Congenital Heart Survey To Recognize Outcomes, Needs, an

[NCBDDD] Population-based Surveillance of Outcomes, Needs, and Well-being of Children and Adolescents with Congenital Heart Defects

Att 23_Paper Survey Somali_May23

Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS

OMB: 0920-1382

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Xog-ururinta Xanuunada Wadnaha ee Lagu Dhasho si loo Aqoonsado Natiijooyinka, Baahiyaha, iyo Fayoobaanta CARRUURTA (CHSTRONG-KIDS)



















Sida lagu sharraxay warqadda aad ka heshay xog-ururintan, waxaanu kula soo xidhiidhaynaa xog-ururintan waayo xogtayadu waxay muujinaysaa in ilmahaagu ku dhashay xaalad wadnaha ah. Waxaanu jeclaan lahayn inaanu ku waydiino su'aalo ku saabsan ilmahaaga, caafimaadkooda, iyo qoyskaaga.

Xog-ururinta waa inuu buuxiyaa waalid ama daryeele qof weyn ah oo ku nool gurigan oo yaqaana daryeelka caafimaadka iyo caafimaadka ilmahaaga.

Fadlan ka jawaab su'aalaha leh macluumaadka ku saabsan ilmahaaga qaba xanuunka wadnaha oo keliya. Waxaad dooran kartaa inaad ka boodo su'aal kasta oo aadan rabin inaad ka jawaabto.

























Macluumaadka Ilmahaaga



  1. Bishee iyo sanadkee ayuu dhashay ilmahani?

Bisha:

Sannadka: ____________

    1. Janaayo

    2. Febraayo

    3. Maarso

    4. Abriil

    5. Meey

    6. Juun

    7. Juulay

    8. Agoosto

    9. Sebtember

    10. Oktoobar

    11. Nofambar

    12. Diisambar



  1. Ilmahani ma Hisbaanik baa mise Laatiino?

    1. Hisbaanik ama Laatiino

    2. Ma aha Hisbaanik ama Laatiino


  1. Waa maxay jinsiyadda ilmahan? (Dooro dhammaan kuwa khuseeya)

  1. Hindi Maraykan ama Dhaladka Alaska oo keligiis ah

  2. Aashiyaan

  3. Madow ama Afrikaan Ameerikaan

  4. Dhaladka Hawaiian ama Jasiiradaha kale ee Baasifigga

  5. Caddaan


Xanuunka Wadnaha ee Ilmahaaga



  1. Waa maxay magaca xanuunka wadnaha ee ilmahani ku dhashay? (Dooro dhammaan kuwa khuseeya)

    1. Cidhiidhiga Xididka Oortaha

    2. Ciladda Dahaadhka Qol yaraha Sare (ASD)

    3. Ciladda Dahaadhka u Dhexeeya Qollka Sare iyo Hoose (AVSD) ama Kanaalka Qolalka wadnaha ee Sare iyo Hoose (AV canal)

    4. Furka Xididka Oortaha ee Laba Fur leh

    5. Isu imaatinka Oortaha

    6. Ciladda lagu dhasho Ebstayn

    7. Cudurka wadnaha bidix oo yar (HLHS)

    8. Furiinka xididka taga sambabka (PDA)

    9. Xidhmitaanka xididada sambabada

    10. Cidhiidhiga ku yimaada xididka sambabka

    11. Hal fentrikal (laba dalool oo fentrikal)

    12. Tetroolojiga Faaloot (TOF)

    13. Isbeddelka xididada waaweyn (TGA)

    14. Xidhmitaanka xididada Traykasbidh

    15. Tarankas Artariyoosas

    16. Ciladda Fentrikular Sebtal (VSD)

    17. Mid kale, sheeg _____________

    18. Ma aqaan/ma hubo

    19. Ma jirto xanuun wadne oo aan ogahay (Fadlan uga jawaab su’aalaha hadhay sida ugu wanaagsan ee aad awoodid)


  1. Ilmahaan waligiis qalliin ma looga sameeyay xanuunka wadnaha ee ay ku dhasheen? Qalliinka wadnaha wuxuu keeni doonaa nabarro ku yaal bartamaha laabta, dhinac, ama dhabarka.

    1. Haa

    2. Maya

    3. Ma aqaan/ma hubo



  1. Waa maxay nooca macluumaadka ama caawimaadda ay tahay inay helaan daryeelayaasha carruurta ku dhalatay xanuun wadne?

  1. [Jawaab qoraal ah oo furan]


  1. Markii ugu horreysay ee ilmahan laga helay xaalad wadne, ma lagu siiyay macluumaad ku filan oo ku saabsan waxa ay tani uga dhigan tahay caafimaadkooda niyadeed, bulsho iyo jidh ahaaneed?

    1. Haa

    2. Maya

    3. Ma aqaan/ma hubo



Dhakhaatiirta wadnaha ee ilmahaaga



  1. Goorma ayay ahayd markii ugu dambeysay ee ilmahan uu arko dhakhtarka wadnaha?

  1. In ka yar 1 sano

  2. 1-2 sano

  3. 3-5 sano – Ugudub su’aasha 13aad

  4. In ka badan 5 sano - Ugudub su’aasha 13aad

  5. Weligii midna ma arag - Ugudub su’aasha 13aad



  1. Immisa booqasho oo bixiye daryeel caafimaad ayaa la socotay dhakhtarka wadnaha ama xarunta caafimaadka wadnaha (kiliiniga kaliya ee arka bukaanada qaba xaaladaha wadnaha) 12 bilood ee la soo dhaafay?

  1. _ _ _ Jawaab tiro ah



  1. Waa kuwee bukaanada ugu badan ee dhakhtarka wadnaha aasaasiga ah ee ilmahan uu caadi ahaan arko?

  1. Carruurta iyo dhallinyarada (dhakhtarka wadnaha ee carruurta)

  2. Dadka waaweyn (dhakhtarka xanuunada wadnaha ee lagu dhasho ee dadka waaweyn ama dhakhtarka wadnaha ee dadka waaweyn) – Ugudub su’aasha 12aad

  3. Ma aqaan/ma hubo



  1. Dhakhtar ama bixiye caafimaad oo kale ma kaala hadlay goorta uu cunugani u baahan doono inuu arko dhakhaatiirta wadnaha ee daaweeya dadka waaweyn (dhakhtarka wadnaha ee xanuunada wadnaha ee lagu dhasho ee dadka waaweyn ama dhakhtarka wadnaha ee dadka waaweyn)?

