how many days did (s)he have the skin rash?The answer could be given in another unit, but for data entry use days. Less than 1 day or 24 hours = 0 days; 1 week=7 days; 1 month=30 days. Enter "99" for "don't know." Enter "88" for "refuse."(Id10235) Where was the rash?FaceTrunk or abdomenExtremitiesEverywhereDoesn't knowRefused to answer(id10235_check) It is not possible to select "Doesn't Know" or "Refused to answer" together with other options. Please go back and correct the selection.(Id10236) Did (s)he have measles rash (use local term)?YesNoDoesn't knowRefused to answer(Id10237) Did (s)he ever have shingles or herpes zoster?YesNoDoesn't knowRefused to answer(Id10238) During the illness that led to death, did her/his skin flake off in patches?YesNoDoesn't knowRefused to answer(Id10239) During the illness that led to death, did he/she have areas of the skin that turned black?YesNoDoesn't knowRefused to answer(Id10240) During the illness that led to death, did he/she have areas of the skin with redness and swelling?YesNoDoesn't knowRefused to answer(Id10241) During the illness that led to death, did (s)he bleed from anywhere?YesNoDoesn't knowRefused to answer(Id10242) Did (s)he bleed from the nose, mouth or anus?YesNoDoesn't knowRefused to answer(Id10243) Did (s)he have noticeable weight loss?YesNoDoesn't knowRefused to answer(Id10244) Was (s)he severely thin or wasted?YesNoDoesn't knowRefused to answer(Id10245) During the illness that led to death, did s/he have a whitish rash inside the mouth or on the tongue?YesNoDoesn't knowRefused to answer(Id10246) Did (s)he have stiffness of the whole body or was unable to open the mouth?YesNoDoesn't knowRefused to answer(Id10247) Did (s)he have puffiness of the face?YesNoDoesn't knowRefused to answer(Id10248_units) How long did (s)he have puffiness of the face?Enter 1 unit only: 0-30 days or 1-60 months. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.DaysMonthsDoesn't knowRefused to answerIf response was greater than 30 days, ask respondent to report time in months(Id10248_a) [Enter how long (s)he had puffiness of the face in days]:Enter 0-30 days. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.Likely response is under 60 months.If response is greater then 60, confirm the response and enter 60.(Id10248_b) [Enter how long (s)he had puffiness of the face in months]:Enter 1-60 months.(Id10248) For how many days did (s)he have puffiness of the face?(Id10249) During the illness that led to death, did (s)he have swollen legs or feet?YesNoDoesn't knowRefused to answer(Id10250_units) How long did the swelling last?Enter 1 unit only: 0-30 days or 1-60 months. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.DaysMonthsDoesn't knowRefused to answerIf response was greater than 30 days, ask respondent to report time in months(Id10250_a) [Enter how long the swelling lasted in days]:Enter 0-30 days. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.Likely response is under 60 months.If response is greater then 60, confirm the response and enter 60.(Id10250_b) [Enter how long the swelling lasted in months]:Enter 1-60 months.(Id10250) How many days did the swelling last?(Id10251) Did (s)he have both feet swollen?YesNoDoesn't knowRefused to answer(Id10252) Did (s)he have general puffiness all over his/her body?YesNoDoesn't knowRefused to answer(Id10253) Did (s)he have any lumps?YesNoDoesn't knowRefused to answer(Id10254) Did (s)he have any lumps or lesions in the mouth?YesNoDoesn't knowRefused to answer(Id10255) Did (s)he have any lumps on the neck?YesNoDoesn't knowRefused to answer(Id10256) Did (s)he have any lumps on the armpit?YesNoDoesn't knowRefused to answer(Id10257) Did (s)he have any lumps on the groin?YesNoDoesn't knowRefused to answer(Id10258) Was (s)he in any way paralysed?YesNoDoesn't knowRefused to answer(Id10259) Did (s)he have paralysis of only one side of the body?YesNoDoesn't knowRefused to answer(Id10260) Which were the limbs or body parts paralysed?Right sideLeft sideLower part of bodyUpper part of bodyOne leg onlyOne arm onlyWhole bodyOtherDoesn't knowRefused to answer(id10260_check) It is not possible to select "only one side paralysed" and "left and right side" or "whole body" together. Please go back and correct the selection.(id10260_check2) It is not possible to select "Doesn't Know" or "Refused to answer" together with other options. Please go back and correct the selection.(Id10261) Did (s)he have difficulty swallowing?YesNoDoesn't knowRefused to answer(Id10262_units) For how long before death did (s)he have difficulty swallowing?Enter 1 unit only: 0-30 days or 1-60 months. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.DaysMonthsDoesn't knowRefused to answerIf response was greater than 30 days, ask respondent to report time in months(Id10262_a) [Enter how long before death (s)he had difficulty swallowing in days]:Enter 0-30 days. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.Likely response is under 60 months.If response is greater then 60, confirm the response and enter 60.(Id10262_b) [Enter how long before death (s)he had difficulty swallowing in months]:Enter 1-60 months.(Id10262) For how many days before death did (s)he have difficulty swallowing?(Id10263) Was the difficulty with swallowing with solids, liquids, or both?SolidsLiquidsBothDoesn't knowRefused to answer(Id10264) Did (s)he have pain upon swallowing?YesNoDoesn't knowRefused to answer(Id10265) Did (s)he have yellow discoloration of the eyes?YesNoDoesn't knowRefused to answer(Id10266_units) For how long did (s)he have the yellow discoloration?Enter 1 unit only: 0-30 days or 1-60 months. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.DaysMonthsDoesn't knowRefused to answerIf response was greater than 30 days, ask respondent to report time in months(Id10266_a) [Enter how long (s)he had the yellow discoloration in days]:Enter 0-30 days. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.Likely response is under 60 months.If response is greater then 60, confirm the response and enter 60.(Id10266_b) [Enter how long (s)he had the yellow discoloration in months]:Enter 1-60 months.(Id10266) For how many days did (s)he have the yellow discoloration?(Id10267) Did her/his hair change in color to a reddish or yellowish color?YesNoDoesn't knowRefused to answer(Id10268) Did (s)he look pale (thinning/lack of blood) or have pale palms, eyes or nail beds?Long term deficiency of the blood results in a pale, whitish appearance of the lips, tongue, and eye sac. Sometime it is referred to as thinning or lack of blood, or pallor.YesNoDoesn't knowRefused to answer(Id10269) Did (s)he have sunken eyes?YesNoDoesn't knowRefused to answer(Id10270) Did (s)he drink a lot more water than usual?YesNoDoesn't knowRefused to answer(Id10271) Was the baby able to suckle or bottle-feed within the first 24 hours after birth?This question should be asked only if the child was less than 1 year old when it died.YesNoDoesn't knowRefused to answer(Id10272) Did the baby ever suckle in a normal way?This question should be asked only if the child was less than 1 year old when it died.YesNoDoesn't knowRefused to answer(Id10273) Did the baby stop suckling?This question should be asked only if the child was less than 1 year old when it died.YesNoDoesn't knowRefused to answerPlease enter a value less then neonatal age in days at death.(Id10274_a) How many days after birth did the baby stop suckling?Less than 1 day= "0". Enter "99" for "don't know." Enter "88" for "refuse."(Id10274_units) How long after birth did the baby stop suckling?Enter 1 unit only: 0-30 days or 1-11 months. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.DaysMonthsDoesn't knowRefused to answerIf response was greater than 30 days, ask respondent to report time in months(Id10274_b) [Enter how long after birth the baby stopped suckling in days]:Enter 0-30 days. Less than 1 day or 24 hours = 0 days; 1 week = 7 days.Enter a response between 1-11 months.(Id10274_c) [Enter how long after birth the baby stopped suckling in months]:Enter 1-11 months.(Id10274) How many days after birth did the baby stop suckling?(Id10275) Did the baby have convulsions starting within the first 24 hours of life?This question should be asked only if the child was less than 1 year old when it died.YesNoDoesn't knowRefused to answer(Id10276) Did the baby have convulsions starting more than 24 hours after birth?This question should be asked only if the child was less than 1 year old when it died.YesNoDoesn't knowRefused to answer(Id10277) Did the baby's body become stiff, with the back arched backwards?This question should be asked only if the child was less than 1 year old when it died.YesNoDoesn't knowRefused to answer(Id10278) During the illness that led to death, did the baby have a bulging or raised fontanelle?Show photo if available. This question should be asked only if the child was less than 18 months old when it died.YesNoDoesn't knowRefused to answer(Id10279) During the illness that led to death, did the baby have a sunken fontanelle?Show photo if available. This question should be asked only if the child was less than 18 months old when it died.YesNoDoesn't knowRefused to answer(Id10281) During the illness that led to death, did the baby become unresponsive or unconscious?This question should be asked only if the child was less than 1 year old when it died.YesNoDoesn't knowRefused to answer(Id10282) Did the baby become unresponsive or unconscious soon after birth, within less than 24 hours?This question should be asked only if the child was less than 1 year old when it died.YesNoDoesn't knowRefused to answer(Id10283) Did the baby become unresponsive or unconscious more than 24 hours after birth?This question should be asked only if the child was less than 1 year old when it died.YesNoDoesn't knowRefused to answerNeonatal child questions part C(Id10284) During the illness that led to death, did the baby become cold to touch?YesNoDoesn't knowRefused to answerPlease enter a value less then neonatal age in days at death.(Id10285) How many days old was the baby when it started feeling cold to touch?If less than 1 day or 24 hours, enter 0 days. Use 1 week = 7 days to determine the number of days. For don't know, enter "99." For refused, enter "88."(Id10286) During the illness that led to death, did the baby become lethargic after a period of normal activity?YesNoDoesn't knowRefused to answer(Id10287) Did the baby have redness or pus drainage from the umbilical cord stump?YesNoDoesn't knowRefused to answer(Id10288) During the illness that led to death, did the baby have skin ulcer(s) or pits?YesNoDoesn't knowRefused to answer(Id10289) During the illness that led to death, did the baby have yellow skin, palms (hand) or soles (foot)?YesNoDoesn't knowRefused to answer(Id10290) Did the baby or infant appear to be healthy and then just die suddenly?Suddenly means died unexpectedly within 24 hours of being in regular health.YesNoDoesn't knowRefused to answer(Id10485) Did s(h)e suffer from extreme fatigue?Probe whether the deceased felt so tired that (s)he found it hard to get out the bed and do the routine things like taking a shower or changing clothesYesNoDoesn't knowRefused to answer(Id10486) Did (s)he