1. Estimating
Health
Risks
A
Secondary
Report
of
a
Parallel
Survey
of
Four
Communities
in
Tola,
Rivas,
Nicaragua.
Project Duration: 1 June, 2015 – 24 July, 2015
Submitted to: Foundation for International Medical Relief of Children
Submitted by: Sanjay Gadi and Anna Dodson
FIMRC Interns
FIMRC Nicaragua – Project Limón

2. Estimating Health Risks Page 1
Table
of
Contents
Section
Title
Page(s)
Executive
Summary……………………………………………………………………………………….……………….2
Methodology………………………………………………………………………………………..……….……………….2
Ethics
and
Confidentiality………………………………………………………………….……………………………2
Major
Findings……………………………………………………………………………………..………………………..3
Child
Nutrition………………………………………………………………….……………………………………….3
Children’s
Health
Services……………………………….…………………………………….………………….6
Female
Reproductive
Health….…………………………………………………….………………………..7
Statistical
Description
of
the
Survey…………………………………………………………..…………………10
Population………………………………………………………………………………..…………………………….10
Income……………………………………………………………………………………..…………………………….10
Overcrowding…………………………………………………………………………..…………………………….11
Household
Health
Factors……………………………………………………………………………………….12
New
Barriers
of
Health
Analysis…………………………………………………………..……………………....15
Dental
Health…………………………………………………………………………..……………………………..15
Mental
Health……………………………………..…………………………………..……………………………..18
Conclusions
and
Recommendations.……………………………………………..…………………………….20
Acknowledgements…………..………………………………………………………………………………………….20
References……………………………………………………………………………………..…………………………….21
Appendix
A
–
Survey…………………………………………………………………………………………………....22

3. Estimating Health Risks Page 2
Executive
Summary
The communities of La Virgen Morena, Las Salinas, Limón II, and Limón I, located in Tola,
Rivas, Nicaragua, were surveyed in order to learn more regarding their health status so that
Foundation for International Medical Relief of Children (FIMRC) could better attend to the
population and their health care needs. The survey was performed on a total of 118 households,
97 children aged 0-5 years, and 120 women aged 15-50 years.
Background
In August, 2009, an initial report on the health status in the communities of Limón I, Limón II,
Cuascoto Asentamiento, and Cuascoto Adentro was performed in order to identify areas of focus
for FIMRC during its formal partnership with the Roberto Clemente Santa Ana Health Clinic in
Limón I. However, in 2010, this partnership ended and FIMRC moved its Nicaraguan site to Las
Salinas, thereby changing the communities it reached to those surveyed in this report. Now, in
2015, this report aims to renew FIMRC’s understanding of the health status of these four
communities so that existing areas of focus can be reassessed and newly identified necessities
can established.
Methodology
The survey was performed by walking house-to-house and interviewing available participants in
each of the four communities in both the morning and afternoon. Though 118 households were
visited (La Virgen = 24, Las Salinas = 27, Limón II = 39, Limón I = 27), only 81 were asked all
questions included in the survey. All surveys were performed in Spanish. In houses 56-70, only
children were surveyed. After visiting house 87, questions regarding mental health were no
longer asked. After visiting house 97, questions regarding dental health, socioeconomic
indicators, and children’s health services were no longer asked. This shortening of the survey
was performed in order to increase our sample size for female reproductive health and child
nutrition, sections that would be compared with data from the 2009 report.
Children’s nutritional assessment z-scores, which included weight-for-age (WAZ), height-for-
age (HAZ), weight-for-height (WHZ), and body-mass index (BMIZ), were calculated using
graphs specific to both sexes and each measurement provided by the Nicaraguan Ministry of
Health. Data was entered into and statistics were completed on a Microsoft Excel spreadsheet.
Ethics
and
Confidentiality
The purpose of this survey and the manner it will be used was explained to and understood by all
participants. All respondents verbally agreed to participate in the survey and maintained consent
throughout. They were allowed to withdraw their consent at anytime during or after the survey.
Respondents’ names have been removed from this publication, as randomized numerical
identifiers will be used instead. The documents that contain names and other personal
information are filed confidentially at the Roberto Clemente Santa Ana Health Clinic.
The data used for this report and subsequent information contained is intended to be sent to
national and international agencies and organizations concerned with the main areas of interest
including child welfare, women’s health, mental health, and dental health