  1. Haa

  2. Maya



  1. 2-dii sano ee la soo dhaafay, intee jeer ayaa uu dhakhtarka wadnaha ee ilmahan

    1. Waqti ku filan la qaatay ilmahan? [Mar walba/Badanaa/Mararka qaarkood/Marnaba]

    2. Si fiican kuu dhegaystay? [Mar walba/Badanaa/Mararka qaarkood/Marnaba]

    3. Muujiyay falcelin qiyamka qoyskaaga iyo caado dhaqameedkaaga? [Mar walba/Badanaa/Mararka qaarkood/Marnaba]

    4. Ku siiyay macluumaadka gaarka ah ee aad uga baahan tahay ilmahan? [Mar walba/Badanaa/Mararka qaarkood/Marnaba]

    5. Kaa caawiyay inaad dareento daneeye ku jira daryeelka ilmahan? [Mar walba/Badanaa/Mararka qaarkood/Marnaba]

    6. Kaala hadlay fursadaha kala duwan ee loo tixgelinayo daryeelka caafimaadka ama daawaynta ilmahan? [Mar walba/Badanaa/Mararka qaarkood/Marnaba]

    7. Kuu fududeeyay inaad soo jeediso walaac ama diido talooyinka ku saabsan daryeelka caafimaadka ee ilmahan? [Mar walba/Badanaa/Mararka qaarkood/Marnaba]

    8. Kaala shaqeeyay sidii aad si wada jir ah u go’aansan lahaydeen daryeelka caafimaadka iyo doorashooyinka daawaynta u fiican ilmahan? [Mar walba/Badanaa/Mararka qaarkood/Marnaba] Ugudub su’aasha 14aad



  1. Haddii ilmahani aanu arag dhakhtarka wadnaha 2-dii sano ee la soo dhaafay ama weligiiba, waayo? (Dooro dhammaan kuwa khuseeya)

  1. Ilmahan ayaa fiicna

  2. Uma malaynayn in ilmahani u baahan yahay inuu arko dhakhtarka wadanaha

  3. Dhakhtarka wuxuu ii sheegay in ilmahani aanu u baahnayn inuu arko dhakharka wadnaha

  4. Caymiska ayaa la beddelay ama lumay

  5. Waxaan u guuray magaalo ama tuulo kale

  6. Ma jeclayn dhakhtarka wadnaha ee ilmahan

  7. Waan waayay dhakhtarka wadnaha

  8. Waxyaabo kale oo badan ayaa ii socday

  9. Waxaa jiray arrimo la xiriira kharashka

  10. Waxaan doortay inaan dibu dhigo ama joojiyo ballamaha COVID dartiis

  11. Dhakhtarka wadanaha ee ilmahan ayaa dibu dhigay ama baajiyay ballamaha COVID dartiis

  12. Mid kale, sheeg _____________





Caafimaadka guud ee ilmahaaga


Haddii ilmahaagu ka yar yahay 6 sano, ugudub su’aasha 16aad.


  1. Waa immisa dhererka ilmahan ee HADDA? (Ku jawaab fiit iyo inji ama mitir iyo sentimitir)

  1. ­­­___ Fiit IYO ___ injis

  2. ___ Mitir IYO ___ sentimitir


  1. Waa immisa miisaanka ilmahan ee HADDA? (Ku jawaab labada midkood rodol ama kiilograam)

    1. ___ Rodol

    2. ___ Kiiloograam



  1. Si guud, maxaad ku sifayn lahayd caafimaadka ilmahan?

  1. Aad iyo aad u fiican

  2. Aad u fiican

  3. Fiican

  4. Dhexdhexaad

  5. Liita


Xaaladda caafimaad ee ilmahaaga



  1. Miyuu dhakhtar ama bixiye caafimaad oo kale WALIGII kuu sheegay in ilmahani uu leeyahay…

  1. Dhibaatooyin welwel [Haa / Maya]

  2. Niyad-jab [Haa / Maya]

  3. Daahitaan korriin [Haa / Maya]

  4. Dhibaatooyin dabeecad ama habdhaqan [Haa / Maya]

  5. Naafonimada garaadka [Haa / Maya]

  6. Ciladda hadalka ama ciladaha kale ee luqadda [Haa / Maya]

  7. Naafonimada barashada [Haa / Maya]

  8. Ciladda Feejignaanta Yar ama Ciladda Feejignaanta Yar/Dhaqdhaqaaqa badan, taas oo ah, ADD ama ADHD [Haa / Maya]

  9. Ootiisamka, Ciladda Ootiisamka Ballaaran, Ciladda Asperger, ama Ciladda Korriinka ee Baahsan (PDD) [Haa / Maya]

  10. Sonkorowga [Haa / Maya]

  11. Down Syndrome [Haa / Maya]

  12. Xaalado kale oo hidde ama dhaxal ah [Haa / Maya]

  13. Wadnaha oo hawlgaba [Haa / Maya]

  14. Mid kale (sheeg) [Haa / Maya] __________________





  1. Ilmahani ma leeyahay mid ka mid ah kuwan soo socda?

    1. Dhego la'aan ama dhibaatooyin xagga maqalka ah [Haa/Maya]

    2. Indho la'aan ama dhibaatooyin xagga aragga ah, xitaa marka loo xidho muraayadaha indhaha [Haa/Maya]



Haddii ilmahaagu ka yar yahay 6 jir, ugudub su’aasha (#19).



    1. Dhibaato socod oo daran ama fuulista jaranjarada - [Haa/Maya]




Baahiyaha daryeelka caafimaad ee ilmahaaga


  1. Ilmahan HADDA ma u baahan yahay ama ma isticmaala daawo uu dhakhtar u qoray, oo aan ahayn fiitamiino?

  1. Haa

  2. Maya



  1. Ilmahani ma u baahan yahay ama ma isticmaala daryeel caafimaad, caafimaadka maskaxda, ama adeegyo waxbarasho oo ka badan inta caadiga ah ee carruurta ay isku da'da yihiin ay u baahan yihiin?