experience a new loss, change or decreased sense of smell or taste?YesNoDoesn't knowRefused to answerSigns and symptoms associated with pregnancy and women(Id10294) Did she have any swelling or lump in the breast?YesNoDoesn't knowRefused to answer(Id10295) Did she have any ulcers (pits) in the breast?YesNoDoesn't knowRefused to answer(Id10296) Did she ever have a period or menstruate?Ask for period and menstruation, and also mention the content of the subquestions already (excessive quantity or little quantity of bleeding, or irregular vaginal bleeding). If anything is mentioned select yes.YesNoDoesn't knowRefused to answer(Id10297) When she had her period, did she have vaginal bleeding in between menstrual periods?Important is the excessive quantity of bloodYesNoDoesn't knowRefused to answer(Id10298) Was the bleeding excessive?YesNoDoesn't knowRefused to answer(Id10301) Was there excessive vaginal bleeding in the week prior to death?Important is the excessive quantity of bloodYesNoDoesn't knowRefused to answer(Id10299) Did her menstrual period stop naturally because of menopause or removal of uterus?YesNoDoesn't knowRefused to answer(Id10302) At the time of death was her period overdue?YesNoDoesn't knowRefused to answerPlease enter a value between 0 and 99.(Id10303) For how many weeks had her period been overdue?The answer could be given in another unit, but for data entry use weeks. Less than 1 week=0. 7 days=1 week. Enter "99" for "don't know." Enter "88" for "refuse."(Id10300) Did she have vaginal bleeding after cessation of menstruation?YesNoDoesn't knowRefused to answer(Id10304) Did she have a sharp pain in her belly (abdomen) shortly before death?YesNoDoesn't knowRefused to answer(Id10305) Was she pregnant or in labour at the time of death?A "yes" response to this question means a foetus or baby remained in the mother's body after she died, even if she was already in labour.YesNoDoesn't knowRefused to answer(Id10306) Did she die within 6 weeks of delivery, abortion or miscarriage?A "yes" response to this question means that a foetus or baby was lost or removed or delivered (vaginally or by C-section) within 6 weeks before she died, whether the baby survived or not.YesNoDoesn't knowRefused to answer(Id10307) Did this woman die more than 6 weeks after being pregnant or delivering a baby?YesNoDoesn't knowRefused to answer(Id10308) Was this a woman who died less than 1 year after being pregnant or delivering a baby?YesNoDoesn't knowRefused to answerPlease enter a value between 0 and 11 months. If the response is more than 11, confirm the response and enter 11.(Id10309) For how many months was she pregnant?Important is the distinction beween early and late pregnancy (threshold is 6 months). For don't know, enter "99." For refused, enter "88."(Id10310) Please confirm, when she died, she was NEITHER pregnant NOR had delivered, had an abortion, or miscarried within 12 months of when she died--is that right?This questions serves to confirm that no maternal death is missed.Yes (SHE WAS NOT PREGNANT; AND SHE DID NOT RECENTLY DELIVER, HAVE ABORTION, OR MISCARRY)No (SHE WAS PREGNANT OR SHE RECENTLY DELIVERED, HAD AN ABORTION OR MISCARRIED)Doesn't knowRefused to answer(Id10310_check) If the response is NO, DON'T KNOW, OR REFUSED, it indicates some uncertainty as to whether the cause of death could have been a maternal or pregnancy-related cause. Go back to the question "Did she ever have a period or menstruate?" and follow the process again. If it is confirmed that the death was related to pregnancy, proceed with the next question "Did she die during labour or delivery?"Questions about possible maternal deaths(Id10312) Did she die during labour or delivery?Labor is the period of time by which contractions are less than 10 minutes apart.YesNoDoesn't knowRefused to answer(Id10313) Did she die after delivering a baby?YesNoDoesn't knowRefused to answer(Id10314) Did she die within 24 hours after delivery?YesNoDoesn't knowRefused to answer(Id10315) Did she die within 6 weeks of childbirth?YesNoDoesn't knowRefused to answer(Id10315) Did she die within 6 weeks of childbirth?(Id10316) Did she give birth to a live baby (within 6 weeks of her death)?The important aspect is if the baby was alive.YesNoDoesn't knowRefused to answer(Id10317) Did she die during or after a multiple pregnancy?YesNoDoesn't knowRefused to answer(Id10318) Was she breastfeeding the child in the days before death?YesNoDoesn't knowRefused to answerPlease enter a value between 0 and 20. If the response is more than 20, confirm the response and enter 20.(Id10319) How many births, including stillbirths, did she/the mother have before this baby?For don't know, enter "99." For refused, enter "88."(Id10320) Had she had any previous Caesarean section?YesNoDoesn't knowRefused to answer(Id10321) During pregnancy, did she suffer from high blood pressure?YesNoDoesn't knowRefused to answer(Id10322) Did she have foul smelling vaginal discharge during pregnancy or after delivery?YesNoDoesn't knowRefused to answer(Id10323) During the last 3 months of pregnancy, did she suffer from convulsions?YesNoDoesn't knowRefused to answer(Id10324) During the last 3 months of pregnancy did she suffer from blurred vision?YesNoDoesn't knowRefused to answer(Id10325) Did bleeding occur while she was pregnant?YesNoDoesn't knowRefused to answer(Id10326) Was there vaginal bleeding during the first 6 months of pregnancy?YesNoDoesn't knowRefused to answer(Id10327) Was there vaginal bleeding during the last 3 months of pregnancy but before labour started?Make sure the respondent understands that it is important that