4. Estimating Health Risks Page 3
Major
Findings
Child
Nutrition
Compared to the data from 2009, current data (Table 1) demonstrates consistent improvement in
male children and worsening among female children across all four anthropometric
measurements. Failure is defined as a z-score of -2 or lower.
Table 1: Change in male and female rates of failure between 2009 and 2015.
Measurement Failure 2009 (%) Failure 2015 (%) Classification of
FailureMale Female Male Female
WAZ 9.0 12.0 5.0 24.1 Underweight
HAZ 9.0 9.0 2.5 9.6 Stunting
WHZ 13.0 17.0 5.6 19.2 Wasting
BMIZ 8.0 8.0 5.0 23.1 Underweight
Moreover, using the Composite Index of Anthropometric Failure (CIAF), in 2009, it was
determined that 23.6% of children experienced some form of failure. In the 2015 sample
population, 22.8% experienced some form of failure (Table 2).
Table 2: Change in CIAF failure between 2009 and 2015.
Failure Experienced Number of Children Percent Children (%)
2009 2015 2009 2015
No Failure 42 71 76.4 77.2
Some Failure 13 21 23.6 22.8
Wasting 2 5 3.6 5.4
Wasting and Underweight 2 8 3.6 8.7
Wasting, Stunting, and
Underweight
0 0 0.0 0.0
Stunting and Underweight 3 4 5.5 4.3
Stunting 6 2 10.9 2.2
Underweight 0 2 0.0 2.2
Total 55 92 100 100
As a visual representation of the changes in rates of underweight observed since 2009 (Table),
Figure 1 demonstrates the shift of the WAZ distribution for female children towards the negative
z-scores and the shift of the WAZ distribution for male towards the positive z-scores. This trend
persists for the other three measurements as well. Though the negative shift in female HAZ
distribution is less severe (Figure 2), female WHZ shift is significant (Figure 3). The negative
shift in female BMIZ distribution is especially severe (Figure 4).

5. Estimating Health Risks Page 4
Figure 1: Weight-for-age z-scores (WAZ) in male and female children.
Figure 2: Height-for-age z-scores (HAZ) in male and female children.
-­‐5.0
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
-­‐4
-­‐2
0
2
4
Frequency
(%)
Z-­‐Score
Male
(n=40)
Female
(n=54)
0.0
10.0
20.0
30.0
40.0
50.0
60.0
-­‐4
-­‐2
0
2
4
Frequency
(%)
Z-­‐Score
Male
(n=40)
Female
(n=52)

6. Estimating Health Risks Page 5
Figure 3: Weight-for-height z-scores (WHZ) in male and female children.
Figure 4: Body mass index z-scores (BMIZ) in male and female children.
It was reported in 2009 data that 13% of both male and female children were overweight, defined
as having a BMIZ of 2 or greater. Now, 2015 data shows that 20.0% of male children and 9.6%
of female children are overweight.
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
-­‐4
-­‐2
0
2
4
Frequency
(%)
Z-­‐Score
Male
(n=36)
Female
(n=52)
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
-­‐4
-­‐2
0
2
4
Frequency
(%)
Z-­‐Score
Male
(n=40)
Female
(n=52)

7. Estimating Health Risks Page 6
Children’s
Health
Services
Households were asked when a child’s last visit to a general doctor and pediatrician, in that
order, was. Figures 5 and 6 display this data, showing that a majority of children in the four
communities visit the general doctor, while only half of surveyed children in Limón I reported
visiting the general doctor. A majority of children in all four communities visit the pediatrician.
Figure 5: Time since last visit to a general doctor.
Figure 6: Time since last visit to a pediatrician.
Households were next asked whether they were aware of the pediatric services provided by
FIMRC. Limón I was least aware of the FIMRC pediatrician.
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
La
Virgen
(n=21)
Las
Salinas
(n=7)
Limon
II
(n=19)
Limon
I
(n=14)
Frequency
(%)
Community
Never
≥37
Months
Ago
25-­‐36
Months
Ago
13-­‐24
Months
Ago
0-­‐12
Months
Ago
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
La
Virgen
(n=23)
Las
Salinas
(n=9)
Limon
II
(n=20)
Limon
I
(n=15)
Frequency
(%)
Community
Never
≥37
Months
Ago
25-­‐36
Months
Ago
13-­‐24
Months
Ago
0-­‐12
Months
Ago