  1. Haa

  2. Maya



  1. Ilmahaan ma xaddidan yahay ama ma laga hortagay si kasta oo ay u awoodaan in ay sameeyaan waxyaabaha inta badan ay samayn karaan carruurta ay isku da'da yihiin?

  1. Haa

  2. Maya – Ugudub su’aasha 23aad


  1. Ilaa intee in le'eg ayay xaaladaha caafimaad ee ilmahan ama dhibaatooyinku saameeyaan awooddooda wax-qabad?

  1. Aad u yar

  2. Xoogaa

  3. In aad u badan



  1. Ilmahani ma u baahan yahay ama ma qaataa daawayn gaar ah, sida daawaynta jidhka, shaqada, ama hadalka?

  1. Haa

  2. Maya



  1. Ilmahani ma qabaa nooc kasta oo ah dhibaato niyadeed, korriin, ama habdhaqan oo ay u baahan yihiin daaweyn ama la-talin?

  1. Haa

  2. Maya



  1. Haddii ay jawaabtu tahay HAA mid ka mid ah su'aalaha kor ku xusan ee qaybtan Baahiyaha Daryeelka Caafimaadka ee Gaarka ah (Su'aalaha 19-24), ma waxaa sabab u ah xaalad caafimaad, habdhaqan, ama xaalad kale oo caafimaad oo la filayo inay socoto 12 bilood ama ka badan?

  1. Haa

  2. Maya

  3. Dhammaan jawaabahaygii su’aalaha 19-24 waxay ahaayeen MAYA




Taariikhda dugsiga/waxbarasho ee ilmahaaga



Haddii ilmahaagu ka yar yahay 3 sano, u gudub su'aasha 46. Haddii ilmahaagu u dhexeeyo 3 iyo 5 jir, tag su'aasha 34aad.

  1. Fasalka immisaad ayuu ku jiraa ilmahani hadda? (Haddii uu yahay fasalka xagaaga, waa maxay heerka fasalka ugu sarreeya ee ilmahani hore u dhammaystay)?

  1. Xadaanada carruurta

  2. Fasalka 1aad

  3. Fasalka 2aad

  4. Fasalka 3aad

  5. Fasalka 4aad

  6. Fasalka 5aad

  7. Fasalka 6aad

  8. Fasalka 7aad

  9. Fasalka 8aad

  10. Fasalka 9aad

  11. Fasalka 10aad

  12. Fasalka 11aad

  13. Fasalka 12aad



  1. Tan iyo markii uu bilaabay xadaanada carruurta, ilmahani ma ku celiyay wax fasallo ah?

  1. Haa

  2. Maya


  1. 12-KII BILOOD EE LA SOO DHAAFAY, ilaa immisa maalmood ayuu ilmahan dugsiga uga maqnaaday xanuunkooda wadnaha, jirro, ama dhaawac?

  1. Maalmo dugsiyeed ma maqnaan

  2. 1-3 maalmood

  3. 4-6 maalmood

  4. 7-10 maalmood

  5. 11 maalmood ama ka badan

  6. Ilmahan lama qorin dugsiga



  1. Ilmahaan WALIGIIS ma yeeshay mid ka mid ah kuwan soo socda ee waxbarashada gaarka ah ama qorshooyinka wax ka qabadka hore? (Dooro dhammaan kuwa khuseeya)

  1. Qorshaha Adeegga Qoyska ee Shakhsi ahaaneed ama IFSP (loo isticmaalo adeegyada wax-ka-qabashada hore ee carruurta ka yar 3 jir)

  2. Barnaamijka Waxbarashada Shakhsi ahaaneed ama IEP (loo isticmaalo adeegyada waxbarashada gaarka ah ee carruurta jirta 3 ama ka weyn)

  3. Qorshaha 504 (mararka qaarkood loo isticmaalo adeegyada waxbarashada gaarka ah halkii laga isticmaali lahaa IEP ama marka lagu daro)

  4. Mid kale, sheeg _________________

  5. Maya, ilmahani waligiis ma yeelan qorshe waxbarasho oo gaar ah



Haddii ilmahaagu ka yar yahay 12 sano, ugudub su’aasha 31aad.



  1. Intee in le’eg ayay kula tahay in ilmahan…

  1. Heli doono shahaado dugsi sare oo caadi ah? Shahaadada dugsiga sare ee caadiga ah waxaa ku jira "GED" laakiin kuma jiraan shahaado dhammaystiran ama dibloomada gaarka ah ee ardayda waxbarashada gaarka ah


[Xaqiiqdii way dhici doontaa / Malaha way dhici doontaa / Malaha ma dhici doonto/Xaqiiqdii ma dhici doonto/Ma garanayo/Hore ayuu u lahaa


  1. Dhigan doono dugsiga kadib dugsiga sare? Oo ay ku jiraan dugsiga farsamada ama ganacsiga


[Xaqiiqdii way dhici doontaa / Malaha way dhici doontaa / Malaha ma dhici doonto / Xaqiiqdii ma dhici doonto / Hore ayuu u lahaa]


  1. Ka qaybgali doono barnaamij tababar gaar ah kadib dugsiga sare ee loogu talogalay dadka qaba naafada garaadka?

[Xaqiiqdii way dhici doontaa / Malaha way dhici doontaa / Malaha ma dhici doonto /Dhab ahaan ma garanayo / Ma aqaan / Horay ayuu u lahaa / Ma khusayso]



  1. Dhammaystiri doono barnaamij dugsi farsamo ama ganacsi?

[Xaqiiqdii way dhici doontaa / Malaha way dhici doontaa / Malaha ma dhici doonto / Xaqiiqdii ma dhici doonto / Ma aqaan / Hore ayuu u lahaa]


  1. Ka qalinjabin doono kuleej 2-sano ah ama kuleej bulsho?

[Xaqiiqdii way dhici doontaa / Malaha way dhici doontaa / Malaha ma dhici doonto / Xaqiiqdii ma dhici doonto / Ma aqaan / Hore ayuu u lahaa]



