DEMOGRAPHIC AND HEALTH SURVEYS - 2015 ZIMBABWE - BIOMARKER QUESTIONNAIRE (ENGLISH)

ZIMBABWE

IDENTIFICATION

PLACE NAME:

NAME OF HOUSEHOLD HEAD:

CLUSTER NUMBER:

HOUSEHOLD NUMBER:

INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER'S NAME

SECOND VISIT
DATE
INTERVIEWER'S NAME

NEXT VISIT
DATE
TIME

THIRD VISIT
DATE
INTERVIEWER'S NAME

FINAL VISIT
DAY
MONTH
YEAR

TOTAL NUMBER OF VISITS

TOTAL ELIGIBLE WOMEN

TOTAL ELIGIBLE MEN

TOTAL ELIGIBLE CHILDREN

NOTES

LANGUAGE OF QUESTIONNAIRE

01 ENGLISH
02 NDEBELE
03 SHONA

LANGUAGE OF INTERVIEW

01 ENGLISH
02 NDEBELE
03 SHONA

TRANSLATOR?

YES 1
NO 2

SUPERVISOR
NAME
NUMBER

FIELD EDITOR
NAME
NUMBER

OFFICE EDITOR
NUMBER

KEYED BY
NUMBER

WEIGHT, HEIGHT, HEMOGLOBIN MEASUREMENT, AND HIV TESTING FOR CHILDREN AGE 0-5

101. CHECK COLUMN 11 IN HOUSEHOLD QUESTIONNAIRE. RECORD THE LINE NUMBER AND NAME FOR ALL ELIGIBLE CHILDREN 0-5 YEARS IN QUESTION 102; IF MORE THAN SIX CHILDREN, USE ADDITIONAL QUESTIONNAIRE(S).

102. CHECK HOUSEHOLD QUESTIONNAIRE: LINE NUMBER FROM COLUMN 11.

LINE NUMBER ___
NAME ___

103. IF MOTHER INTERVIEWED: COPY CHILD'S DATE OF BIRTH (DAY, MONTH, AND YEAR) FROM BIRTH HISTORY. IF MOTHER NOT INTERVIEWED ASK: What is (NAME)'s date of birth?

DAY ___
MONTH ___
YEAR ___

104. CHECK 103: CHILD BORN IN 2010-2015?

YES 1
NO 2 (GO TO 121)

105. WEIGHT IN KILOGRAMS.

KILOGRAMS ___
NOT PRESENT 9994
REFUSED 9995
OTHER 9996

106. HEIGHT IN CENTIMETERS.

CENTIMETERS ___
NOT PRESENT 9994 (GO TO 108)
REFUSED 9995 (GO TO 108)
OTHER 9996 (GO TO 108)

107. MEASURED LYING DOWN OR STANDING UP?

LYING DOWN 1
STANDING UP 2

108. MEASURER: ENTER YOUR INTERVIEWER NUMBER.

INTERVIEWER NUMBER ___

108A. LINE NUMBER OF PARENT/OTHER ADULT RESPONSIBLE FOR THE CHILD FROM COLUMN 1 OF HOUSEHOLD SCHEDULE.

RECORD '00' IF NOT LISTED

LINE NUMBER ___

109. CHECK 103: CHILD AGE 0-5 MONTHS, I.E., WAS CHILD BORN IN MONTH OF INTERVIEW OR 5 PREVIOUS MONTHS?

0-5 MONTH 1 (GO TO 113)
OLDER 2

PARENTAL/RESPONSIBLE ADULT CONSENT FOR CHILD ANEMIA TEST

111. ASK CONSENT FOR ANEMIA TEST FROM PARENT/OTHER ADULT.

PROVIDE PARENT/RESPONSIBLE ADULT WITH PARENTAL CONSENT FORM.

112. CIRCLE THE CODE AND SIGN YOUR NAME.

GRANTED 1 (SIGN) ___
REFUSED 2 (SIGN) ___
NOT PRESENT 3

PARENTAL/RESPONSIBLE ADULT CONSENT FOR CHILD DBS COLLECTION

113. ASK CONSENT FOR DBS COLLECTION FROM PARENT/OTHER ADULT

PROVIDE PARENT/RESPONSIBLE ADULT WITH PARENTAL CONSENT FORM.