this bleeding happened before birthYesNoDoesn't knowRefused to answer(Id10328) Did she have excessive bleeding during labour or delivery?Here the excessive quantity of blood DURING birth is what we ask forYesNoDoesn't knowRefused to answer(Id10329) Did she have excessive bleeding after delivery or abortion?Here the excessive quantity of blood AFTER birth is what we ask forYesNoDoesn't knowRefused to answer(Id10330) Was the placenta completely delivered?YesNoDoesn't knowRefused to answer(Id10331) Did she deliver or try to deliver an abnormally positioned baby?Enquire the respondent about his/hers understanding of what is an abnormally positioned baby; if unclear or wrong, explain that it refers to babys' whose first body part exiting the vagina is not the head.YesNoDoesn't knowRefused to answerPlease enter a value between 0 and 99. If response was greater than 98 hours, confirm the response and enter 98.(Id10332) For how many hours was she in labour?The answer could be given in another unit, but for data entry use hours. Less than 60 minutes = 0 hours. 1 day=24 hours. Enter "99" for "don't know." Enter "88" for "refuse."(Id10333) Did she attempt to terminate the pregnancy?YesNoDoesn't knowRefused to answer(Id10334) Did she recently have a pregnancy that ended in an abortion (spontaneous or induced)?YesNoDoesn't knowRefused to answer(Id10335) Did she die during an abortion?YesNoDoesn't knowRefused to answer(Id10336) Did she die within 6 weeks of having an abortion?YesNoDoesn't knowRefused to answer(Id10337) Where did she give birth / complete the miscarriage / have the abortion?HospitalOther health facilityHomeOn route to hospital or facilityOtherDoesn't knowRefused to answer(Id10338) Did she receive professional assistance during the delivery?Explain to the respondent what is meant by professional assistance: delivery attended by a medical professional (doctor, nurse or midwife).YesNoDoesn't knowRefused to answer(Id10339) Who delivered the baby / completed the miscarriage / performed the abortion?DoctorMidwifeNurseRelativeSelf (the mother)Traditional birth attendantOtherDoesn't knowRefused to answerHow did the mother deliver her baby?(Id10342) Was the delivery normal vaginal, without forceps or vacuum?YesNoDoesn't knowRefused to answer(Id10343) Was the delivery vaginal, with forceps or vacuum?YesNoDoesn't knowRefused to answer(Id10344) Was the delivery a Caesarean section?YesNoDoesn't knowRefused to answer(Id10347) Was the baby born more than one month early?YesNoDoesn't knowRefused to answer(Id10340) Did she have an operation to remove her uterus shortly before death?YesNoDoesn't knowRefused to answerNeonatal and child history, signs and symptoms(Id10352_units) How old was the child when the fatal illness started?Enter 1 unit only: 1-11 months or 1-11 years.MonthsYearsDoesn't knowRefused to answerIf response was greater than 11 months, ask respondent to report time in years(Id10352_a) [Enter how old the child was when the fatal illness started in months]:Enter 1-11 months.Duration entered exceeds age at death.(Id10352_b) [Enter how old the child was when the fatal illness started in years]:Enter 1-11 years(Id10352) How many years old was the child when the fatal illness started?Neonatal child questions part A(Id10354) Was the child part of a multiple birth?This question should be asked only if the child was less than 1 year old when it died. If two or more children are born at the same time, it is counted as a multiple birth, even if one or more of the babies are born dead.YesNoDoesn't knowRefused to answer(Id10355) Was the child the first, second, or later in the birth order?This question should be asked only if the child was less than 1 year old when it died.FirstSecond or laterDoesn't knowRefused to answer(Id10356) Is the mother still alive?This question should be asked only if the child was less than 1 year old when it died. If mother is present at the interview, select 'yes' without asking the question aloud.YesNoDoesn't knowRefused to answer(Id10357) Did the mother die before, during or after the delivery?This question should be asked only if the child was less than 1 year old when it died.Before deliveryDuring deliveryAfter deliveryDoesn't knowRefused to answerTime between delivery and death of mother(Id10358_units) How long after the delivery did the mother die?This question should be asked only if the child was less than 1 year old when it died. The respondent may reply in days, weeks or months. If less than 24 hours, record "0" days. If less than 7 days enter in days. If more than 7 days but less than 7 weeks, enter in weeks. If more than 7 weeks enter in months.DaysWeeksMonthsDoesn't knowRefused to answerPlease enter a value between 2 and 12 months. If response was greater than 12 months, confirm the response and enter 12.(Id10358) How many months after the delivery did the mother die?Enter 2-12 months.If response was greater than 6 days, ask respondent to report time in weeks(Id10359) How many days after the delivery did the mother die?Enter 0-6 days. Less than 1 day or 24 hours = 0 days.If response was greater than 7 weeks, ask respondent to report time in months(Id10359_a) How many weeks after the delivery did the mother die?Enter 1-7 weeks.