RESEARCH QUESTIONNAIRE

Title: “Assessment of the Prevalence, Knowledge, and Lifestyle Behaviors Associated with Non-
Communicable Diseases (Diabetes Mellitus and Hypertension) among patients attending health
care facilities in Dodoma and Manyara Regions, 2025.”

Number of Questionnaire:
Name of the Region: put the
option
Name of the District: put the
option
Name of the Ward: put the
option
Health center/ dispensary:
name all the health care
facilities

SECTION A: DEMOGRAPHIC INFORMATION

A1. Age (years)________________
A2. Sex
a. Male
b. Female
A3. Marital Status (15 years and above)
a. SingleNever married
b. Married
c. Divorced/ Widowed
A4. Highest Education Level
a. No formal education
b. Primary
c. Secondary
d. Tertiary/College
A5. Occupation status
a. Farmer
b. Business
c. Employee (paid salary_
d. casual labors (day worker, temporary, vibarua)
e. student
f. Unemployed(household chores
Livestock keeping
Don’t do any economic activities
others (Mention)
Section B: Prevalence of NCDs
B1. Have you ever had your blood pressure measured?
a. Yes
b. No
B2. If yes, where do you have your blood pressure measured?
a) Health facilities (Hospital, Health center, Dispensary)
b) Community health campaigns or outreaches
c) At home (using BP machine)
d) Others (specify ___________)
B3. Have you ever had your blood sugar measured?
a. Yes
b. No
B4. If yes, where do you have your blood sugar measured?
a) Health facilities (Hospital, Health center, Dispensary)
b) Community health campaigns or outreaches
c) At home (using BP machine)
d) Others (specify ___________)

B5. Have you ever been diagnosed with any of the following?
a. Hypertension
b. Diabetes Mellitus
c. Both
d. None
B6. If diagnosed DM, how long have you had the condition? ______________________
B7. If diagnosed HTN, how long have you had the condition? ______________________
B8. For HTN patient, did you take medication for hypertension yesterday or today?????
a. Yes
b. No
B9. For DM patient, did you take medication for Diabetes Mellitus yesterday or today?????
a. Yes
b. No
B10. Is there is a family history of diabetes mellitus? To any close relative (father, mother, sister
or brother) with diabetes mellitus.
a. Yes
b. No
c. Father/Mother
d. Sibling
e. Grandparent
f. Others (Uncle, aunt etc)
g. Don’t know
Do you Know any other person with DM not your relative??
a. Neibhours
b. Friend
c. Other (mention)
d. No one
h.
B11. Is there is a family history of hypertension? To any close relative (father, mother, sister or
brother) with hypertension.
i. No
j. Father/Mother
k. Sibling
l. Grandparent
m. Others (Uncle, aunt etc)
n. Don’t know
o. Yes
p. No
Do you Know any other person with hypertension not your relative??
q. Neigbhours
r. Friend
s. Other (mention)
t. No one
u.

SECTION C: KNOWLEDGE ON HYPERTENSION AND DIABETES MELLITUS.

Knowledge on Hypertension
What do you know about hypertension??
What it is
Causes
Symptoms
Prevention
1. Hypertension is a condition where blood pressure stays higher than normal.
a) True
b) False
c) I don’t know
2. High blood pressure can occur even without any symptoms.
a) True
b) False
c) I don’t know
3. Which of the following can be symptoms of hypertension?
a) Severe headache
b) Blurred vision
c) Confusion or fatigue
d) Chest pain or discomfort
 e) Nose-bleeding
f) I don’t know
4. People with hypertension always feel sick.
a) True
b) False
c) I don’t know
5. Taking prescribed medication daily helps control hypertension.
a) True
b) False
c) I don’t know
6. Reducing salt intake is important in managing hypertension.
a) True
b) False
c) I don’t know
7. Regular physical activity can help prevent hypertension.
a) True
b) False
c) I don’t know
8. Being overweight increases the risk of hypertension.
a) True
b) False
c) I don’t know

Knowledge on Diabetes Mellitus

What do you know about diabetes ??
What it is
Causes
Symptoms
Prevention

1. Diabetes Mellitus occurs when the body cannot regulate sugar levels properly.
 a) True
b) False
c) I don’t know
2. There are two major types of diabetes: Type 1 and Type 2.
a) True
b) False
c) I don’t know
3. Which of the following can be symptoms of diabetes mellitus?
a) Frequent urination
b) Excessive thirst
c) Increased hunger
d) I don’t know
4. Blurred vision can be a sign of diabetes mellitus.
a) True
b) False
c) I don’t know
5. Taking medication or insulin as prescribed helps control diabetes.
a) True
b) False
c) I don’t know
6. Eating a healthy diet can help manage diabetes.
a) True
b) False
c) I don’t know
7. Regular exercise can help prevent Type 2 diabetes mellitus.
a) True
b) False
c) I don’t know
8. Being overweight increases the risk of developing diabetes mellitus.
a) True
b) False
 c) I don’t know

SECTION D: LIFESTYLE BEHAVIOR

Lifestyle behavior: Tobacco Use
D1. Do you currently smoke any tobacco products?
a. Yes
b. No
D2. How frequently do you currently smoke tobacco?
a. Aeveryday
b. . 1. – 2 days per week
c. 3 – 4 days per week
d. 5 – 6 days per week