  1. Ka qalinjabin doono kuleej 4 sano ah?

[Xaqiiqdii way dhici doontaa / Malaha way dhici doontaa / Malaha ma dhici doonto / Xaqiiqdii ma dhici doonto / Ma aqaan / Hore ayuu u lahaa]



  1. Qaadan doono liisanka darawalnimada?

[Xaqiiqdii way dhici doontaa / Malaha way dhici doontaa / Malaha ma dhici doonto / Xaqiiqdii ma dhici doonto / Ma aqaan / Hore ayuu u lahaa]



  1. Ugu dambeyntii ku noolaadaan meel ka baxsan guriga iyaga oo aan la ilaalin?

[Xaqiiqdii way dhici doontaa / Malaha way dhici doontaa / Malaha ma dhici doonto / Xaqiiqdii ma dhici doonto / Ma aqaan / Hore ayuu u lahaa]



  1. Ugu dambayntii ay keligood u noolaadaan si gaar ah iyaga oo la ilaalinayo?

[Xaqiiqdii way dhici doontaa / Malaha way dhici doontaa / Malaha ma dhici doonto / Xaqiiqdii ma dhici doonto / Ma aqaan / Hore ayuu u lahaa]



  1. Ugu dambeyntii ay heli doonaan shaqo lacag leh? Tan waxaa ku jira shaqo kasta oo la bixiyo -- ilmuhu uma baahna inuu sameeyo wax ku filan oo uu naftiisa ku masruufo. Tan waxaa ka mid noqon kara shaqo hoy ama la taageero.

[Xaqiiqdii way dhici doontaa / Malaha way dhici doontaa / Malaha ma dhici doonto / Xaqiiqdii ma dhici doonto / Ma aqaan / Hore ayuu u lahaa]



  1. Heli doono wax ku filan oo ay isku masruufaan iyaga oo aan kaalmo dhaqaale ka helin qoyskooda ama barnaamijyada dheefta ee dawladda?

[Xaqiiqdii way dhici doontaa / Malaha way dhici doontaa / Malaha ma dhici doonto / Xaqiiqdii ma dhici doonto / Ma aqaan / Hore ayuu u lahaa]






Waxqabadyada ilmahaaga iyo deegaanka bulshada


  1. USBUUCII LA SOO DHAAFAY, immisa maalmood ayuu ilmahani jimicsi sameeyay, cayaaray, ama ka qaybqaatay dhaqdhaqaaq jireed ugu yaraan 60 daqiiqo?

  1. 0 maalmood

  2. 1-3 maalmood

  3. 4-6 maalmood

  4. Maalin kasta


  1. 12-KII BILOOD EE LA SOO DHAAFAY, ilmahani ma ka qayb qaatay:

  1. Koox isboorti ama isaga ama iyadu ma qaadan jireen casharro isboorti dugsiga kadib ama maalmaha fasaxa? [Haa/Maya]

  2. Ma jiraan naadiyo ama ururo ay ku jiraan dugsi kadib ama maalmaha fasaxa ah? [Haa/Maya]

  3. Ma jiraan waxqabadyo kale oo habaysan ama casharo, sida muusiga, qoob ka ciyaarka, luqadda, ama farshaxanada kale? [Haa/Maya]

  4. Ma jiraan nooc kasta oo adeegga bulshada ah ama shaqo iskaa wax u qabso ah ee dugsiga, kaniisadda, ama bulshada dhexdeeda? [Haa/Maya]

  5. Ma jirtaa shaqo kasta, oo ay ku jiraan shaqooyinka caadiga ah iyo sidoo kale xannaanada carruurta, jarista cawska, ama shaqo kale oo marmar ah? [Haa/Maya]


  1. 12-KII BILOOD EE LA SOO DHAAFAY, immisa jeer ayaa ilmahan loo xoog-sheegtay, la qaatay, ama laga saaray carruurt kale?

  1. Marna

  2. 1-2 jeer (12-kii bilood ee la soo dhaafay)

  3. 1-2 jeer bishiiba

  4. 1-2 jeer toddobaadkiiba

  5. Ku dhawaad maalin kasta


  1. Marka la barbardhigo carruurta kale ee da'dooda ah, intee in le'eg ayay ku adag tahay ilmahani inuu samaysto ama haysto saaxiibada?

  1. Waxba kuma adka

  2. Xoogaa way ku adag tahay

  3. In badan way ku adag tahay


U diyaargarowga ilmahaaga inuu wax barto



Ka jawaab su'aalaha 35-45 kaliya haddii ilmahaagu u dhexeeyo 3 iyo 5 sano jir. Haddii kale u gudub su'aasha 46aad.



  1. Immisa jeer ayuu ilmahani la wadaagaa alaabta lagu ciyaaro ama ciyaaraha carruurta kale?

    1. Mar walba

    2. Inta badan

    3. Ilaa nus wakhti

    4. Mararka qaar

    5. Marna


  1. Immisa jeer ayuu ilmahani welwel ka muujiyaa marka ay arkaan kuwa kale oo dhaawacmay ama aan faraxsanayn?

    1. Mar walba

    2. Inta badan

    3. Ilaa nus wakhti

    4. Mararka qaar

    5. Marna


  1. Immisa jeer ayuu ilmahani si fiican ula ciyaaraa carruurta kale?

    1. Mar walba

    2. Inta badan

    3. Ku dhawaad ilaa nus wakhti

    4. Mararka qaar

    5. Marna



  1. Intee jeer ayuu ilmahani aqoonsan karaa oo magacaabi karaan waxay iskood u dareemayaan?

    1. Mar walba

    2. Inta badan

    3. Ilaa nus wakhti

    4. Mararka qaar

    5. Marna



  1. Intee in le’eg ayay ku adag tahay ilmahan marka la waydiiyo inuu joojiyo hal waxqabad oo uu bilaabo waxqabad cusub?

    1. Mar walba

    2. Inta badan

    3. Ilaa nus wakhti

    4. Mararka qaar

    5. Marna


  1. Immisa jeer ayuu ilmahani xanaaqaa?

    1. Mar walba

    2. Inta badan

    3. Ilaa nus wakhti

    4. Mararka qaar

    5. Marna


  1. Immisa jeer ayay ilmahani dhib kala kulmaan dejinta?

    1. Mar walba

    2. Inta badan

    3. Ilaa nus wakhti

    4. Mararka qaar

    5. Marna


  1. Immisa jeer ayay ilmahan ku adag tahay inay sugaan markooda?

    1. Mar walba

    2. Inta badan

    3. Ilaa nus wakhti

    4. Mararka qaar

    5. Marna


  1. Immisa jeer ayaa ilmahani si fudud loo jeedin karaa?

    1. Mar walba

    2. Inta badan

    3. Ilaa nus wakhti

    4. Mararka qaar

    5. Marna


  1. Intee in le’eg ayuu ilmahani ku feejignaan karaa hawsha aad siisay ugu yaraan dhowr daqiiqo? Tusaale ahaan, hawlo fudud?