8. Estimating Health Risks Page 7
Figure 7: Awareness of FIMRC pediatric services.
Female
Reproductive
Health
Women were asked how long ago their last past smear and gynecological appointments were, in
that order. Women in all four communities reported attending pap smear visits and gynecological
appointments at much higher rates than those in 2009, though women of Limón I reported the
lowest rates of attendance in both measures (Figures 8, 9).
Figure 8: Time since last pap smear.
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
La
Virgen
(n=26)
Las
Salinas
(n=9)
Limon
II
(n=24)
Limon
I
(n=17)
Frequency
(%)
Community
Do
Not
Know
Do
Know
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
La
Virgen
(n=31)
Las
Salinas
(n=29)
Limon
II
(n=25)
Limon
I
(n=30)
Frequency
(%)
Community
Never
≥37
Months
Ago
25-­‐36
Months
Ago
13-­‐24
Months
Ago
0-­‐12
Months
Ago

9. Estimating Health Risks Page 8
Figure 9: Time since last visit to a gynecologist.
Women were next asked whether they were aware of the gynecological services provided by
FIMRC. Knowledge of these services was highest in the communities of La Virgen Morena and
Las Salinas, and lowest in Limón I, the community in which gynecological and pap smear
attendance was also lowest.
Figure 10: Awareness of FIMRC gynecological services.
Lastly, women were asked if they performed breast examinations on themselves. A majority of
women in all communities reported not performing self-breast exams. However, rates of self-
breast examination have increased since 2009, when approximately 90% of women in every
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
La
Virgen
(n=31)
Las
Salinas
(n=29)
Limon
II
(n=25)
Limon
I
(n=30)
Frequency
(%)
Community
Never
≥37
Months
Ago
25-­‐36
Months
Ago
13-­‐24
Months
Ago
0-­‐12
Months
Ago
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
La
Virgen
(n=31)
Las
Salinas
(n=30)
Limon
II
(n=26)
Limon
I
(n=32)
Frequency
(%)
Community
Do
Not
Know
Know

10. Estimating Health Risks Page 9
community reported never having performed a self-breast exam. It is interesting to note the
direct relationship between the geographic location of a community with its rates of self-breast
examination.
Figure 11: Self-breast exams performance.
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
La
Virgen
(n=33)
Las
Salinas
(n=32)
Limon
II
(n=27)
Limon
I
(n=34)
Frequency
(%)
Community
Do
Not
Examine
Do
Examine

11. Estimating Health Risks Page 10
Statistical
Description
of
the
Survey
This section describes the survey sample through dimensions vital to data received. It examines
population, income, overcrowding, snd household health factors. Furthermore, this statistical
description compares disparities between the four main communities included in this survey: La
Virgen Morena, Las Salinas, Limón I, and Limón II.
Population
Figure 12 shows a general population pyramid by sex for all 4 communities combined. The
largest age group is between 0 and 9 years old accounting for 13.30% of the population. The
general shape of the pyramid suggests a growing population.
Figure 12: Population pyramid of the four communities.
Income
Figures 13 displays reported monthly incomes in USD. Average income has risen slightly since
2009 from a daily wage of $5-10 to $8-11 dollars. The cause of this increase can be attributed to
the growing tourism along the costal region and increasing job opportunities in connected labor
divisions, such as construction and restaurant jobs. Income is also closely tied with community.
Households in La Virgen and Limon II reported earning the highest incomes, averaging around
ten to eleven dollars daily, whereas Las Salinas and Limon I have average daily incomes of
approximately 8-9 daily dollars.
-­‐8
-­‐6
-­‐4
-­‐2
0
2
4
6
8
10
0
to
4
5
to
9
10
to
14
15
to
19
20
to
24
25
to
29
30
to
34
35
to
39
40
to
44
45
to
49
50
to
54
55
to
59
60
to
64
65
to
69
70
to
74
75
to
79
80+
Percent
Population
Age
Females
Males

12. Estimating Health Risks Page 11
Figure 13: Average daily wage in USD.
Overcrowding
Figure 14 shows a bar graph for households that are experiencing overcrowding, defined as 3 or
more people sleeping in a single room. In total, 10.3% of the households sampled are
overcrowded, which is an improvement from 46% overcrowding calculated in 2009. Limon II
showed the most overcrowding although it is the second wealthiest community in the survey.
Additionally, Limon I showed no evident overcrowding although it is the second poorest
community in the survey.
Figure 14: Percent overcrowding experienced.
0
2
4
6
8
10
12
Community
Average
La
Virgen
Las
Salinas
Limon
II
Limon
I
Daily
Wage
(USD)
Community
0
5
10
15
20
25
La
Virgen
Las
Salinas
Limon
II
Limon
I
Overcrowding
(%)
Community

