Literal question
ANEMIA AND SYPHILIS TEST FOR ADULTS
INFORMED CONSENT FOR ANEMIA TEST:
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 and/or an infection. The results of this survey will help the government of Madagascar to put in place programs to treat and prevent anemia.
We would like you to participate in the anemia test by giving a few drops of blood from your 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 you to participate in the anemia test. You may accept or refuse, it is up to you to decide.
ASK CONSENT FROM A PARENT OR OTHER RESPONSIBLE ADULT FOR YOUTH AGE 15-17 YEARS: Now, will you allow (YOUTH 15-17 YEARS OLD) to participate in the anemia test? CIRCLE THE APPROPRIATE CODE IN QUESTION 107 AND SIGN.
ASK CONSENT FROM RESPONDENT AGE 18 YEARS OR OLDER AND FROM THE YOUTH AGE 15-17 YEARS WHOSE PARENT/ADULT GAVE CONSENT: Now, will you participate in the anemia test? CIRCLE THE APPROPRIATE CODE IN QUESTION 110 AND SIGN.