    1. Mar walba

    2. Inta badan

    3. Ilaa nus wakhti

    4. Mararka qaar

    5. Marna



  1. Immisa jeer ayuu ilmahani sii wadaa inuu ka shaqeeyo hawsha xitaa marka ay ku adag tahay iyaga?

    1. Mar walba

    2. Inta badan

    3. Ilaa nus wakhti

    4. Mararka qaar

    5. Marna


Daryeelka caafimaadka ee ilmahaaga


  1. Halkee ayuu ilmahani aadaa marka ay jirran yihiin ama aad u baahan tahay talo caafimaad oo ku saabsan caafimaadkooda?

    1. Ilmahani ma laha meel caadi ah oo uu u tago daryeel caafimaad ama talo marka uu buko

    2. Xafiiska dhakhtarka

    3. Qolka Gurmadka ee Isbitaalka

    4. Waaxda Bukaan-socodka ee Isbitaalka

    5. Xarunta Daryeelka Degdegga ah

    6. Kiliinig ama Xarun Caafimaad

    7. Kiliiniga Bakhaarka Tafaariiqda ama "Kiliiniga Minute"

    8. Dugsiga (Xafiiska Kalkaalisada, Xafiiska Tababaraha Ciyaaraha)

    9. Meel kale


  1. 12-KII BILOOD EE LA SOO DHAAFAY, immisa jeer ayuu ilmahani booqday dhakhtar, kalkaaliye caafimaad, ama xirfadle caafimaad oo kale si uu u helo baadhis ka hortag ah? Baaritaanka ka-hortagga ah waa marka ilmahan uusan xanuunsaneyn ama uusan dhaawacmin, sida booqashada sannadlaha ah ama isboortiga jireed, ama booqashada badqabka ilmaha.

  1. 0 booqasho

  2. 1 booqasho

  3. 2 booqasho ama ka badan


  1. 12-KII BILOOD EE LA SOO DHAAFAY, immisa jeer ayuu ilmahani booqday qolka xaaladaha degdegga ah ee isbitaalka?

  1. Midna

  2. 1 mar

  3. 2 mar ama ka badan



  1. 12-KII BILOOD EE LA SOO DHAAFAY, ilmahan ma la dhigay isbitaalka si uu ugu yaraan hal habeen u joogo?

  1. Haa

  2. Maya



Baahiyaha ilmahaaga ee aan la daboolin



  1. 12-KII BILOOD EE LA SOO DHAAFAY, ilmahani ma u baahday mid ka mid ah daryeelka caafimaad ee soo socda laakiin uusan helin? (Dooro dhammaan kuwa khuseeya)

  1. Daryeelka wadnaha

  2. Daryeel caafimaad oo kale

  3. Daryeelka ilkaha

  4. Daryeelka aragga

  5. Daryeelka maqalka

  6. Adeegyada caafimaadka maskaxda

  7. Mid kale, sheeg _____________

  8. Ilmahani waxa uu helay dhammaan daryeelka caafimaad ee ay u baahnaayeen 12-kii bilood ee la soo dhaafay Ugudub su’aasha 52aad



  1. Ma mid ka mid ah sababahan soo socda ayaa gacan ka gaystay in ilmahan aanu helin adeegyada caafimaad ee loo baahan yahay?

  1. Ilmahani ma lahayn caymis caafimaad oo daboolaya adeegyada loo baahan yahay [Haa / Maya]

  2. Ilmahani uma qalmin adeegyada [Haa / Maya]

  3. Adeegyada ilmahani u baahnaa lagama helin aaggaaga [Haa / Maya]

  4. Waxaa jiray dhibaatooyin helitaanka ballan markii ilmahan uu u baahday mid [Haa / Maya]

  5. Waxaa jiray dhibaatooyin xagga helitaanka gaadiidka ama daryeelka ilmaha [Haa / Maya]

  6. Waxyaabo kale oo badan ayaa ii socday [Haa / Maya]

  7. Rugta caafimaadka ama xafiiska dhakhtarku ma furnayn markii ilmahani u baahnaa daryeel [Haa / Maya]

  8. Waxaa jiray arrimo la xiriira kharashka [Haa / Maya]

  9. Waxaan doortay inaan dibu dhigo ama joojiyo ballamaha COVID dartiis [Haa / Maya]

  10. Rugta caafimaadka ama xafiiska dhakhtarka ayaa dibu dhigay ama baajiyay ballamaha COVID dartiis [Haa / Maya]

  11. Mid kale, sheeg [Haa / Maya] _____________


Caymiska ilmahaaga


  1. Ilmahan HADDA ma ka ku jiraa WAX caymis caafimaad ah ama qorshe caymis caafimaad?

    1. Haa

    2. Maya - Haddi ilmahani uu yahay ugu yaraan 12 jir, aad su'aasha 54aad. Haddii kale ugudub su'aasha 60aad.



  1. Ilmahan HADDA ma ku jiraa mid ka mid ah noocyada caymiska caafimaadka ama qorshooyinka caymiska caafimaadka?

    1. Caymis loo marayo loo-shaqeeye hore ama mid hadda ah [Haa/Maya]

    2. Caymis si toos ah looga iibsaday shirkad caymis, oo ay ku jirto Suuqa Caymiska Caafimaadka ee Sharciga Daryeelka La awoodi karo (ACA) [Haa/Maya]

    3. Medicaid (oo ay ku jiraan MassHealth, MinnesotaCare, PeachCare, ama Georgia Families), Caawimada Caafimaadka, ama nooc kasta oo ah qorshaha kaalmada dawladda ee kuwa dakhligoodu yar yahay ama naafo ah [Haa/Maya]

    4. TRICARE ama daryeelka caafimaadka milatariga kale [Haa/Maya]

    5. Adeegga Caafimaadka Hindiya [Haa/Maya]

    6. Mid kale, sheeg [Haa/Maya] _____________



U wareegidda daryeelka caafimaadka ee dadka waaweyn


Ka jawaab su'aalaha 54-59 kaliya haddii ilmahani yahay ugu yaraan 12 jir. Haddii kale ugudub su'aasha 60aad.