(Id10360) Where was the deceased born?This question should be asked only if the child was less than 1 year old when it died. Read the question and slowly read the first 5 choices. Respondent should hear all 5 choices and then respond.HospitalOther health facilityHomeOn route to hospital or facilityOtherDoesn't knowRefused to answer(Id10361) Did you/the mother receive professional assistance during the delivery?This question should be asked only if the child was less than 1 year old when it died. Explain to the respondent what is meant by a professional assistance: delivery attended by a medical professional (doctor, midwife, or nurse).YesNoDoesn't knowRefused to answer(Id10362) At birth, was the baby of usual size?Show photos if available, explain to the respondent that even if the answer is "no" some more questions will be asked, just to make sure no important detail has been missed.YesNoDoesn't knowRefused to answer(Id10363) At birth, was the baby smaller than usual, (weighing under 2.5 kg)?Show photos if available. This question should be asked only if the child was less than 1 year old when it died.YesNoDoesn't knowRefused to answer(Id10364) At birth, was the baby very much smaller than usual, (weighing under 1 kg)?Show photos if available. This question should be asked only if the child was less than 1 year old when it died.YesNoDoesn't knowRefused to answer(Id10365) At birth, was the baby larger than usual, (weighing over 4.5 kg)?Show photos if available. This question should be asked only if the child was less than 1 year old when it died.YesNoDoesn't knowRefused to answer(id1036X_check) It is not possible to select "No usual size at Birth", "No weighing under 2.5 kg" and "No weighing over 4.5 kg" together. Please go back and correct the selection.Please enter a value between 0 and 9999 and coherent with previous answers.(Id10366) What was the weight (in grammes) of the deceased at birth?Ask if the child health card is available. If the card is available and the birth weight is recorded, enter the birth weight from the card. If the card is not available, record the weight based on the respondent's report if known. Record the weight in grammes in 4 digits. Respondents may give the answer in kilograms. For the data entry, convert to grammes. 1 kilogram=1,000 grammes. Enter "9999" for "don't know." Enter "8888" for "refuse."Please enter a value between 0 and 11 months.(Id10367) How many months long was the pregnancy before the child was born?For don't know, enter "99." For refused, enter "88."(Id10368) Were there any complications in the late part of the pregnancy (defined as the last 3 months, before labour)?YesNoDoesn't knowRefused to answer(Id10369) Were there any complications during labour or delivery?YesNoDoesn't knowRefused to answer(Id10370) Was any part of the baby physically abnormal at time of delivery? (for example: body part too large or too small, additional growth on body)?This question should be asked only if the child was less than 1 year old when it died.YesNoDoesn't knowRefused to answer(Id10371) Did the baby/ child have a swelling or defect on the back at time of birth?This question should be asked only if the child was less than 1 year old when it died.YesNoDoesn't knowRefused to answer(Id10372) Did the baby/ child have a very large head at time of birth?This question should be asked only if the child was less than 1 year old when it died.YesNoDoesn't knowRefused to answer(Id10373) Did the baby/ child have a very small head at time of birth?This question should be asked only if the child was less than 1 year old when it died.YesNoDoesn't knowRefused to answerPlease enter a value between 0 and 20. If the response is more than 20, confirm the response and enter 20.(Id10394) How many births, including stillbirths, did the baby's mother have before this baby?For don't know, enter "99." For refused, enter "88."(neonatal_childB) Neonatal child questions part B(Id10376) Was the baby moving in the last few days before the birth?YesNoDoesn't knowRefused to answer(Id10377) Did the baby stop moving in the womb before labour started?YesNoDoesn't knowRefused to answerBaby moving(Id10379_unit) How long before labour did you/the mother last feel the baby move?Enter 1 unit only: 0-23 hours or 1-60 days. 1 week = 7 days.HoursDaysDoesn't knowRefused to answerLikely response is under 60 days. If response was greater than 60 days, confirm the response and enter 60.(Id10379) [Enter how long before labour did you/the mother last feel the baby move in days]:Enter 1-60 days. 1 week = 7 days.If response was greater than 23 hours, ask respondent to report time in days.(Id10380) [Enter how long before labour did you/the mother last feel the baby move in hours]:Enter 0-23 hours.Please enter a value between 0 and 99. If response was greater than 98 hours, confirm the response and enter 98.(Id10382) How many hours did labour and delivery take?If less than one hour enter 0. For don't know, enter "99." For refused, enter "88."(Id10383) Was the baby born 24 hours or more after the water broke?YesNoDoesn't knowRefused to answer(Id10384) Was the liquor foul smelling?YesNoDoesn't knowRefused to answer(Id10385) What was the colour of the liquor when the water broke?Green or brownClear (normal)OtherDoesn't knowRefused to answer(mother_deliv) How was the baby delivered?(Id10387) Was the delivery normal vaginal, without forceps or vacuum?YesNoDoesn't knowRefused to answer(Id10388) Was the delivery vaginal, with forceps or vacuum?YesNoDoesn't knowRefused to answer(Id10389) Was the delivery a Caesarean section?YesNoDoesn't knowRefused to answer(id10389_check) It is not possible to select "No" to all three previous questions. Please go back and review the answers.(Id10391) Did you/the mother receive any vaccinations since reaching adulthood including during this pregnancy?YesNoDoesn't knowRefused to answerPlease enter a value between 0 and 9. If the response is more than 9, confirm the response and enter 9.