13 2018 MCH Survey Juris Module_MarshallIslands_Marshallese

Questionnaire and Data Collection Testing, Evaluation, and Research for the Health Resources and Services Administration (HRSA)

2018 MCH Survey Juris Module_MarshallIslands_Marshallese_Formatted

Title V Maternal and Child Health (MCH) Block Grant Jurisdictional MCH Survey Instrument

OMB: 0915-0379

Document [doc]
Download: doc | pdf



Marshall Islands


[ONLY ASK THIS QUESTION IF CHILD IS 0-1 YEAR OLD AND IF BIOLOGICAL MOTHER]

Inaj kajjitōk jet kajjitōk ko kake ejmour eo am.

  1. Ilo terre eo kwar buroro kio, jete alen am kar loelok juon taktō, nooj, ak ro rej jerbal ilo jikin ejmour eo ñan am kakkōlkōle ilo am JIno BORORO?

    1. ☐ 0 lolok ko

    2. ☐ 1 lolok [Etal ñan MI2]

    3. ☐ 2 lolok ko [Etal ñan MI2]

    4. ☐ 3 vlolok ko [Etal ñan MI2]

    5. ☐ 4 ak elōñlok lolok ko [Etal ñan MI2]

77 ☐ Jab jelā [Etal ñan MI2]

99 ☐ Jab kōnaan uaak [Etal ñan MI2]

[Elaññe 0 lolok ko] Elōñ ke iaan men kein raar bōbrae eok jān am etal in kakkōlkōl am bororo?


AET

JAB

Ij jab jelā

Ij jab kōnaan uaak

MI1a. Ear ejjelok aō iien lolok meñe iar kōnaan kar juon

1 ☐

2 ☐

77 ☐

99 ☐

MI1b. Ejjelok kar aō ial ñan jikin taktō ak opij eo an taktō.

1 ☐

2 ☐

77 ☐

99 ☐

MI1c. Taktō eo aō ear jab maroñ jijab io awa ko imaan ainwot aō kar kōnaan.

1 ☐

2 ☐

77 ☐

99 ☐

MI1d. Elap an lōñ men ko iaar aikuij kōṃṃan

1 ☐

2 ☐

77 ☐

99 ☐

MI1e. Ejjelok aō iien imaroñ jolok jān jebal ak jikuul

1 ☐

2 ☐

77 ☐

99 ☐

MI1f. Iaar jab maroñ elolo aō rikokkajriri ajri eo neju.

1 ☐

2 ☐

77 ☐

99 ☐

MI1g. Iaar jab jelā ke iaar Bororo

1 ☐

2 ☐

77 ☐

99 ☐

MI1h. Ejjelok aō health insurance ñan kōllaik wōnaan aō loelok taktō

1 ☐

2 ☐

77 ☐

99 ☐

MI1i. Eaar emmon aō mour im iaar jab lōmnak iaar aikuij loe juon taktō

1 ☐

2 ☐

77 ☐

99 ☐

MI1j. Iaar jab kōnaan taktō in Bororo

1 ☐

2 ☐

77 ☐

99 ☐

MI1k. Iaar jab kōnaan bwe jabrewōt en jelā ke iar bororo

1 ☐

2 ☐

77 ☐

99 ☐

MI1l. Bar jet, jouij im kamelele

1 ☐

2 ☐

77 ☐

99 ☐
















Kim naaj kōnaan kajjitōk jet kajjitōk ko kake jelā im imenene ko am kōn jerbal in kakōlkōl im kapok nañinmij in kanjer ilo ittit im ilo lowan kod.

  1. [ONLY ASK THIS QUESTION OF WOMEN 25-49 AND BIOLOGICAL MOTHER]

Emoj ke bok pap smear kōṃṃan jān taktō, ak rijerbal ro jet an jikin ejmour eo?

    1. ☐ Aet

    2. ☐ Jab

77 ☐ Jab jelā [Etal ñan MI3]

99 ☐ Jab kōnaan uaak [Etal ñan MI3]

[Elaññe jab] Etke kwar jab kōṃṃan teej ko me rej bōk jdik kanneik jān ilowan pipi eo ñan kappok cancer?

