Items:

Over the last 12 months, have any members of your householdcompound, adults or children, needed care for any reason? This could include financial or emotional support, physical, health or personal care.

1. How many needed care?

Please tell me about the adults needing and receiving care in the last 12 months. For each person:

2. What is your relationship to this person? The person iswas your

Response Options:
Spousepartner - 2
DaughterSon - 3
Daughter- or Son-in-law - 4
Grandchild - 5
Parent - 6
Parent-in-law - 7
BrotherSister - 8
Other relative, adult (e.g. cousin) - 11
Not related, Adult - 12

3. Is this person dead or alive?

Response Options:
Alive - 1
Dead - 2
Don’t know - 88

4. Why doesdid this person need care or support (or: why did this person die?)

Response Options:
Non health-related - 1
HIVAIDS-related - 2
Other health-related reason - 3
Physical impairmentdisability - 4
Mental impairmentdisability - 5

5. Who is or was the main person providing care for this adult? Is it you yourself, someone else in this household, or someone outside of this household?

Response Options:
Respondent - 1
Someone else in HH - 2
Someone outside HH - 3

6. Even if you were not the main caregiver, diddo you provide care or support to this person?

Response Options:
Yes - 1
No - 2

7. For how long have you been providing care? (over the last 12 months)

Response Options:
Less than 30 days
1 to 3 months
More than 3 months but less than 6 months
6 months or more

8. What type of support was provided? (choose all that apply)

Response Options:
Financial - 1
SocialEmotional - 2
Health - 3
Physical - 4
Personal - 5

9. Iswas support and care generally provided

Response Options:
Daily - 1
Several days per week - 2
Once per week - 3
Once per month - 4
Occasionally, as needed - 5

10. How much supportcare does this person require?

Response Options:
Regular help to do most things - 1
Regular help to do specific activities - 2
Occasional help with most things - 3
Occasional help with specific activities - 4
Other - 5

11. About how much time per week on average diddo you spend providing supportcare for this adult?

Response Options:
By hours: ____
By minutes: ____
Don’t know – 88:88

12. How much difficulty did you have with providing this supportcare?

Response Options:
None - 1
Mild - 2
Moderate - 3
Severe - 4
Extreme or could not do - 5