  1. U qalmitaanka caymiska caafimaadka badanaa way isbeddeshaa xilliga lagu jiro qaangaarnimada. Ma ogtahay sida ilmahan loo caymin doono marka uu qaangaaro?

  1. Haa – Ugudub su’aasha 56aad

  2. Maya


  1. Hadday jawaabtu tahay maya, ma jiraa qof kaala hadlay sidii loo heli lahaa ama loo haysan lahaa nooc ka mid ah caymiska caafimaadka marka uu ilmuhu qaangaarayo?

    1. Haa

    2. Maya



  1. Dhaqtar ama bixiye daryeelka caafimaadka oo kale weli ma kaala hadleen baahida ilmahan u qabo inuu arko dhakhtarka wadnaha inta ay nool yihiin?

  1. Haa

  2. Maya



  1. Dhakhtarka ilmahan ama bixiyaha daryeelka caafimaadka ee kale si firfircoon ma ula shaqeeyay ilmaha si ay:

  1. U sameeyaan doorashooyin wanaagsan oo ku saabsan caafimaadkiisa/keeda? Tusaale ahaan, cunista cunto caafimaad leh, jimicsi joogto ah, aan la isticmaalin tubaakada, khamriga ama daroogooyinka kale, ama dibu dhigista galmada



[Haa / Maya / Ma aqaan]



  1. U helaan xirfado uu ku maareeyo caafimaadkiisa/keeda iyo daryeelkooda caafimaad? Tusaale ahaan, fahmida baahiyaha caafimaad ee hadda jira, ogaanshaha waxa la sameeyo marka xaalad degdeg ah oo caafimaad timaado, ama qaadashada dawooyinka isaga/iyadu ay u baahan karaan



[Haa / Maya / Ma aqaan]



  1. U fahmaan isbeddellada daryeelka caafimaadka ee ku dhaca da'da 18? Tusaale ahaan, fahmidda isbeddellada ku yimaada asturnaanta, oggolaanshaha, helitaanka macluumaadka, ama go'aan qaadashada



[Haa / Maya / Ma aqaan]



  1. Intee in le'eg ayay kula tahay in ilmahaagu u diyaarsan yahay inuu sameeyo doorashooyin wanaagsan oo ku saabsan caafimaadkiisa/keeda, maamulo caafimaadkiisa/keeda iyo daryeelkooda, oo uu wax ka qabto isbeddellada daryeelka caafimaadka ee ku dhaca da'da?

    1. Aad u diyaarsan

    2. Xoogaa diyaarsan

    3. Aad uma diyaarsana

    4. Gebi ahaan diyaar maaha



  1. Dhakhaatiirta ilmahan ama bixiyeyaasha kale ee daryeelka caafimaadka ma kula shaqeeyeen adiga iyo ilmahan si ay u abuuraan qorshe daryeel oo ay u daboolaan yoolkooda iyo baahidooda caafimaad?

    1. Haa

    2. Maya



  1. Fadlan qiimee sidaad uga walaacsan tahay xaaladda caafimaadka mustaqbalka ee ilmahan

    1. Aad u walaacsan

    2. Xoogaa walaacsan

    3. Aad uma walaacsana

    4. Ma walaacsani haba yaraatee


Tallaalada


  1. 12-KII BILOOD EE LA SOO DHAAFAY, ilmahan ma qaatay tallaalka hargabka? Tallaalka hargabka waxaa badanaa la bixiyaa deyrta wuxuuna ka ilaaliyaa hargabka xilliga hargabka.

    1. Haa

    2. Maya


COVID-19


  1. Ilmahaan waligiis ma qaaday koronafayras ama COVID-19 (oo ku saleysan baaritaanka bosatif ah ee COVID-19 ama xirfadle caafimaad oo kuu sheegaya ilmaha inuu qabo COVID-19?

  1. Haa

  2. Maya

  3. Ma helin natiijooyin


  1. Fadlan dooro bayaanka sida ugu fiican u qeexaya ilmahan ee ku saabsan tallaalka COVID-19:

  1. Ilmahan waxa uu qaatay dhammaan qiyaasaha lagu taliyey ee tallaalka COVID-19 - Ugudub su’aasha 65aad

  2. Ilmahan waxa la siiyay xoogaa laakiin ma aha dhammaan qiyaasaha lagu taliyey ee tallaalka, waxaanan ugu talogalay in ay qaataan dhammaan qiyaasaha lagu taliyey – Ugudub su’aasha 65aad

  3. Ilmahan waxa la siiyay xoogaa laakiin ma aha dhammaan qiyaasaha tallaalka ee lagu taliyey, mana rabo in la siiyo dhammaan qiyaasaha lagu taliyey

  4. Ilmahan ma qaadan wax tallaal ah oo loogu talogalay COVID-19

  5. Mid kale


  1. Maxay yihiin sababaha aad u dooratay in aan ilmahan si buuxda looga tallaalin COVID-19? (Dooro dhammaan kuwa khuseeya)

