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National Health and Morbidity Survey 2019 Technical Report − Volume I 360 109 QUESTIONNAIRE National Health And Morbidity Survey 2019 Institute for Public Health Ministry of Health Malaysia MODUL CP: SAWAN / EPILEPSY KRITERIA KELAYAKAN: SEMUA AHLI ISIRUMAH ELIGIBILITY CRITERIA: ALL MEMBERS OF THE HOUSEHOLD Bulatkan jawapan yang bersesuaian / Please circle the appropriate answer. Sekarang saya ingin bertanya beberapa soalan mengenai sawan. Now I would like to ask you a few questions about seizures. CP01 Pernahkah anda diberitahu bahawa anda pernah mengalami sawan atau kekejangan yang disebabkan oleh demam panas sewaktu kanak-kanak? Did anyone ever tell you that you had a seizure or convulsion caused by a high fever when you were a child?

  1. Ya / Yes
  2. Tidak / No
  3. Mungkin / Possible (-7) TT (-9) EJ CP02 [Selain daripada sawan yang anda mengalami disebabkan oleh demam panas]* Pernahkah anda mengalami, atau sesiapa memberitahu bahawa anda mengalami penyakit sawan atau epilepsi?
    [Other than the seizure[s] you had because of a high fever]* Have you ever had, or has anyone ever told you that you had, a seizure disorder or epilepsy?
  4. Ya / Yes … sila ke CP04
  5. Tidak / No … sila ke CP03
  6. Mungkin / Possible … sila ke CP03 (-7) TT (-9) EJ … sila ke CP03 jika TT/EJ CP03 [Selain daripada sawan yang anda mengalami disebabkan oleh demam panas]* Pernahkah anda mengalami, atau sesiapa memberitahu bahawa anda mengalami, mana-mana yang berikut… [Other than the seizure[s] you had because of a high fever]* Have you ever had, or has anyone ever told you that you had, any of the following… CP03a Sawan dalam mana-mana keadaan? A seizure, convulsion, fit or spell under any circumstances?
  7. Ya / Yes
  8. Tidak / No
  9. Mungkin / Possible (-7) TT (-9) EJ CP03b Pergerakan yang tidak terkawal pada mana-mana anggota atau seluruh badan anda seperti menggerenyet, tersentak-sentak, terketar- ketar atau menjadi lembik? Uncontrolled movements of part or all of your body such as twitching, jerking, shaking or going limp?
  10. Ya / Yes
  11. Tidak / No
  12. Mungkin / Possible (-7) TT (-9) EJ CP03c Perubahan keadaan mental atau tahap kesedaran yang tidak dapat dijelaskan; atau episod melamun yang tidak mampu dikawal oleh anda? An unexplained change in your mental state or level of awareness; or an episode of “spacing out” that you could not control?
  13. Ya / Yes
  14. Tidak / No
  15. Mungkin / Possible (-7) TT (-9) EJ CP03d Sewaktu di zaman kanak-kanak, pernahkah anda diberitahu bahawa anda berangan atau termenung lebih kerap daripada kanak-kanak lain? Did anyone ever tell you that when you were a small child, you would daydream or stare into space more than other children?
  16. Ya / Yes
  17. Tidak / No
  18. Mungkin / Possible (-7) TT (-9) EJ CP03e Pernahkah anda mengalami pergerakan badan atau perasaan yang luar biasa apabila terdedah kepada kelipan lampu, permainan video atau silauan matahari? Have you ever noticed any unusual body movements or feelings when exposed to strobe lights, video games, flickering lights, or sun glare?
  19. Ya / Yes
  20. Tidak / No
  21. Mungkin / Possible (-7) TT (-9) EJ Appendix 7

Non-Communicable Diseases: Risk Factors and other Health Problems 361 110 BORANG SOAL SELIDIK Tinjauan Kebangsaan Kesihatan Dan Morbiditi 2019 Institut Kesihatan Umum Kementerian Kesihatan Malaysia CP03f Sejurus selepas bangun tidur, sama ada pada waktu pagi atau selepas lelap sebentar, pernahkah anda mengalami sentakan atau pergerakan kurang cermat yang tidak dapat dikawal, seperti barang terlepas atau terpelanting dari genggaman anda? Shortly after waking up, either in the morning or after a nap, have you ever noticed uncontrollable jerking or clumsiness, such as dropping things or things suddenly “flying” from your hands?