More than 3 day per week

b. 2 or fewer days per week
D3. Which type of tobacco product do you used
Manufactured cigarettes
Hand-rolled cigarettes
Pipes full of tobacco
Cigars / cheroots / cigarillos
Shisha sessions
Ugolo
Others (mention)
D4. If you are not smoking now, in the past, have you ever smoked any tobacco products?
a. Yes
b. No
D5. In the past, how frequently did you smoke tobacco?
a. a.
b. everyday
c. 1. – 2 days per week
d. 3 – 4 days per week
 e. 5 – 6 days per week
More than 3 day per week
b. 2 or fewer days per week
D6. Which type of smoke product do you used
Manufactured cigarettes
Hand-rolled cigarettes
Pipes full of tobacco
Cigars / cheroots / cigarillos
Shisha sessions
Ugolo
Others (mention)

Lifestyle behavior: Alcohol Consumption

D7. Have you ever consumed any alcoholAre you currently drinking alcohol ?
a. Yes
b. No
D8. Frequency of drinking alcohol
a. a. Dailyeveryday
b. every week
c. b. Every
d. Monthly
f. Occasionally (special occasion, wedding, holidays etc)
D9. Which type of alcohol do you consume:
Local spirits (e.g. Gongo),
Local beer/wine (e.g. Mbege, Ulanzi, Komoni etc.)
Local wine
Industrial spirits (e.g. Konyagi, Whisky, Gin, Rum, Brandy etc.)
Industrial wine
Industrial beer/wine (e.g. Safari Lager, Kilimanjaro Lager, Castle Lite, Red wine etc.)
Don’t know
Lifestyle behavior: Diet
D10. In a typical week, on how many days do you eat fruit?
a. Days per week [____________]
b. Every day
a. everyday
b. 1. – 2 days per week
c. 3 – 4 days per week
d. 5 – 6 days per week
e. c. Don’t eat at all
D10. In a typical day, how do you eat fruits?
D11. how often do you consume fruits during your meals?
b) Once per day (in one meal)
breakfast
Lunch
Dinner
Snack
c) Twice per day (in two meals)
d) Three times per day (in all meals: breakfast, lunch, and dinner)
Lifestyle behavior: Vegetables Consumption
D12. In a typical week, on how many days do you eat vegetables?
a.
a. everyday
b. 1. – 2 days per week
c. 3 – 4 days per week
5 – 6 days per weekDays per week [____________]
b. Every day
c. Don’t eat at all
D13. h. In a typical day, how do you eat fruits?ow often do you consume vegetables during your
meals?
b)
breakfast
Lunch
Dinner
Snack
never
Once per day (in one meal)
c) Twice per day (in two meals)
d) Three times per day (in all meals: breakfast, lunch, and dinner)
In a typical week, on how many days do you eat whole cerealsas staple (dona/brown rice)
a. everyday
b. 1. – 2 days per week
c. 3 – 4 days per week
5 – 6 days per week
Never
In a typical week, on how many days do you eat whole cerealsas staple (dona/brown rice)
breakfast
Lunch
Dinner
Snack
Never

Lifestyle behavior: Fatty rich foods Consumption

D14. In a typical week, on how many days do you eat fatty deep fried rich food? (e.g. chipsi,
mandazi, vitumbua, kachori)
d. a.
e. everyday
f. 1. – 2 days per week
g. 3 – 4 days per week
5 – 6 days per weekDays per week [____________]
b. Every day
c. Don’t eat at all
D13. h. In a typical day, how do you eat deep fried foods (e.g. chipsi, mandazi, vitumbua,
kachori)?
b)
breakfast
Lunch
Dinner
Snack

Lifestyle behavior: Salt Use

D15. How frequent Do you add salt or salty sauce to your food while eating (Table salt)?
a. a. Yeseverytime when I eat
b. Occasionally when I feel is not enough
c. I usually don’t add salt at all
b. No
D16. In a typical week, How frequently do you eat Do you eat processed foods high in salt?
(Sausages, nyama choma, canned meat/fishPopcorn with added salt, Dagaa wa chumvi)
a. a.
b. everyday
c. 1. – 2 days per week
d. 3 – 4 days per week
5 – 6 days per week Yes
b. No

Lifestyle behavior: Physical Activity

D17. Does your work involve vigorous-intensity activity? (Examples: heavy lifting, construction,
running, football, Bus conductor)
a. Yes
b. No
D18. Days per week of vigorous work activity: [____________]
D19. Does your work involve moderate-intensity activity? (Examples: brisk walking, carrying
light loads, brisk walking, cycling)
a. Yes
b. No
D20. Days per week of moderate work activity: [______________]
D21. How much time do you spend sitting or reclining per day? (e.g. Watching move, playing
games, using a smartphone, playing video games, riding in a car/bus, Sitting in shops)
Hours per day: [_______________]
In a typical week, do you do timed/planned physical exercises
a. everyday
b. 1. – 2 days per week
c. 3 – 4 days per week
5 – 6 days per week
Never
In a typical week, do you walk for at least 30 minutes before stopping

a. everyday
b. 1. – 2 days per week
c. 3 – 4 days per week
5 – 6 days per week
Never