[Etal ñanMI3]

[Elaññe aet] Net eo EPAAK TATA kwar ke kappok kanjer in pipi ne am ilo am kōṃṃan teej eo rej bōk jidik kanniek jān lowan pipi eo ñan air bōk ñan lale ilo lab im kappok?

    1. ☐ Juon iiō etto ak diklok

    2. ☐ Elōñlok jān 1 iiō, ijoke jab lōñlok jān 2 iiō ko

    3. ☐ Elōñlok jān 2 iiō ko, ijoke jab lōñlok jān 3 iiō ko

    4. ☐ Elōñlok jān 3 iiō ko, ijoke jab lōñlok 5 iiō ko

    5. ☐ Over 5 iiō ko remotlok

77 ☐ Jab jelā

99 ☐ Jab kōnaan uaak

Ta kar lukkun UN EO elap kwar kōṃṃan test in?

    1. ☐ Mottan kakōlkōl ko

    1. ☐ kōnke juon abañ

    2. ☐ Un ko jet

77 ☐ Jab jelā

99 ☐ Jab kōnaan uaak

Kwar ke bōk tōbrak eo?

    1. ☐ Aet

    1. ☐ Jab

77 ☐ Jab jelā

99 ☐ Jab kōnaan uaak

  1. [ONLY ASK THIS QUESTION OF WOMEN 25-49 AND BIOLOGICAL MOTHER]

Emōj ke am pijaik ittit? pijaik ittit kake x-ray kake juon majiin eo kwoj katartar lok ittit ko nan pija.

    1. ☐ Aet

    2. ☐ Jab

77 ☐ Jab jelā [Etal ñan MI4]

99 ☐ Jab kōnaan uaak [Etal ñan MI4]

[Elaññe jab] Etke kwar jab pijaik ittitim (mammogram)?



[ Elaññe aet] Net eo epaak tata kwar akōlkōl im pijaik ittitim (mammogram)?

    1. ☐ Juon iiō etto or less

    1. ☐ Elōñlok jān 1 iiō, ijoke jab elōñlok 2 iiō ko

    2. ☐ Elōñlok 2 iiō ko, ijoke jab elōñlok 3 iiō ko

    3. ☐ Elōñlok 3 iiō ko, ijoke jab elōñlok 5 iiō ko

    4. ☐ Laplok jan 5 iiō ko etto

77 ☐ Jab jelā

99 ☐ Jab kōnaan uaak

  1. [ONLY ASK THIS QUESTION OF WOMEN 25-49 AND BIOLOGICAL MOTHER]

Emoj ke am etal bwe taktō ren kakkilene im kappok kanjer ilo ittim, ak kakōlkōl leok im kappoik kokkal ko jet ikanjer in ittit? Juon kakkolkol in ittim ej Ilo iien itti ko taktō ro rej jibwi im kappok ebwoj im bar kanjer in ittit.

    1. ☐ Aet

    2. ☐ Jab [Etal ñan M15]

    1. ☐ Jab jelā [Etal ñan M15]

    1. ☐ Jab kōnaan uaak [Etal ñan M15]

[Elaññe aet] Net eo EPAAK TATA kwar etal im kakōlkōle ittim?

    1. ☐ Juon iiō etto ak diklok

    1. ☐Elōñlok 1 iiō, ijoke jab elōñlok 2 iiō ko

    2. ☐ Elōñlok 2 iiō ko, ijoke jab elōñlok 3 iiō ko

    3. ☐ Elōñlok 3 iiō ko, ijoke jab elōñlok 5 iiō ko

    4. ☐ Elōñlok 5 iiō s etto

77 ☐ Jab jelā

99 ☐ Jab kōnaan uaak

  1. Kwoj jelā ke ia eo jikin kappok melele emman im jipañ kake abañ kein elaññe kwoj aikuij melele elaplok kaki abañ kein?

AET

JAB

Ij jab jelā

Ij jab kōnaan uaak

MI5a. Ewor Jelā kake im maron tobare ñan jipañ ko ñan kōrā ro lomaro beele rej mane ir.

1 ☐

2 ☐

77 ☐

99 ☐

MI5b. Ewor Jelā kake im maron tobare ñan jipañ ko kōn nañinmij in tōñal, kobatat,im idaak kadōk.