13. Estimating Health Risks Page 12
Household
Health
Factors
Figures 15-18 depict household health factors, which are defined as properties of a house that
significantly impact health outcomes.
Figure 15 shows a surprising discovery that La Virgen has the highest percentage of dirt floors
even though it reports highest average income. The other communities show relatively normal
data with the lower income communities having a higher percentage of dirt floors than higher
income communities. Dirt floors are one of the principal routes of exposure to intestinal
parasites, particularly among children, since they play in the dirt and put their hands directly into
their mouths.1
Therefore, children who live in houses with dirt floors are at a higher risk for
becoming infected with intestinal parasites.
Figure 15: Floor type.
Figure 16 reports the average number of animals owned by households in each community. The
poorer communities have, on average, more animals per household than wealthier communities.
This relationship can be evidence of poorer supplementing their low income by using personal
livestock as a source of resources. However, a family’s risk of contracting zoonotic diseases
increases with the number of animals it owns.2
Therefore, households in Las Salinas, Limón II,
and Limón I seem to be at a higher risk for contracting zoonotic disease than those in La Virgen
Morena, though all four communities are at risk.
0
10
20
30
40
50
60
70
80
90
100
La
Virgen
Las
Salinas
Limon
II
Limon
I
Frequency
(%)
Community
Dirt
Other

14. Estimating Health Risks Page 13
Figure 16: Average number of animals.
Figure 17 shows the percentage of each type of cooking fuel used per community. Cooking fuel
is an important household health factor to considering because cooking with wood increases
exposure to harmful carcinogens and smoke, which can cause respiratory ailments.3
Households
in La Virgen Morena, the wealthiest community, reported the highest usage of gas and electricity
and the lowest usage of wood, suggesting that they are the least likely to experience respiratory
diseases. On the other hand, a significantly larger percent of households in Limón I use wood
than any other community. Limón I households are therefore at the highest risk for respiratory
diseases.
Figure 17: Cooking fuel type used.
0
2
4
6
8
10
12
La
Virgen
Las
Salinas
Limon
II
Limon
I
Number
of
Animals
Community
0
10
20
30
40
50
60
La
Virgen
Las
Salinas
Limon
II
Limon
I
Frequency
(%)
Community
Wood
Gas
Both
Electric

15. Estimating Health Risks Page 14
Figure 18 shows the methods by which water is treated in each community. La Virgen
community members collect water from a community well, which is regularly treated with
chloride. However, chloride treatment is not as effective in killing microbes and cleaning the
water as filtering or buying bottled water. La Virgen community members are therefore more
likely to become sick from inadequate water quality. Limon II is the only community that has a
significant percentage of families who buy bottled water. Las Salinas has the highest percentage
of filter families.
Figure 18: Water treatment type used.
0
10
20
30
40
50
60
70
80
90
La
Virgen
Las
Salinas
Limon
II
Limon
I
Frequency
(%)
Community
None
Buy
Bottled
Chloride
Filter
Chloride
and
Filter

16. Estimating Health Risks Page 15
New
Barriers
of
Health
Analysis
The data presented in this section of the survey deals with dental and mental health. Although no
correlating data was collected in the 2009 survey, the following findings offer a baseline status
for mental and dental health off of which future studies can be conducted. The following data
also suggests the need for dental and psychological services in the four communities, potential
areas for FIMRC Nicaragua’s development.
Dental
Health
A majority of people in all four communities reported brushing at least twice daily, and a
majority of people in La Virgen Morena, Las Salinas, and Limón II reported brushing three times
a day (Figure 19).
Figure 19: Number of times teeth are brushed per day.
Almost all of the households in each community stored toothbrushes away from the toilet or
latrine, where contaminated water could otherwise be aerosolized and spread to the toothbrush
(Figure 20).4
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
La
Virgen
(n=101)
Las
Salinas
(n=82)
Limon
II
(n=80)
Limon
I
(n=93)
Frequency
(%)
Community
1
2
3

17. Estimating Health Risks Page 16
Figure 20: Location where toothbrush is stored.
Floss is used by approximately half of the households across all four communities. Floss is also
interestingly inversely related to community wealth, as Limón I reported the highest usage of
floss while La Virgen Morena reported the lowest (Figure 21).
Figure 21: Rates of floss usage.
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
La
Virgen
(n=107)
Las
Salinas
(n=82)
Limon
II
(n=80)
Limon
I
(n=93)
Frequency
(%)
Community
Away
from
Excrement
Near
Excrement
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
La
Virgen
(n=107)
Las
Salinas
(n=82)
Limon
II
(n=80)
Limon
I
(n=93)
Frequency
(%)
Community
Uses
Floss
Does
Not
Use
Floss