(Id10392) How many doses?For don't know, enter "99." For refused, enter "88."(Id10393) Did you/the mother receive tetanus toxoid (TT) vaccine?YesNoDoesn't knowRefused to answer(Id10395) During labour, did the baby's mother suffer from fever?YesNoDoesn't knowRefused to answer(Id10396) During the last 3 months of pregnancy, labour or delivery, did you/the baby's mother suffer from high blood pressure?YesNoDoesn't knowRefused to answer(Id10397) Did you/the baby's mother have diabetes mellitus?YesNoDoesn't knowRefused to answer(Id10398) Did you/the baby's mother have foul smelling vaginal discharge during pregnancy or after delivery?YesNoDoesn't knowRefused to answer(Id10399) During the last 3 months of pregnancy, labour or delivery, did you/the baby's mother suffer from convulsions?YesNoDoesn't knowRefused to answer(Id10400) During the last 3 months of pregnancy did you/the baby's mother suffer from blurred vision?YesNoDoesn't knowRefused to answer(Id10401) Did you/the baby's mother have severe anemia?YesNoDoesn't knowRefused to answer(Id10402) Did you/the baby's mother have vaginal bleeding during the last 3 months of pregnancy but before labour started?YesNoDoesn't knowRefused to answer(Id10403) Did the baby's bottom, feet, arm or hand come out of the vagina before its head?YesNoDoesn't knowRefused to answer(Id10404) Was the umbilical cord wrapped more than once around the neck of the child at birth?YesNoDoesn't knowRefused to answer(Id10405) Was the umbilical cord delivered first?YesNoDoesn't knowRefused to answer(Id10406) Was the baby blue in colour at birth?YesNoDoesn't knowRefused to answerRisk factors(Id10411) Did (s)he drink alcohol?YesNoDoesn't knowRefused to answer(Id10412) Did (s)he use tobacco?YesNoDoesn't knowRefused to answer(Id10413) Did (s)he smoke tobacco (cigarette, cigar, pipe, etc.)?YesNoDoesn't knowRefused to answer(Id10414) What kind of tobacco did (s)he use ?CigarettesPipeChewing tobaccoLocal form of tobaccoOtherDoesn't knowRefused to answer(id10414_check) It is not possible to select cigarettes or pipe and "no" to "Did (s)he smoke tobacco?". Please go back and correct the selections.Please enter a value between 0 and 99. If the response is more than 98, confirm the response and enter 98.(Id10415) How many cigarettes did (s)he smoke daily?For don't know, enter "99." For refused, enter "88."Please enter a value between 0 and 99. If the response is more than 98, confirm the response and enter 98.(Id10416) How many times did (s)he use tobacco products each day?For don't know, enter "99." For refused, enter "88."Health service utilisation(Id10418) Did (s)he receive any treatment for the illness that led to death?YesNoDoesn't knowRefused to answer(Id10419) Did (s)he receive oral rehydration salts?YesNoDoesn't knowRefused to answer(Id10420) Did (s)he receive (or need) intravenous fluids (drip) treatment?YesNoDoesn't knowRefused to answer(Id10421) Did (s)he receive (or need) a blood transfusion?YesNoDoesn't knowRefused to answer(Id10422) Did (s)he receive (or need) treatment/food through a tube passed through the nose?YesNoDoesn't knowRefused to answer(Id10423) Did (s)he receive (or need) injectable antibiotics?YesNoDoesn't knowRefused to answer(Id10424) Did (s)he receive (or need) antiretroviral therapy (ART)?YesNoDoesn't knowRefused to answer(Id10425) Did (s)he have (or need) an operation for the illness?YesNoDoesn't knowRefused to answer(Id10426) Did (s)he have the operation within 1 month before death?YesNoDoesn't knowRefused to answer(Id10427) Was (s)he discharged from hospital very ill?YesNoDoesn't knowRefused to answer(Id10428) Did (s)he receive any immunizations?YesNoDoesn't knowRefused to answer(Id10429) Do you have the child's vaccination card?In some countries, the vaccination card is called the "Road to Health" card.YesNoDoesn't knowRefused to answer(Id10430) Can I see the vaccination card (note the vaccines the child received)?Only fill in the vaccination sheet if the respondent has the vaccination card at the present moment during the VA interview; the interviewer should fill in the vaccination sheet, not the respondent.YesNoDoesn't knowRefused to answer(Id10431) Select EPI vaccines doneCheck all vaccines that are indicated on the card. For vaccines that require multiple doses, only check the box if all doses have been received. This includes for children who died before the final doses were received, even if they had received all vaccines appropriate for their age.BCGDPT 1,2,3Hep BHibMeaslesMeningitisPenta 1,2,3PneumoPolio 1,2,3RotaNo VaccinesDoesn't know(id10431_check) It is not possible to select "No vaccines", "Don't know" or "refuse" together with other options. Please go back and correct the selection.(Id10432) Was care sought outside the home while (s)he had this illness?YesNoDoesn't knowRefused to answer(Id10433) Where or from whom did you seek care?Traditional healerHomeopathReligious leaderGovernment hospitalGovernment health center or clinicPrivate hospitalCommunity-based practitioner associated with health systemTrained birth attendantPrivate physicianRelative, friend (outside household)PharmacyDoesn't knowRefused to answer(id10433_check) It is not possible to select "Don't know" or "refuse" together with other options. Please go back and correct the selection.(Id10434) What was the name and address of any hospital, health center or clinic where care was sought(Id10435) Did a health care worker tell you the cause of death?YesNoDoesn't knowRefused to answer(Id10436) What did the health care worker say?