Appendix V: Questionnaire 1 Biodata Study no.: ________________ Date: __________________ Data collector’s Initials: ____________ Prescription code number: _________ Child’s Sociodemographic characteristic Age (years): Date of Birth: ______________ _________________ Gender: Male Female □ □ Does child go to school? Yes No □ □ 1. Is the school located near a flower farm? Yes No □ □ 2. If yes: specify the distance < 500m > 500m □ □ 3. If no, has child ever attended school near flower farm? Yes No N/A □ □ □ 4. Does the work on the farm? Yes No □ □ Guardian’s Sociodemographic Characteristics 1. Guardian: Father Mother mother and father □ □ □ Guardian’s Occupation: Flower farm worker □ House help□ Farmer□ Driver□ House wife□ Business man/lady□ Motor cyclist□ Teacher□ pastor□ N/A 3. Has the guardian ever worked on a flower farm? Yes No □ □ 4. If yes, specify duration: _________________________________ 0.5-1year 1-2 years 2-5years > 5years N/A □0-0.5yrs □ □ □ □ □ 5. How long has the child been managed for asthma? < 3 months 3 6 months 6-12 months >1-5yrs >5yrs □ □ – □ □ □ 6. co-morbidities No□ Yes □ 7. If yes, specify…………………………………………………………………............. Sickle cell anaemia□ N/A□ 8. Highest educational level of guardian: 45
Appendix V: Questionnaire 1 Biodata Study no.: ________________ Date: __________________ Data collector’s Initials: ____________ Prescription code number: _________ Child’s Sociodemographic characteristic Date of Birth: ______________ Age (years): _________________ Gender: Male □ Female □ Does child go to school? □ Yes □ No 1. Is the school located near a flower farm? □ Yes □ No 2. If yes: specify the distance □ < 500m □ > 500m 3. If no, has child ever attended school near flower farm? □ Yes □ No □ N/A 4. Does the work on the farm? Yes □ No □ Guardian’s Sociodemographic Characteristics 1. Guardian: □ Father □ Mother □ mother and father Guardian’s Occupation: Flower farm worker □ House help□ Farmer□ Driver□ House wife□ Business man/lady□ Motor cyclist□ Teacher□ pastor□ N/A 3. Has the guardian ever worked on a flower farm? □ Yes □ No 4. If yes, specify duration: _________________________________ □0-0.5yrs □ 0.5-1year □ 1-2 years □ 2-5years □ > 5years □ N/A 5. How long has the child been managed for asthma? □ < 3 months □ 3 – 6 months □ 6-12 months □ >1-5yrs □ >5yrs 6. co-morbidities No□ Yes □ 7. If yes, specify…………………………………………………………………............. Sickle cell anaemia□ N/A□ 8. Highest educational level of guardian: 45
Carol_PDF.docx