18. Estimating Health Risks Page 17
Most people have never visited a dentist, but a considerable percentage of people have within the
past year (Figure 22).
Figure 22: Time since last dental visit.
Figures 23 and 24 show that a majority of the population surveyed has no cavities and no
replaced teeth, and that extremely few people have more than a few cavities or false teeth.
Figure 23: Number of cavities per community.
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
La
Virgen
(n=102)
Las
Salinas
(n=82)
Limon
II
(n=80)
Limon
I
(n=88)
Frequency
(%)
Community
Never
≥37
Months
Ago
25-­‐36
Months
Ago
13-­‐24
Months
Ago
0-­‐12
Months
Ago
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
La
Virgen
(n=98)
Las
Salinas
(n=80)
Limon
II
(n=81)
Limon
I
(n=81)
Frequency
(%)
Community
0
1
to
3
4
to
6
7+

19. Estimating Health Risks Page 18
Figure 24: Number of false teeth per community.
While this data may seem to suggest that dental health is currently admirable, with all
communities reporting regular brushing, correct storage of toothbrushes, minimal cavities, and
few false teeth, the reality is that people are simply not visiting the dentist. In every community,
of those who have gone to the dentist within the past twelve months, most have gone as the cause
of a dental problem, not a regular checkup. The minimal cavity reporting may be explained
through the reality that the closest dentist is a bus ride of several hours away. Individuals are not
catching their minor cavities until they develop into more serious issues. Dental care is not
covered in the national, free health care, causing many families, especially in poorer
communities like those that FIMRC serves, to not go to the dentist. Having a dentist on site at
FIMRC would provide a valuable, previously unattainable service to the communities of La
Virgen, Las Salinas, Limon I, and Limon II.
Mental
Health
Figure 25 shows that a significant percentage of the population reports regular stress and times of
persistent sadness, conveyed to those interviewed as a time in which they felt sad and as though
they could not feel happy again. Figure 26 shows reports on possible symptoms of persistent
sadness that were used to infer a more profound sadness than is normal, potentially hinting at
depression.
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
La
Virgen
(n=98)
Las
Salinas
(n=80)
Limon
II
(n=81)
Limon
I
(n=81)
Frequency
(%)
Community
0
1
to
3
4
to
6
7+

20. Estimating Health Risks Page 19
Figure 25: Mental Health
Figure 26: Determining depression.
A stigma exists in Nicaragua that severe depression and anxiety are illnesses that merit
institutionalization, not treatment. This method of questioning was the most practical way to
reach the more meaningful understanding of these more threatening health concerns. The data
suggests a psychologist would be a beneficial addition to this area’s health care system.
0
10
20
30
40
50
60
70
80
90
100
Stress
Persistent
Sadness
Frequency
(%)
Mental
Health
Measure
0
10
20
30
40
50
60
70
80
90
100
Loss
of
Interest
Loss
of
Appetite
Loss
of
Energy
Frequency
(%)
Mental
Health
Measure

21. Estimating Health Risks Page 20
Conclusions
and
Recommendations
FIMRC’s work has been positively affecting the communities of La Virgen Morena, Las Salinas,
Limón II, and Limón I, as evidenced by decreased rates of malnutrition and anthropometric
failure in male children, increased performance of pap smears and self-breast exams, and
increased attendance to the gynecologist. Furthermore, in spite of increasing rates of underweight
and wasting, which are acute measures of malnourishment, have increased since 2009, stunting,
a chronic measure of malnourishment, has seen a decrease (Table 2). This trend suggests that
children’s long-term health has improved.
However, there are still improvements to be had. It is important to note that female children—as
opposed to their male counterparts—are severely worsening in health, with all four measures of
failure indicating increased rates of malnutrition (Table 1). A new focus on the health of female
children is gravely needed in these communities, where male-favoritism is negatively affecting
girls’ physical health.
The pediatric services provided by FIMRC appear to have been used quite extensively. However,
education efforts in Limón I to increase awareness about these services are recommended to
continue improving attendance to pediatric visits.
Still only about half of the women in these communities get a pap smear performed, visit the
gynecologist, and know about the gynecological services provided by FIMRC. Self-breast exams
are still alarmingly infrequent, as a majority of women in all four communities do not perform
them. Education efforts to increase awareness about the availability of FIMRC’s gynecological
services and to teach women how to examine their own breasts can improve these measures as
well as overall female reproductive health in these four communities.
It is imperative that this report be translated into Spanish and distributed to the Nicaraguan
Ministry of Health and any other relevant organization in the area. It is also the community
members’ right that these findings be conveyed to them for their personal benefit.
Acknowledgements
The following people were crucial in gathering and compiling the information for this report:
Jessica Southern R.N., Anthony Nardone, and FIMRC interns and volunteers. With the support
of these individuals and the welcoming spirit of the community members of La Virgen Morena,
Las Salinas, Limon I, and Limon II, this study was made possible.

