Items:

Urination Module

How often have you experienced any of the following in the previous 30 days when going to urinate?
1. Worried about not having a proper facility to urinate
2. Could not always go to urinate when there was a need
3. Worried that someone would see me while urinating
4. Experience difficulty controlling the urge to urinate
5. Had difficulty finding a clean place to urinate
6. Felt worried that I would step on urine
7. Worried people would talk about me if they saw me
8. Felt concerned I would get an infection if I was urinating in an unsuitabledirty place
9. Feared I would be harmed by animals or insects when I went to urinate
10. Feared I would be harmed by someone when I went to urinate
11. Felt scared urinating in the dark at night
12. Felt concerned I would get an infection if I urinated on someone else's urine
13. Felt scared of ghosts when I went to urinate at night
14. Had difficulty finding a private place to urinate
15. Had difficulty or pain sitting or getting up for urination
16. Had difficulty accessing water for urination
17. Had to suppress urge because people were around and could not go
18. Had to do extra work washing clothes because of dirty conditions where urinating
19. Had to leave dependents (like children, sick, or elderly) alone to urinate
20. Had to stand while urinating because someone came
21. Had trouble finding someone to watch dependents (like children, sick, or elderly) so I could urinate
22. Withheld water to control urge to urinate
23. Had to suppress when workload was high
24. Worried others would get upset if asked to accompany for urination
25. Had to suppress when I got an urge at night

Defecation Module

How often have you experienced any of the following in the previous 30 days when going to defecate?
26. Worried about not having toilet to defecate
27. Had to go far to defecate
28. Defecation process Activity of defecation took a long time to complete
29. Had difficulty finding a clean place to defecate
30. Could not access preferred location
31. Worried I would fall when going to defecate
32. Had to suppress urge when workload was high
33. Felt scared defecating in the dark at night
34. Worried people would talk about me if they saw me
35. Feared I would be harmed by animals or insects when I went to defecate
36. Had to do extra work washing clothes because of dirty conditions when defecating
37. Worried about getting an infection when going to defecate
38. Had difficulty or pains squatting for defecation
39. Felt scared of ghosts when I went to defecate at night
40. Had difficulty accessing water for defecation
41. Had difficulty cleaningwashing myself after defecation
42. Had to suppress urge because I can only defecate at certain times of the day
43. Feared I would be harmed by someone when I went to defecate
44. Had trouble finding someone to watch dependents (like children, sick, or elderly) so I could defecate
45. Had trouble controlling urge to defecate
46. Worried about defecting in the same place as others
47. Withheld food to control urge to defecate
48. Worried about dependents (children, sick, or elderly who need me when I go to defecate
49. Worried that have no money to build or maintain toilet
50. Have had to go back and forth to defecation location because could not find privacy

Response Options:
Never - 1
Sometimes - 2
Often – 3
Always – 4