Was the hospital or long term care facility: - operated by the government - privately operated - NGO - other
When was your [child's] last overnight stay? - In the last 4 weeks - In the last year - In the last 2 years - In the last 3 years - In the last 5 years
Which of the following best describes the reason for your [child's] last overnight stay? - High fever, severe diarrhoea, or cough - Childbirth - Arthritis - Asthma - Heart disease - Bodily injury - Minor surgery - Other
How long was your [child's] stay on this occasion? - 1-2 days - 3-5 days - 6-14 days - 15 days and more
In your opinion, was the skill of the health care providers adequate for your [child’s] treatment?
In the last 4 weeks, how much did your household spend on care by traditional or alternative healers?
In the last 4 weeks, how much did your household spend on dentists?
In the last 4 weeks, how much did your household spend on medication or drugs?
In the last 4 weeks, how much did your household spend on health care products such prescription glasses, hearing aids, prosthetic devices, etc.?
In the last 4 weeks, how much did your household spend on diagnostic and laboratory tests such as X-rays or Blood tests?
In the last 4 weeks, how much did your household spend on any other health care products or services that were not included above?
In the last 12 months, how many times did members of your household go to a hospital and stay overnight?
In the last 12 months, how much did the household pay for all costs associated with overnight stays in a hospital? Please exclude any expenses in the last 4 weeks that you have already told me about, and exclude any reimbursement from insurance.
Current income of any household members.
Savings (e.g. bank account).
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