  1. Ya / Yes
  2. Tidak / No
  3. Mungkin / Possible (-7) TT (-9) EJ CP03g Pernahkah anda mengalami sebarang kejadian luar biasa dan berulangan yang lain? Have you ever had any other type of repeated unusual spells?
  4. Ya / Yes
  5. Tidak / No
  6. Mungkin / Possible (-7) TT (-9) EJ CP04 Pernahkah anda mengambil ubat untuk sawan? Have you ever taken medications for seizures?
  7. Ya / Yes
  8. Tidak / No
  9. Mungkin / Possible (-7) TT (-9) EJ CP05 Tanya soalan berikut hanya jika responden menjawab “Ya” atau “Mungkin” kepada mana-mana soalan di dalam Modul ini (CP01-CP04). Oleh sebab anda telah menjawab “Ya” atau “Mungkin” kepada sekurang- kurangnya satu soalan di dalam Modul ini, pasukan penyelidik ingin menghubungi anda melalui telefon untuk bertanya beberapa soalan lanjut untuk saringan epilepsi. Adakah anda bersetuju untu dihubungi? As you have answered “Yes” or “Possible” to at least one question in this Module, the research team would like to contact you by telephone to ask some further questions to screen for epilepsy. Do you agree to be contacted?
  10. Ya, saya bersetuju untuk dihubungi di nombor berikut:
    Yes, I agree to be contacted at the following number: [Sekiranya ruangan ini diisi, sila pastikan responden menandatangani Borang Persetujuan Saringan Epilepsi]

Adakah ini nombor telefon responden sendiri?
Is this the respondent’s own telephone number? • Ya / Yes • Tidak – sila nyatakan hubungan pemilik nombor telefon kepada respondent:
No – please state phone number owner’s relationship to respondent:

  1. Maaf, saya tidak mahu dihubungi. Sorry, I do not wish to be contacted.

Frasa [Selain daripada sawan yang anda mengalami disebabkan oleh demam panas] hanya disertakan sekiranya responden menjawab “Ya” atau “Mungkin” bagi soalan CP01. * Phrase “Other than the seizure[s] you had because of a high fever” added only if subject responded “Yes” or “Possible” to CP01. Questionnaire

National Health and Morbidity Survey 2019 Technical Report − Volume I 362 111 QUESTIONNAIRE National Health And Morbidity Survey 2019 Institute for Public Health Ministry of Health Malaysia MODUL CK: KESIHATAN MENTAL DEWASA KRITERIA KELAYAKAN: AHLI ISIRUMAH BERUMUR 18 TAHUN DAN KE ATAS ID Negeri (2 Digit) DP (2 Digit) & DB (3 Digit) BP (4 Digit) UB (3 Digit) TK (3 Digit) Strata (1 Digit) Isi Rumah & Individu (2 Digit) (2 Digit) PATIENT HEALTH QUESTIONAIRE