1 ☐

2 ☐

77 ☐

99 ☐

MI5c. Ewor Jelā kake mōñā ko roine im maron tobare jipañ ko nan eppok mōñā.

1 ☐

2 ☐

77 ☐

99 ☐



  1. [ONLY ASK THIS QUESTION IF CHILD IS CSHCN]

Ewōr ke am jelā kake nañinmij kein rej waloktok jān nam ko?

AET

JAB

Ij jab jelā

Ij jab kōnaan uaak

MI6a. Zika Virus

1 ☐

2 ☐

77 ☐

99 ☐

MI6b. Dengue Fever

1 ☐

2 ☐

77 ☐

99 ☐

MI6c. Chickingunya

1 ☐

2 ☐

77 ☐

99 ☐

Kio ewōr jet am kajjitōk ko kake bōbrae jorrān ilo wan ettōr (car safety).


  1. [ONLY ASK THIS QUESTION IF CHILD IS 0-5 YEARS OLD]

Ne ajri eo nejūṃ ej iuwe ilo juon wan ettōr, ewi iikūtkūt in an jijet ilo juon jea an ajri?

    1. ☐ Aolep iien

    2. ☐ Eekka

    3. ☐ Jet iien

    4. ☐Ejeja

    5. ☐ Jañin

77 ☐ Jab jelā

99 ☐ Jab kōnaan uaak

  1. [ONLY ASK THIS QUESTION IF CHILD IS 0-5 YEARS OLD]

Ne ajri eo nejūṃ ilo juon jea an ajri, Ekka ke an pad ilo jea eo tumaan ke tulik in wan ettōr ko (car, truck, ak van)?

    1. ☐ Jea eo imaan

    2. ☐ Jea eo lokōn

77 ☐ Jab jelā

99 ☐ Jab kōnaan uaak

  1. [ONLY ASK THIS QUESTION IF CHILD IS 0-5 YEARS OLD]

Ne ajri eo nejūṃ ilo juon jea an ajri, ekka ke an jitmaanlok ak jitliklok ilo wan ettōr ko?

    1. ☐ Aet

    2. ☐ Jab

77 ☐ Jab jelā

99 ☐ Jab kōnaan uaak

  1. [ONLY ASK THIS QUESTION IF CHILD IS 0-5 YEARS OLD]

Ilo wan ettōr eo waam im ekka an ajri eo iuwe ie, (car, truck, ak van) ewōr ke an airbag ijo jikin pajinjea eo?

    1. ☐ Aet

    2. ☐ Jab

77 ☐ Jab jelā

99 ☐ Jab kōnaan uaak

  1. Ewi iikūtkūt in am kōjerbale kanor in jea ko (seat belts) ilo iien am ettōr ak iuwe ilo juon wan ettōr? Kwo maron ba bwe:

    1. ☐ Aolep iien

    2. ☐ Enanin aolep iien

    3. ☐ Jet iien

    4. ☐ Ejeja

    5. ☐ Jañin

    6. ☐ Jañin kattor ak iuwe ilo juon car

77 ☐ Jab jelā

99 ☐ Jab kōnaan uaak

















[ONLY ASK THIS QUESTION IF BIOLOGICAL MOTHER]

Inaaj kōnaan kajjitok jet kajjitok ko kake karōk koppan juon baaṃḷe (family planning) im kejparok an jemān. im jinān.

  1. Ewōr ke an jelā kake wewain ko kōjerbali ñan karōk koppan baaṃḷe (family planning methods)? karōk koppan baaṃḷe ekitpuj men kein me kōrā ro ak ro mōttair remaron kōjerbali ñan bōbrae Bororo ainwot (birth control, condoms, implants, or withdrawal).

    1. ☐ Aet

    2. ☐ Jab

    1. ☐ Jab jelā [ETAL ÑAN MI13 (15-43); MI14 (>15, 43<)]

99 ☐ Jab kōnaan uaak [ETAL ÑAN MI13 (15-43); MI14 (>15, 43<)]

[Elaññe aet] Emōj ke am kōjerbal jet iaan wawein ko nan karōk koppan baaṃḷe?