22. Estimating Health Risks Page 21
Appendix
A
–
Survey
Conducted By: _______________________
Family Number: ______________________
Date: _______________________________
Community: _________________________
1. ID 2. Name 3. Date of Birth 4. Age 5. Sex 6. Role
Hygienic and Sanitary Characteristics Socioeconomic Status Lifestyle Habits
10. Number of Bedrooms 17. Domestic Animals 20. Floor 27. Smokes, How Often?
a. Chickens
11. Cooking Fuel Type b. Pigs 21. Walls
c. Cows 28. Drinks, How Often?
12. Indoor/Outdoor Oven? d. Dogs 22. Roof
e. Cats
13. Water Source f. Horses 23. Mosquito Nets 29. Exercise, How
Often?
g. Other
14. Water Storage Type 18. Garbage Deposit Type 24. Garden
15. Water Treated? How? 19. Excrement Deposit
Type
25. Ventilation (if indoor
stove)
30. Hours of Sleep
16. Electricity? 26. Household Income
Dental Health
ID 31. # Times
Brush/Day
32. Location
Brush Kept
33. Flosses? 34. Dr., How
Often/Yr
35. Last Dt.
Visit?
36.
#Cavities
37. # Teeth
Replaced
ID 7. Education 8. Profession 9. Existing Illnesses

23. Estimating Health Risks Page 22
Nutritional Status, Children Ages 0-5 Family Nutrition
ID 38.
Ht.
39.
Wt.
40. Time
Breastfed
41. Time
Formula
42. How Many Times/Day? 43. Amt./Month
a. Rc b. Bn c. Mt d. Vg e. Fr f. Da a. Rice
b. Beans
c. Salt
d. Sugar
e. Oil
44. Income Spent
on Food
Female Reproductive Health, Ages 15 and Older
ID 45. Pap
Smear, How
Often/Yr.?
46. Last
Pap Smear
47. Gyno
Visit, How
Often/Yr.?
48. Last
Gyno Visit
49. Future
Visits?
50. FIMRC
Gyno?
51. Self-Breast
Exam Freq.?
Breastfeeding Behaviors Birth Control Knowledge
ID 52. How Learned? 53. How Long? 54. Birth Control: Aware 55. Birth Control: Used
Prenatal Health (Pregnant or Recently Pregnant Women)
ID 56. Prenatal Visits,
How Often/Month?
57. Last
Prenatal Visit
58. Prenatal
Vitamins
59. Pregnancy Illnesses and Complications
Mental Health
ID 60. How Often
Stressed/Day?
61. Top Reasons for Stress 62. Persistent
Sadness
63. Loss
of Interest
64. Loss of
Appetite
65. Loss of
Energy
Health Services - Children Health Services
ID 66. Dr.,
How
Often/Yr.
67. Last
Dr. Visit
68.
Perceived
Efficacy
69. Ped.,
How
Often/Yr.
70. Last
Ped. Visit
71.
Perceived
Efficacy
72.
FIMRC
Ped.?
73. Closest
Clinic
74. Clinic Dist.
75. Cost of Visit

24. Estimating Health Risks Page 23
References
1
Cattaneo, M. D., Galiani, S., Gertler, P. J., Martinez, S., & Titiunik, R. (2009). Housing, health,
and happiness. American Economic Journal: Economic Policy, 75-105.Chicago
2
Minnesota Department of Health. (2012). Common Zoonotic Diseases from Farm Animals.
Retrieved from http://umash.umn.edu/resources/pdf/UMASH-MDH-Zoonoses.pdf
3
Smith, K. R. (2006). Health impacts of household fuelwood use in developing countries.
UNASYLVA-FAO-, 57(2), 41.Chicago
4
Montero, E. A., Isom, I. B., Fults, J., Cvijanovich, S., Chismark, A., & Tran, B. B. (2012). The
Effects of Proximity on Aerosol Distribution of Bacteria on Toothbrushes. Journal of the
California Dental Hygienists' Association, 27(2).Chicago