PHQ-9 SILA BACA DENGAN CERMAT: Pihak kami ingin mengetahui sama ada anda mempunyai sebarang masalah perubatan, dan bagaimana kesihatan anda secara umum, sejak 2 minggu lalu. Sila jawab semua soalan dan pilih jawapan yang paling hampir dengan keadaan anda sekarang. SILA AMBIL PERHATIAN yang kami ingin mengetahui masalah terkini dan bukannya masalah di masa lalu. Adalah sangat penting untuk anda menjawab SEMUA soalan dibawah. Sila tandakan √ Terima kasih. PERNAHKAH BARU-BARU INI ANDA:
Tiada langsung Beberapa hari Lebih dari 7 hari Hampir setiap hari 1. Kurang berminat atau keseronokan dalam melakukan sesuatu perkara 2. Rasa sedih, tidak gembira atau putus asa 3. Masalah untuk tidur atau tidur nyenyak atau tidur berlebihan 4. Rasa letih atau mempunyai sedikit tenaga 5. Kurang selesa atau makan berlebihan 6. Rasa buruk/teruk mengenai diri anda – atau anda seorang yang gagal atau anda telah menyebabkan diri anda atau keluarga anda kecewa 7. Masalah untuk menumpukan perhatian ke atas sesuatu perkara seperti membaca surat khabar atau menonton televisyen 8. Bergerak atau bercakap terlalu perlahan sehinggakan orang lain perasan? Atau sebaliknya- menjadi sangat resah atau gelisah sehingakan anda telah bergerak dengan banyak daripada biasa 9. Memikirkan adalah lebih baik saja jika anda mati atau mencederakan diri sendiri dalam beberapa cara Terima kasih atas kerjasama anda. Appendix 7

Non-Communicable Diseases: Risk Factors and other Health Problems 363 112 BORANG SOAL SELIDIK Tinjauan Kebangsaan Kesihatan Dan Morbiditi 2019 Institut Kesihatan Umum Kementerian Kesihatan Malaysia MODULE CK: ADULT MENTAL HEALTH ELIGIBILITY CRITERIA: MEMBER OF THE HOUSEHOLD AGED 18 YEARS AND ABOVE

ID Negeri (2 Digit) DP (2 Digit) & DB (3 Digit) BP (4 Digit) UB (3 Digit) TK (3 Digit) Strata (1 Digit) Isi Rumah & Individu (2 Digit) (2 Digit) PATIENT HEALTH QUESTIONAIRE

       PHQ-9

PLEASE READ THIS CAREFULLY: We would like to know if you have had any medical complaints and how your health has been in general over the past two weeks. Please answer ALL the questions simply by choosing the answer which you think most nearly applies to you. Remember that we want to know about present and recent complaints, not those you had in the past. It is important that you try to answer ALL the questions. Please tick √ Thank you. HAVE YOU RECENTLY: Not at all Several days More than half the days Nearly everyday 1. Little interest or pleasure in doing things. 2. Feeling down, depressed or hopeless. 3. Trouble falling asleep, or staying asleep, or sleeping too much. 4. Feeling tired or having little energy. 5. Poor appetite or overeating. 6. Feeling bad about yourself – or that you are a failure, or have let yourself or your family down. 7. Trouble concentrating on things, such as reading the newspaper or watching television. 8. Moving or speaking so slowly that other people could have noticed? Or the opposite – being so fidgety or restless that you have been moving around more than usual. 9. Thoughts that you would be better off dead or of hurting yourself in some way. Thank you very much for your co-operation. Questionnaire

National Health and Morbidity Survey 2019 Technical Report − Volume I 364 1 CODE BOOK National Health And Morbidity Survey 2019 Institute for Public Health Ministry of Health Malaysia Appendix 8

Non-Communicable Diseases: Risk Factors and other Health Problems 365 1 CODE BOOK National Health And Morbidity Survey 2019 Institute for Public Health Ministry of Health Malaysia Code Book

National Health and Morbidity Survey 2019 Technical Report − Volume I 366 2 BUKU KOD Tinjauan Kebangsaan Kesihatan Dan Morbiditi 2019 Institut Kesihatan Umum Kementerian Kesihatan Malaysia Gambar Modul CA – Rawatan Mata Fundus Examination using Direct Ophthalmoscope Fundus Examination using Slit Lamp Fundus Examination using Non-Mydriatic Fundus Camera Gambar Modul CE -Rokok Cop rasmi cukai Amaran Maklumat mengenai 4000 bahan kimia Maklumat tidak boleh jual kepada individu dibawah umur Nama dan alamat pengilang/pembekal Appendix 8

