Literal question
ANEMIA TEST FOR CHILDREN AGE 0-5 YEARS
BEFORE PROCEEDING WITH THE ANEMIA TEST FOR A CHILD, YOU MUST FIRST OBTAIN INFORMED CONSENT FROM A FAMILY MEMBER/ADULT RESPONSIBLE FOR THE CHILD.
As part of this survey, we would like to know anemia levels for children, women and men. Anemia is a serious health problem that is caused by poor nutrition. The results of this survey will help the government to put in place programs to treat and prevent anemia.
We would like all of your children or children within your care between the ages of 0-5 to participate in the anemia test by giving a few drops of blood from their finger. For this test, we use sterilized, individual instruments that are clean and risk-free. The blood will be analyzed using new equipment and the results will be given to you immediately after the blood draw. Results are confidential.
Do you have any questions?
We would like (NAME OF CHILD) to participate in the anemia test. You may accept or refuse, it is up to you to decide.
Now, will you allow (NAME OF CHILD) to participate in the anemia test?
RECORD. IF THE PARENT (OR OTHER ADULT) IN THE HOUSEHOLD ACCEPTS, CIRCLE '1' AND SIGN AT QUESTION 6. IF THE PARENT (OR OTHER ADULT) IN THE HOUSEHOLD REFUSES, CIRCLE '2', THEN SKIP TO QUESTION 12 AND RECORD THE FINAL RESULT '3' (REFUSED).
IF THE PARENT (OR OTHER ADULT) CONSENTED AND THE BLOOD WAS DRAWN, BUT THE HEMOGLOBIN LEVELS WERE NOT MEASURED, CIRCLE 996 (GO TO 12).
RECORD LINE NUMBER
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