114. CIRCLE THE CODE AND SIGN YOUR NAME.

GRANTED 1 (SIGN) ___
REFUSED 2 (SIGN) ___ (GO TO 117)
(SIGN AND ENTER YOUR INTERVIEWER NUMBER) ___
NOT PRESENT 3 (GO TO 117)

PARENTAL/RESPONSIBLE ADULT CONSENT FOR CHILD ADDITIONAL TESTING

115. ASK CONSENT FOR ADDITIONAL TESTING FROM PARENT/ADULT.

PROVIDE PARENT/RESPONSIBLE ADULT WITH PARENT CONSENT FROM.

116. CIRCLE THE CODE AND SIGN YOUR NAME.

GRANTED 1 (SIGN) ___
REFUSED 2 (SIGN) ___
NOT PRESENT 3

117. PREPARE EQUIPMENT AND SUPPLIES ONLY FOR THE TEST(S) FOR WHICH CONSENT HAS BEEN OBTAINED AND PROCEED WITH THE TEST(S).

118. ADDITIONAL TESTS.

CHECK 116.

IF CONSENT HAS NOT BEEN GRANTED, WRITE "NO ADDITIONAL TESTS" ON THE FILTER PAPER.

119. RECORD HEMOGLOBIN LEVEL HERE AND IN THE ANEMIA PAMPHLET.

G/DL ___
NOT PRESENT 994
REFUSED 995
OTHER 996

120. PLACE BAR CODE LABEL.

CHECK HOUSEHOLD QUESTIONNAIRE COLUMN 7 (AGE):

IF LESS THAN 2 YEARS, USE A BAR CODE ON BLUE PAPER.

IF 2 YEARS OR MORE, USE A BAR CODE ON WHITE PAPER.

PUT THE 1ST BAR CODE LABEL

NOT PRESENT 99994
REFUSED 99995

PUT THE 2ND BAR CODE LABEL ON THE RESPONDENT'S FILTER PAPER AND THE 3 RD ON THE TRANSMITTAL FORM.

121. GO BACK TO 103 IN NEXT COLUMN OF THIS QUESTIONNAIRE OR IN THE FIRST COLUMN OF THE NEXT PAGE; IF NO MORE CHILDREN, GO TO 122.

HIV TESTING FOR CHILDREN AGE 6-14

122. CHECK COLUMN 11A IN HOUSEHOLD QUESTIONNAIRE. RECORD THE LINE NUMBER AND NAME FOR ALL ELIGIBLE CHILDREN 6-14 YEARS IN QUESTION 123; IF MORE THAN SIX CHILDREN, USE ADDITIONAL QUESTIONNAIRE(S).

123. CHECK HOUSEHOLD QUESTIONNAIRE:

LINE NUMBER FROM COLUMN 11A.

NAME FROM COLUMN 2.

LINE NUMBER ___
NAME ___

124. CHECK HOUSEHOLD QUESTIONNAIRE COLUMN 7 (AGE):

6-11 YEAR 1 (GO TO 130)
12-14 YEARS 2

125. CHECK HOUSEHOLD QUESTIONNAIRE COLUMN 8 (MARITAL STATUS):

CODE 4 (NEVER IN UNION) 1 (GO TO 130)
OTHER 2

EMANCIPATED ADOLESCENT CONSENT FOR DBS COLLECTION

126. ASK CONSENT FOR DBS COLLECTION.

PROVIDE ADOLESCENT WITH EMANCIPATED ADOLESCENT CONSENT FORM.

127. CIRCLE THE CODE, SIGN YOUR NAME, AND ENTER YOUR INTERVIEWER NUMBER.

GRANTED 1 (SIGN AND ENTER YOUR INTERVIEWER NUMBER)
RESPONDENT REFUSED 2 (SIGN AND ENTER YOUR INTERVIEWER NUMBER) (GO TO 142)
NOT PRESENT 3 (GO TO 142)

EMANCIPATED ADOLESCENT CONSENT FOR ADDITIONAL TESTING

128. ASK CONSENT FOR ADDITIONAL TESTING.

PROVIDE ADOLESCENT WITH EMANCIPATED ADOLESCENT CONSENT FORM.

129. CIRCLE THE CODE AND SIGN YOUR NAME.

GRANTED 1 (SIGN AND GO TO 140)
RESPONDENT REFUSED 2 (SIGN AND GO TO 140)

PARENTAL/RESPONSIBLE ADULT CONSENT FOR DBS COLLECTION

130. ASK CONSENT FOR DBS COLLECTION FROM PARENT/ADULT.

PROVIDE PARENT/RESPONSIBLE ADULT WITH PARENTAL CONSENT FORM.