Non-Communicable Diseases: Risk Factors and other Health Problems 367 3 CODE BOOK National Health And Morbidity Survey 2019 Institute for Public Health Ministry of Health Malaysia Jenis – jenis produk tembakau yang dihisap

Rokok yang dikilang Rokok gulung sendiri Kretek

Curut Bidis Paip tembakau Shisha Code Book

National Health and Morbidity Survey 2019 Technical Report − Volume I 368 4 BUKU KOD Tinjauan Kebangsaan Kesihatan Dan Morbiditi 2019 Institut Kesihatan Umum Kementerian Kesihatan Malaysia Jenis – jenis produk tembakau tanpa asap Rokok elektronik Mengunyah Tembakau Menghidu Tembakau Gambar Modul CJ – Amalan Pemakanan CJ1 Kopi atau Teh 1 cawan = 200 ml 1 gelas kecil (300 ml) = 1.5 cawan 1 gelas kecil (195 ml) = 1 cawan 1 gelas besar teh tarik (400 ml) = 1.5 cawan CJ2 Sukatan Gula 1 sudu teh = 5g 1 peket gula = 5g = 1 sudu teh gula 1 kiub gula = 5g = 1 sudu teh gula 1 sudu makan = 15g = 3 sudu teh gula Appendix 8

Non-Communicable Diseases: Risk Factors and other Health Problems 369 5 CODE BOOK National Health And Morbidity Survey 2019 Institute for Public Health Ministry of Health Malaysia CJ3 Sukatan Susu Pekat Manis 1 sudu makan = 9g = 3 sudu teh CJ4 Sukatan Krimer 1 paket krimer = 5g = 1 sudu teh Code Book

National Health and Morbidity Survey 2019 Technical Report − Volume I 370 6 BUKU KOD Tinjauan Kebangsaan Kesihatan Dan Morbiditi 2019 Institut Kesihatan Umum Kementerian Kesihatan Malaysia CJ5 Minuman Bercoklat / Bermalta 1 gelas standard (250ml) = 1.25 cawan 200 ml = 1 cawan 190ml = 1 cawan 225 ml = 1.1 cawan 240 ml = 1.2 cawan CJ6 Minuman Pra Campur

1 peket = 20-30g Appendix 8

Non-Communicable Diseases: Risk Factors and other Health Problems 371 7 CODE BOOK National Health And Morbidity Survey 2019 Institute for Public Health Ministry of Health Malaysia CJ7 Minuman Berkarbonat a b c d a = 200 ml = 0.8 gelas b = 325 ml = 1.3 gelas c = 390 ml = 1.6 gelas d = 500 ml = 2 gelas 400 ml = 1.6 gelas CJ8 Minuman BUKAN Berkarbonat 250 ml = 1 gelas 355 ml = 1.4 gelas 330 ml = 1.3 gelas 250 ml = 1 gelas 300 ml = 1.2 gelas 500 ml = 2 gelas 200 ml = 0.8 gelas Code Book

National Health and Morbidity Survey 2019 Technical Report − Volume I 372 8 BUKU KOD Tinjauan Kebangsaan Kesihatan Dan Morbiditi 2019 Institut Kesihatan Umum Kementerian Kesihatan Malaysia CJ9 Pinggan sihat Malaysia / Suku Suku Separuh CJ10 Buah-buahan Sukatan 1 Hidangan Buah 0.5 biji buah jambu batu = 1 hidangan 0.5 biji buah naga = 1 hidangan 1 biji epal = 1 hidangan 1 biji oren = 1 hidangan 2 biji pisang = 1 hidangan 2 biji ciku = 1 hidangan 2 biji belimbing = 1 hidangan 1 potong betik = 1 hidangan Appendix 8

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