Literal question
708) Declaration of consent for anemia test
READ THE CONSENT TO EACH RESPONDENT. CIRCLE CODE 1 IN 708 IF THE RESPONDENT ACCEPTS THE ANEMIA TEST AND CODE 3 IF SHE REFUSES.
FOR WOMEN AGES 15-17 WHO HAVE NEVER BEEN IN A UNION, ASK FOR THE CONSENT OF HER PARENT/OTHER ADULT IDENTIFIED IN 707 BEFORE ASKING FOR THE CONSENT OF THE ADOLESCENT HERSELF. CIRCLE CODE 2 IN 708 IF THE PARENT/ADULT REFUSES. ONLY CONDUCT THE TEST IF YOU OBTAINED BOTH CONSENTS, THAT OF THE PARENT/ADULT AND OF THE ADOLESCENT RESPONDENT.
As part of this survey, we are asking people all over the country to take an anemia test. Anemia is a serious health problem that usually results from poor nutrition, infection, or chronic disease. The results of this survey will assist the government to develop programs to prevent and treat anemia.
For the anemia test, we need a few drops of blood from a finger. The equipment used to take the blood is clean and completely safe. It has never been used before and will be thrown away after each test.
The blood will be tested for anemia immediately, and the result will be told to you right away. The result will be kept strictly confidential and will not be shared with anyone other than member of our survey team.
Do you have any questions?
You can say yes, or you can say no to the test. It is up to you to decide.
Will you allow (NAME of adolescent) to take the anemia test?
GRANTED 1- (SIGN)____________
PARENT/OTHER RESPONSIBLE ADULT REFUSED 2- (SIGN)______
RESPONDENT REFUSED 3-(SIGN)__________