(Id10437) Do you have any health records that belonged to the deceased?YesNoDoesn't knowRefused to answer(Id10438) Can I see the health records?YesNoDoesn't knowRefused to answer(Id10439_check) [Is the date of the most recent (last) visit available?]YesNo(Id10439) [Record the date of the most recent (last) visit](Id10440_check) [Is the date of the second most recent visit available?]YesNo(Id10440) [Record the date of the second most recent visit](Id10441_check) [Is the date of the last note on the health records available?]YesNo(Id10441) [Record the date of the last note on the health records](Id10442) [Record the weight (in kilogrammes) written at the most recent (last) visit](enter e.g. 3.5)(Id10443) [Record the weight (in kilogrammes) written at the second most recent visit](Id10444) [Transcribe the last note on the health records](Id10445) Has the deceased's (biological) mother ever been tested for HIV?YesNoDoesn't knowRefused to answer(Id10446) Has the deceased's (biological) mother ever been told she had HIV/AIDS by a health worker?YesNoDoesn't knowRefused to answerBackground and context(Id10450) In the final days before death, did s/he travel to a hospital or health facility?Enter "yes" if the deceased was a stillbirth delivered in a health facility or a live birth delivered in a health facility that died before leaving the facility.YesNoDoesn't knowRefused to answer(Id10451) Did (s)he use motorised transport to get to the hospital or health facility?For stillbirths and live births delivered in a health facility, answer based on mother's experience.YesNoDoesn't knowRefused to answer(Id10452) Were there any problems during admission to the hospital or health facility?For stillbirths and live births delivered in a health facility, answer based on mother's experience.YesNoDoesn't knowRefused to answer(Id10453) Were there any problems with the way (s)he was treated (medical treatment, procedures, interpersonal attitudes, respect, dignity) in the hospital or health facility?For stillbirths and live births delivered in a health facility, answer based on mother's experience.YesNoDoesn't knowRefused to answer(Id10454) Were there any problems getting medications or diagnostic tests in the hospital or health facility?For stillbirths, answer based on mother's experience.YesNoDoesn't knowRefused to answer(Id10455) Does it take more than 2 hours to get to the nearest hospital or health facility from the deceased's household?For stillbirths and live births delivered in a health facility that died before leaving the facility, answer based on mother's experience.YesNoDoesn't knowRefused to answer(Id10456) In the final days before death, were there any doubts about whether medical care was needed?For stillbirths answer based on mother's experience.YesNoDoesn't knowRefused to answer(Id10457) In the final days before death, was traditional medicine used?For stillbirths answer based on mother's experience.YesNoDoesn't knowRefused to answer(Id10458) In the final days before death, did anyone use a telephone or cell phone to call for help?YesNoDoesn't knowRefused to answer(Id10459) Over the course of illness, did the total costs of care and treatment prohibit other household payments?YesNoDoesn't knowRefused to answerDeath certificate with cause of death(Id10462) Was a medical certificate of cause of death issued?The following information serves only to complete cause of death information in some environments. In routine CRVS this information could be skipped in the interview, and information be collected from other sources, if available.YesNoDoesn't knowRefused to answer(Id10463) Can I see the medical certificate of cause of death?This section aims to collect information from the international standard medical certificate of cause of death. This level of detail may or may not be present in the death certificate issued to the family. Record "no" if medical information about the cause of death is not available. The medical certificate of cause of death is commonly obtained from a physician at a hospital and should be distinguished from the Death Certificate which is issued by the civil registration organisation.YesNoDoesn't knowRefused to answer(Id10464) [Record the immediate cause of death from the certificate (line 1a)]If this detail is not present, record "-" (not available).(Id10465) [Duration (Ia):]For all following lines, add duration, if stated. If this detail is not present, record "-" (not available).(Id10466) [Record the first antecedent cause of death from the certificate (line 1b)]An antecedent cause is the one that caused the one on the line above, e.g. diabetes mellitus may be an antecedent cause to kidney disease. If this detail is not present, record "-" (not available).(Id10467) [Duration (Ib):]If this detail is not present, record "-" (not available).(Id10468) [Record the second antecedent cause of death from the certificate (line 1c)]If this detail is not present, record "-" (not available).(Id10469) [Duration (Ic):]If this detail is not present, record "-" (not available).(Id10470) [Record the third antecedent cause of death from the certificate (line 1d)]If this detail is not present, record "-" (not available).(Id10471) [Duration (Id):]If this detail is not present, record "-" (not available).(Id10472) [Record the contributing cause(s) of death from the certificate (part 2)]If this detail is not present, record "-" (not available).(Id10473) [Duration (part2):]If this detail is not present, record "-" (not available).Open narrative(Id10476) Thank you for your information. Now can you please tell me in your own words about the events that led to the death?Record detailed notes of response; use additional paper as needed. If needed, probe for additional details on when respondent recognized symptoms, care sought, barriers to care, issues with transport, abnormalities, etc.