  1. Waxaan ka walaacsanahay waxyeelada ka iman karta tallaalka

  2. Waxaan dareemayaa in tallaallada loo abuuray si degdeg ah

  3. Ma rumaysni in tallaalku waxtar u leeyahay ka hortagga faafitaanka COVID-19

  4. Anigu kama welwelin ilmahan in uu qaadayo COVID-19

  5. Waxaan guud ahaan ka soo horjeedaa tallaalada

  6. Saaxiib ama xubin qoyska ka mid ah ayaa xasaasiyad xun ku yeeshay tallaalka

  7. Uma maleynayo in tallaalku lagama maarmaan yahay sababtoo ah COVID-19 maaha khatar halis ah

  8. Dhakhtarka ilmahan ayaa igula taliyay inaan la tallaalin ilmahan

  9. Mid kale, sheeg _______________________

  10. Waxaan doorbidayaa inaanan sheegin


Kugu saabsan adiga


  1. Sidee baad ehel ugu tahay ilmahan?

  1. Waalid bayoolaji ahaan dhalay ama korsaday

  2. Aabbo-adeer

  3. Awoowe

  4. Waalid korin

  5. Mid kale: Qaraabo

  6. Mid kale: Aan qaraabo ahayn



  1. Waa immisa da’daadu sannad ahaan?

    1. _ _ _ Jawaab tiro ah



  1. Waa maxay xaaladdaada guur?

  1. Guursaday

  2. Ma guursan, laakiin la nool lammaane

  3. Weligii aan guursan

  4. La furay

  5. Kala maqan

  6. Laga dhintay



  1. Waa maxay heerka ugu sarreeya ama heerka dugsiga ee aad dhammaysay?

    1. Fasalka 8aad ama ka yar

    2. Fasalka 9aad-12aad; Maleh Diblooma

    3. Ka qalinjabiyay Dugsiga Sare ama Dhammaystiray GED

    4. Dhammaystiray barnaamij dugsiyeedka farsamada gacanta, ganacsiga ama tijaarada

    5. Qaar ka mid ah Kuleejka Buundada leh, laakiin aan lahayn Digrii

    6. Digrii Xigeen (AA, AS)

    7. Digriiga Koowaad ee Jaamacadda (BA, BS, AB)

    8. Digriiga Masterka (MA, MS, MSW, MBA)

    9. Shahaadada Doctorate (PhD, EdD) ama Digriiga Xirfadlayaasha (MD, DDS, DVM, JD)



  1. Kuwa soo socda kee baa sida ugu fiican u qeexaya heerka shaqo ee aad hadda hayso?

  1. Shaqeeya waqti buuxa

  2. Shaqeeya waqti gelin ah

  3. Shaqeeya mushahahar LA’AAN

  4. Aan shaqayn laakiin shaqo raadis ah

  5. Aan shaqayn shaqona aan raadin


  1. Guud ahaan, waa sidee caafimaadka maskaxdaada ama shucuurtaada?

  1. Aad iyo aad u fiican

  2. Aad u fiican

  3. Fiican

  4. Dhexdhexaad

  5. Liita

  1. Intee in le'eg ayaad dareemeysaa in aad wax ka qabaneyso baahiyaha maalinlaha ah ee korinta ilmo qaba cudurka wadnaha?

  1. Si aad u wanaagsan

  2. Xoogaa si wanaagsan

  3. Aan aad u wanaagsanayn

  4. Gebi ahaan aan wanaagsanayn



  1. 12-KII BILOOD EE LA SOO DHAAFAY, ma jiray qof aad la xiriiri karto taageerada shucuureed ee maalinlaha ah ee barbaarinta ama korinta ilmo qaba xanuun wadne?

  1. Haa

  2. Maya Ugudub Su’aasha 74aad



  1.  Hadday haa tahay, miyaad taageero ka heshay:

  1. Xaaska/Sayga ama lammaanaha guriga? [Haa / Maya]

  2. Xubin kale oo qoyska ah ama saaxiib dhow? [Haa / Maya]

  3. Bixiyaha daryeelka caafimaadka? [Haa / Maya]

  4. Goobta cibaadada ama hoggaamiyaha diinta? [Haa / Maya]

  5. Koox taageero ama udoodis oo la xiriirta xaalad caafimaad oo gaar ah? [Haa / Maya]

  6. Koox taageero oo asaaga ah? [Haa / Maya]

  7. La-taliye ama xirfadle kale oo caafimaadka maskaxda ah? [Haa / Maya]

  8. Qof kale, sheeg [Haa / Maya] _____________



  1. 12-KII BILOOD EE LA SOO DHAAFAY, qoyskaagu dhib ma kala kulmeen bixinta kharashka caafimaadka ee ilmahan ama biilasha caafimaadka?

    1. Haa

    2. Maya



  1. DURING THE PAST 12 MONTHS, have you or other family members…

  1. Ka tagteen shaqo ama ma qaadateen fasax maqnaansho sababtoo ah caafimaadka ama xaaladaha caafimaad ee ilmahan? [Haa/Maya]

  2. Yarayseen saacadaha aad shaqeyso sababtoo ah caafimaadka ilmahan ama xaaladaha caafimaad ee ilmahan? [Haa/Maya]

  3. Ka fogaatay in aad beddesho shaqooyinka sababtoo ah welwelka ku saabsan ilaalinta caymiska caafimaadka ilmahan? [Haa/Maya]



  1. CELCELIS AHAAN TODDOBAADKII, immisa saacadood ayaad adiga ama xubnaha kale ee qoyska ku bixisaan daryeelka caafimaadka guriga? Daryeelku waxa ka mid noqon kara beddelka faashadda ama siinta dawooyinka iyo daawaynta marka loo baahdo.

  1. Ilmahani uma baahna daryeel caafimaad oo guriga lagu bixiyo toddobaad kasta

  2. In ka yar 1 saac toddobaadkiiba

  3. 1-4 saacadood toddobaadkiiba

  4. 5-10 saacadood toddobaadkiiba

  5. 11 saacadood ama ka badan toddobaadkiiba



  1. Waqti kasta 12-KII BILOOD EE LA SOO DHAAFAY, xitaa hal bil, ma jiraa qof qoyskaaga ka tirsan oo helay:

  1. Kaalmada lacagta caddaanka ah ee barnaamijka daryeelka dawladda? [Haa / Maya]

  2. Gargaarka Cuntada ama Dheefaha Nafaqada Dheeraadka ah (SNAP)? [Haa / Maya]

  3. Quraac bilaash ah ama qiimo jaban ama qado oo dugsiga ah? [Haa / Maya]

  4. Dheefaha laga helayo barnaamijka Haweenka, Dhallaanka, iyo Carruurta (WIC)? [Haa / Maya]



  1. ILAA IYO MARKII UU ILMAHANI DHASHAY, intee jeer ayay aad u adkayd in la daboolo waxyaabaha aasaasiga ah, sida cuntada ama guryaynta, dakhliga qoyskaaga?

