Ubusanzwe urya amafunguro angahe buri munsi? / How many meals do you usually have each day?

Umukozi wo ku munsi /
3 or more meals

Amafunguro 2 / 2 meals

Ifunguro 1 / 1 meal

Ubusanzwe urya amafunguro angahe buri munsi? / Do you eat vegetables every day?

Yego / Yes

Rimwe na rimwe/ Sometimes

Oya / No

Ese urya imboga buri munsi? / Do you eat fruits every day?

Yego / Yes

Rimwe na rimwe/ Sometimes

Oya / No

Ese ufite ikibazo cyo kubura ubushake bwo kurya? / Do you have a loss of appetite?

Yego / Yes

Oya / No

Ese wagiye ugabanya ibiro vuba aha? (ukwezi kumwe gushize) / Have you experienced weight loss recently?( the past 1 month)

Yego / Yes

Oya / No

Ese hari kimwe muri ibi bikurikira uhura nacyo? (Hitamo byose bihuye n'ibyo uhura na byo) / Are you experiencing any of the following? (Select all that apply)

Umunaniro cyangwa intege nke / Fatigue or weakness

Gutakaza ibiro/ Weight loss

Kubabara munda / Abdominal pain

Guhitwa / Diarrhea

Kuruka / Vomiting

Ese hari indwara wahuye nayo mu kwezi gushize? / Have you experienced any illness these past month?

Yego / Yes

Oya / No

Ese mu kwezi gushize wasuzumwe indwara y'imirire mibi? / Have you been diagnosed with malnutrition the past month?

Yego / Yes

Oya / No

Ese wigeze urwara inzoka zo mu nda hanyuma ugahabwa umuti wa albendazole mu kwezi gushize? / Have you been diagnosed with intestinal worms and given albendazole in the past month?

Yego / Yes

Oya / No

Ese ukeneye imiti? / Does he/she need medication?

Yego / Yes

Oya / No

Ku kibazo cyavuzwe haruguru, ndakwinginze usobanure uburyo bwo gusuzuma no kuvura / Please specify the diagnosis and treatment to the above question.

Gusuzuma / Diagnosis

Kuvura / Treatment

Ese akeneye koherezwa kugira ngo akurikirane izindi nzego? / Does he/she need a referral for further management?

Yego / Yes

Oya / No

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