(Id10477) [Select any of the following words that were mentioned as present in the narrative.]Chronic kidney diseaseDialysisFeverHeart attackHeart problemJaundiceLiver failureMalariaPneumoniaRenal (kidney) failureSuicideNone of the above words were mentionedDon't know(Id10478) [Select any of the following words that were mentioned as present in the narrative.]AbdomenCancerDehydrationDengue feverDiarrhoeaFeverHeart problemsJaundice (yellow skin or eyes)PneumoniaRashNone of the above words were mentionedDon't know(Id10479) [Select any of the following words that were mentioned as present in the narrative.]AsphyxiaIncubatorLung problemPneumoniaPreterm deliveryRespiratory distressNone of the above words were mentionedDon't know(id10477_check) It is not possible to select "Don't know" or "None of the above" together with other options. Please go back and correct the selection.(id10478_check) It is not possible to select "Don't know" or "None of the above" together with other options. Please go back and correct the selection.(id10479_check) It is not possible to select "Don't know" or "None of the above" together with other options. Please go back and correct the selection.(comment) CommentHautBasTrès basHautBasTrès basHUMIDESÈCHENe sait pasFémininMasculinAmbiguous/intersexParentEnfantAutre membre de la familleAmiSpouseSoignantAgent Publicune autre relationRefus de repondreOuiNonNe sait pasRefus de repondreFémininMasculinAmbiguous/intersexOuiNonFémininMasculinAmbiguous/intersexOuiNonRefus de repondreOuiNonRefus de repondrenouveau-néenfantadulteJourmoisannéeNe sait pasRefus de repondrehôpitalautre établissement de santéà domicilesur la route de hôpital ou de établissementautresNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonCitoyen à la naissanceCitoyen naturaliséRessortissant étrangerNe sait pasRefus de repondreCélibataireMarié(e)Vie avec un PartenaireDivorcé(e)Veuf (ve)Trop jeune pour être marié(e)Ne sait pasRefus de repondreOuiNonAucune éducation formelleécole primaireSecondary schoolHigher than secondary schoolNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondrePrincipalement au chômageEmployéAuxiliaire familialPensionnéEtudiantAutresNe sait pasRefus de repondreOuiNonOuiNonOuiNonOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondrePiétonconducteur ou passager dans la voiture ou véhicule légerconducteur ou passager dans un autobus ou d'un véhicule lourdconducteur ou du passager sur une motoconducteur ou du passager sur un cycle de pédaleconducteur ou du passager sur un bicycletteNe sait pasRefus de repondrePiétonObjet fixeVoiture ou véhicule légerVéhicule lourds ou busMotoBicycletteautresNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreChienserpentinsecte ou scorpionautresNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreJourmoisannéeNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreJourmoisNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreLégèremodéréegraveNe sait pasRefus de repondreContinueDes hauts et des basSeul la nuitNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreJourmoisNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreJourmoisannéeNe sait pasRefus de repondreContinueDes hauts et des basNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreJourmoisNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreJourmoisNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreStridorGrognementune respiration sifflanteNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreMinutesHeuresJourNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreJourmoisNe sait pasRefus de repondreJourmoisNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreJourmoisNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreHeuresJourMoisNe sait pasRefus de repondreabdomen supérieurabdomen inférieurNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreJourMoisNe sait pasRefus de repondreRapidementlentementNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreJourMoisNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreJourmoisNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreJourmoisNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreJourmoisNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreHeuresJourNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreJourmoisNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreVisageExtrémitéspartoutNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreJourmoisNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreJourmoisNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreCôté droitcôté gauchePartie inférieure du corpspartie supérieure du corpsUne jambe seulementun bras seulementtout le corpsautresNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreJourmoisNe sait pasRefus de repondreSolidesLiquidesLes deux deNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreJourmoisNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreJourmoisNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreYes (SHE WAS NOT PREGNANT; AND SHE DID NOT RECENTLY DELIVER, HAVE ABORTION, OR MISCARRY)No (SHE WAS PREGNANT OR SHE RECENTLY DELIVERED, HAD AN ABORTION OR MISCARRIED)Ne sait pasRefus de 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repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreCigarettePipeMâcher du tabacautres formes locales de tabacsAutreNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait pasRefus de repondreOuiNonNe sait 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