Women's Health Needs STUDY_SCREENER

Attachment G2. Women’s Health Needs Study Questionnaire (Somali translations)

Section	Question	English Items	Qayb	Su'aal	Maadooyinka Ingiriiska
Screener Cover Page	OMB notice	Form Approved	Jaldigga Bogga Baaraha	Ogaysiiska OMB	Foomka La ansixiyay
		OMB Number:			Nambarka OMB:
		Expiration Date:			Taariikha Dhicitaanka:
Screener	Survey Title	Women's Health Needs Study	Baaraha	Ciwaanka Sahanka	Daraasada Baahiyaha Caafimaad Haweenka
Screener	OMB Burden Statement	Public reporting burden of this collection of information is estimated to average 1 minute per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx).	Baaraha	Ogaysiiska Masuuliyada e OMB	Wargalinta dadwaynaha ee aruurinta macluumaadkaan waxaa lagu qiyaasay celcelis ahaan 1 daqiiqo jawaabtiiba, ayna kujiraan waqtiga dib u eegista lagu samaynaayo tilmaamaha, raadinta ilaha macluumaadka ee horay ujiray, aruurinta iyo ilaalinta macluumaadka loobaahanyahay, iyo dhamaystirka iyo dib umuraajacaynta aruurinta macluumaadka. Waxaa suuragal ah inaan wakaalad fulin ama maalgalin, qofkana lagama doonaayo inuu jawaab kabixiyo su'aalaha macluumaad aruurinta ilaa inay muujinayso maahee nambarka saxda ah ee an wali dhicin ee maaraynta OMB. Udir fikradaha laxariira qiyaasta cadayntaan ama waxkasta oo laxariira mawduucaan ayna kujiraan soojedinada laxariira yaraynta culayskaan una gudbi Madaxa Kalahufida Warbixinada ee CDC/ATSDR; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx).
SECTION A. SCREENER			QAYBTA A. BAARAHA
A	Screener 1	Have you previously participated in the Women’s Health Needs Study (WHNS)? Yes [END SURVEY] No	A	Baaraha 1	Horay ma uga qaybgashay Daraasada Cilmi Baarista Baahiyaha Caafimaadka ee Haweenka (WHNS)? Haa [DHAMAADKA SAHANKA] Maya
	Screener 2	Which of the following languages do you speak?		Baaraha 2	Midee ayaad kud=hadashaa luuqadaha soosocda?
		Amharic Arabic English Oromo Somali Swahili Tigrinya Other, please specify:			Amharic Carabi Ingiriis Oromo Soomaali Sawaaxili Tigrinya Midkale, fadlan sheeg:
	Screener 3	Which language would you prefer to use for this interview? [INTERVIEWER NOTE: IF YOU DO NOT SPEAK THE LANGUAGE PREFERRED, MAKE NOTE AND END INTERVIEW].		Baaraha 3	Luuqadee ayaad jeceshahay in waraysigaan aad kugasho? [OGAYSIISKA WARAYSTAHA: HADAADAN KUHADLIN LUUQADA QOFKA AAD WARAYSANAYSO UU DOORTO, QORO DALABKA OO SOOGABAGABEE WARAYSIGA].
	Screener 4	In which country were you born?		Baaraha 4	Wadankee ayaad kudhalatay?
		Don’t Know Prefer not to answer			Ma aqaano Madoonaayo inaan kajawaabo
	Screener 5	Have you ever lived in any of the following countries?		Screener 5	Waligaa makunoolayd mid kamid ah wadamada soosocda?
		Yes No			Haa Maya
		Egypt Ethiopia Kenya Somalia *			Masar Itoobiya Kenya Soomaaliya
	Screener 6	In which country was your father born?		Baaraha 6	Wadankee ayuu aabahaa kudhashay?
		Don’t Know Prefer not to answer			Ma aqaano Madoonaayo inaan kajawaabo
	Screener 7	In which country was your mother born?		Baaraha 7	Wadankee ayay hooyadaa kudhalatay?
		Don’t Know Prefer not to answer			Ma aqaano Madoonaayo inaan kajawaabo
	Screener 8	Has your mother lived in any of the following countries?		Baaraha 8	Hooyadaa makunoolayd marna mid kamid ah wadamada soosocda?
		Egypt Ethiopia Kenya Somalia *			Masar Itoobiya Kenya Soomaaliya
	Screener 9	How old are you?		Baaraha 9	Meeqa sano ayaad jirtaa?
		Under 18 years 18-24 25-29 30-34 35-39 40-49 Over 49 years Prefer not to answer			Ka yar 18 sanno 18 illaa 24 25 illaa 29 30 illaa 34 35 illaa 39 40 illaa 49 Ka badan 49 sanno Madoonaayo inaan kajawaabo

*Other countries depending on expected population of sites