    1. Marna

    2. Mar mar dhif ah

    3. Inta badan

    4. Marar badan



Macluumaadka qoyska



  1. Ilmahani ma leeyahay waalid kale ama daryeel bixiye qof weyn ah oo ku nool gurigan?

  1. Haa

  2. Maya - Ugudub Su’aasha 83aad


  1. Sidee daryeel bixiyaha kale ehel ugu yahay ilmahan?

  1. Waalid bayoolaji ahaan dhalay ama korsaday

  2. Aabbo-adeer

  3. Awoowe

  4. Waalid korin

  5. Mid kale: Qaraabo

  6. Mid kale: Aan qaraabo ahayn



  1. Waa maxay darajada ugu sarreysa ama heerka dugsiga ee uu daryeel bixiyahan dhammaystay?

    1. Fasalka 8aad ama ka yar

    2. Fasalka 9aad-12aad; Maleh Diblooma

    3. Ka qalinjabiyay Dugsiga Sare ama Dhammaystiray GED

    4. Dhammaystiray barnaamij dugsiyeedka farsamada gacanta, ganacsiga ama tijaarada

    5. Qaar ka mid ah Kuleejka Buundada leh, laakiin aan lahayn Digrii

    6. Digrii Xigeen (AA, AS)

    7. Digriiga Koowaad ee Jaamacadda (BA, BS, AB)

    8. Digriiga Masterka (MA, MS, MSW, MBA)

    9. Shahaadada Doctorate (PhD, EdD) ama Digriiga Xirfadlayaasha (MD, DDS, DVM, JD)

  2. Kuwan soo socda kee baa sida ugu wanaagsan u qeexaya xaaladda shaqo ee daryeel bixiyahan?

    1. Shaqeeya waqti buuxa

    2. Shaqeeya waqti gelin ah

    3. Shaqeeya mushahar LA’AAN

    4. Aan shaqayn laakiin raadiya shaqo

    5. Aan shaqayn shaqona aan raadin



  1. Immisa carruur ah oo da’doodu ka yar tahay 18 jir ayaa hadda ku nool guriga, oo aan lagu darin ilmahan?

  1. _ _ _ Jawaab tiro ah


  1. Waa maxay luqadda aasaasiga ah ee guriga lagaga hadlo?

    1. Ingiriisi

    2. Isbaanish

    3. Soomaali

    4. Mid kale, sheeg ____________


Waayo-aragnimo carruurnimo oo xun (ACEs)


Su'aalaha soo socdaa waxay ku saabsan yihiin dhacdooyin laga yaabo inay dhaceen intii uu noolaa ilmahan. Waxyaalahan waxay ku dhici karaan qoys kasta, laakiin dadka qaar ayaa laga yaabaa inay dhibsadaan su'aalahan. Xusuusin ahaan, waxaad ka boodi kartaa su'aalo kasta oo aadan rabin inaad ka jawaabto.


  1. Inta aqoontaada ah, ilmahani WALIGIIS ma la kulmay mid ka mid ah kuwan soo socda?

  1. Waalidka ama masuulka ilmaha ayaa is furay ama kala tagay [Haa / Maya]

  2. Waalidka ama masuulka ilmaha ayaa dhintay [Haa / Maya]

  3. Waalidka ama masuulka ilmaha waxa uu ku jiray jeel ama xabsi prison [Haa / Maya]

  4. Wuxuu arkay ama maqlay waalidiinta ama dadka waaweyn oo dharbaaxaya, garaacaya, laadaya, ama feedh isku garaacaya guriga dhexdiisa [Haa / Maya]

  5. Wuxuu ahaa dhibane rabshad ama goob rabsho ka dhacday xaafadooda [Haa / Maya]

  6. Wuxuu la noola qof maskaxda ka jirran, is dilay, ama niyad-jab daran qabay [Haa / Maya]

  7. Wuxuu la noolaa qof dhibaato ka haysato khamriga ama maandooriyaha [Haa / Maya]

  8. Waxaa loola dhaqmo ama loo xukumay isirkooda ama kooxdooda [Haa / Maya]

  9. Waxaa loola dhaqmay ama loo xukumay xaalad caafimaad ama naafo [Haa / Maya]



Haddii ilmuhu ka yar yahay 6 jir, ugudub su’aasha xigta (#86).



  1. Waxaa loola dhaqmay ama loo xukumay si aan caddaalad ahayn sababtoo ah dooqooda galmoodka ama aqoonsiga jinsiga [Haa / Maya]


Baahiyaha mustaqbalka


  1. Maxaad ka filaysaa ilmahan mustaqbalka?

    1. [Jawaab qoraal ah oo furan]



  1. Maxaa walaac ah ee aad ka qabtaa ilmahan mustaqbalka?

  1. [Jawaab qoraal ah oo furan]




Macluumaadka xiriirka



  1. Haddii aad jeclaan lahayd inaad hesho cusbooneysiin xilliyeed ku saabsan horumarka iyo natiijooyinka xog-ururinta, fadlan na sii ciwaanka iimaylkaaga.







Culayska warbixinta dadwaynaha ee xog ururintan ayaa lagu qiyaasay celcelis ahaan 20 daqiiqo, oo ay ku jirto dhamaystirka iyo dib u eegista ururinta macluumaadka. Wakaaladu ma samayn karto ama ma kafaala qaadi karto qofkana loogama baahna inuu ka jawaabo xog ururin ilaa ay muujiso lambarka xakamaynta OMB ee hadda jira. U soo dir faallooyinka ku saabsan qiyaasta culayskan ama dhinac kasta oo kale oo ka mid ah ururintan macluumaadka, oo ay ku jiraan soo jeedinta lagu dhimayo culayskan Sarkaalka Cadaynta Warbixinta CDC/ATSDR, 1600 Clifton Road NE, MS D-74, Atlanta, GA 30333: ATTN: PRA (0920) -22CL).

Foom La Ansixiyay / Lambarka OMB. 0920-22CL / Taariikhda Dhicista xx/xx/XXXX


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorWright, Brittany (CDC/DDNID/NCBDDD/DBDID)
File Modified0000-00-00
File Created2023-08-30

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