    1. ☐ Aet

    1. ☐ Jab

77 ☐ Jab jelā

99 ☐ Jab kōnaan uaak

[Elaññe jab] Emōj ke am kajeon bukot menin jipañ ko ikijien wawein ko nan karōk koppan baaṃḷe (family planning methods)?

    1. ☐ Aet

    1. ☐ Jab

77 ☐ Jab jelā

99 ☐ Jab kōnaan uaak

  1. [ONLY ASK THIS QUESTION IF BIOLOGICAL MOTHER]

Kwoj ke ilo terre I n kōjerbal baamle planning services, ainwot kantrole kolotak, jan Ministry of Health im Human Services clinic ko?

    1. ☐ Aet

    2. ☐ Jab

77 ☐ Jab jelā

99 ☐ Jab kōnaan uaak

  1. [ONLY ASK THIS QUESTION IF BIOLOGICAL MOTHER]

Emoj ke am bōk melele kake kannin kōn itti (breastfeeding) ilo iien kein mokta jān am naaj kolotak (prenatal care)?

    1. ☐ Aet

    2. ☐ Jab

77 ☐ Jab jelā

99 ☐ Jab kōnaan uaak

  1. Ewōr ke am jelā ke ewōr jerbal ko ikijien wā in bōbrae nañinmij ko (immunization) im aurok eo ñan an ajri eo bōk wā in bōbrae nañinmij ko?

    1. ☐ Aet

    2. ☐ Jab

77 ☐ Jab jelā

99 ☐ Jab kōnaan uaak

  1. Ewōr ke am jelā ke elōñ opij ko (agencies) remaron lelok jipañ ñan kōrā mōjno ro rej mane ir?

    1. ☐ Aet

    2. ☐ Jab

77 ☐ Jab jelā

99 ☐ Jab kōnaan uaak

  1. Emōj ke am kakōlkōl kōn nañinmij in tōñal?

    1. ☐ Aet

    2. ☐ Jab

77 ☐ Jab jelā [Etal ñan MI18 (CSHCN); MI20 (jabt CSHCN, 0-5); end(jabt CSHCN, 6-11)]

99 ☐ Jab kōnaan uaak [Etal ñan MI18 (CSHCN); MI20 (jabt CSHCN, 0-5); end (jabt CSHCN, 6-11)]

[Elaññe aet] Ta tōbrak eo?

    1. ☐ Ewor/Do not have nañinmij in tōñal

    1. ☐ Ejjelok/Have nañinmij in tōñal

77 ☐ Jab jelā

99 ☐ Jab kōnaan uaak

[Elaññe jab] Etke ej jañin mōj am kakōlkōl kōn nañinmij in tōñal?

77 ☐ Jab jelā

99 ☐ Jab kōnaan uaak

Kajjitōk kein jet rej kake jerbal ko ñan kejparok ejmour an ajri eo nejūṃ.

  1. [ONLY ASK THIS QUESTION IF CHILD IS CSHCN]

Ewōr ke am jelā ke elōñ opij ko (agencies) me remaron lewaj jipañ ñan ajri ro ewōr air utame ko in ānbwin?

    1. ☐ Aet

    2. ☐ Jab

77 ☐ Jab jelā

99 ☐ Jab kōnaan uaak

  1. [ONLY ASK THIS QUESTION IF CHILD IS CSHCN ]

Ewōr ke am jelā ke akōlkōlik ajri ro ewōr air utame ko in ānbwin ko remaron madmōdi ilo imōn taktō eo?

    1. ☐ Aet

    2. ☐ Jab

77 ☐ Jab jelā

99 ☐ Jab kōnaan uaak

  1. [ONLY ASK THIS QUESTION IF CHILD IS 0-5 YEARS OLD ]

Emōj ke an ajri Nejūṃ bōk kakōlkōl in rūttolok kar mokta jān an ak ne ej 6 allōñ rettan?

    1. ☐ Aet

    2. ☐ Jab

77 ☐ Jab jelā

99 ☐ Jab kōnaan uaak

File Typeapplication/msword
Authormumford-elizabeth
Last Modified BySYSTEM
File Modified2018-07-12
File Created2018-07-12
© 2024 OMB.report | Privacy Policy