131. CIRCLE THE CODE AND SIGN YOUR NAME.

GRANTED 1 (SIGN) (GO TO 142)
PARENT/OTHER RESPONSIBLE ADULT REFUSED 2 (SIGN) (GO TO 142)
NOT PRESENT 3 (GO TO 142)

132. CHECK 124: CHILD AGE 6 YEARS?

6 YEARS 1 (GO TO 135)
7-14 YEARS 2

MINOR RESPONDENT CONSENT FOR DBS COLLECTION

133. ASK CONSENT FOR DBS COLLECTION FROM MINOR RESPONDENT.

PROVIDE MINOR WITH ASSENT FORM.

134. CIRCLE THE CODE, SIGN YOUR NAME, AND ENTER YOU INTERVIEWER NUMBER.

GRANTED 1 (SIGN AND ENTER YOUR INTERVIEWER NUMBER)
MINOR RESPONDENT REFUSED 2 (SIGN AND ENTER YOUR INTERVIEWER NUMBER) (GO TO 142)
NOT PRESENT 3 (GO TO 142)

PARENTAL/RESPONSIBLE ADULT CONSENT FOR ADDITIONAL TESTING

135. ASK CONSENT FOR ADDITIONAL TESTING FROM PARENT/ADULT.

PROVIDE PARENT/RESPONSIBLE ADULT WITH PARENTAL CONSENT FORM.

136. CIRCLE THE CODE AND SIGN YOUR NAME.

GRANTED 1 (SIGN)
PARENT/OTHER RESPONSIBLE ADULT REFUSED 2 (SIGN) (GO TO 140)

137. CHECK 124: CHILD AGE 6 YEARS?

6 YEARS 1 (GO TO 140)
7-14 YEARS 2

MINOR RESPONDENT CONSENT FOR ADDITIONAL TESTING

138 ASK CONSENT FOR ADDITIONAL TESTING FROM MINOR RESPONDENT.

PROVIDE MINOR WITH ASSENT FORM.

139. CIRCLE THE CODE AND SIGN YOUR NAME.

GRANTED 1 (SIGN)
MINOR RESPONDENT REFUSED 2 (SIGN)

140. ADDITIONAL TESTS.

IF EMANCIPATED ADOLESCENT RESPONDENT, CHECK 129; IF MINOR RESPONDENT, CHECK 136 AND 139

IF CONSENT HAS NOT BEEN GRANTED, WRITE 'NO ADDITIONAL TESTS' ON THE FILTER PAPER.

141. PLACE BAR CODE LABEL.

PUT THE 1ST BAR CODE LABEL HERE.

NOT PRESENT 99994
REFUSED 99995
OTHER 99996

PUT THE 2ND BAR CODE LABEL ON THE RESPONDENT'S FILTER PAPER AND THE 3RD ON THE TRANSMITTAL FORM.

142. GO BACK TO 123 IN NEXT COLUMN OF THIS QUESTIONNAIRE OR IN THE FIRST COLUMN OF AN ADDITIONAL QUESTIONNAIRE; IF NO MORE CHILDREN GO TO 201.

WEIGHT, HEIGHT, HEMOGLOBIN MEASUREMENT AND HIV TESTING FOR WOMEN AGE 15-49

201. CHECK COLUMN 9 IN HOUSEHOLD QUESTIONNAIRE. RECORD THE LINE NUMBER, NAME, AGE, AND MARITAL STATUS FOR ALL ELIGIBLE WOMEN IN 202, 203, AND 204.

IF THERE ARE MORE THAN THREE WOMEN, USE ADDITIONAL QUESTIONNAIRE(S).

202. CHECK HOUSEHOLD QUESTIONNAIRE: LINE NUMBER FROM COLUMN 9.

LINE NUMBER ___
NAME ___

203. CHECK HOUSEHOLD QUESTIONNAIRE COLUMN 7 (AGE):

15-17 YEARS 1
18-49 YEARS 2

204. CHECK HOUSEHOLD QUESTIONNAIRE COLUMN 8 (MARITAL STATUS):

CODE 4 (NEVER IN UNION) 1
OTHER 2

205. WEIGHT IN KILOGRAMS.

KILOGRAMS ___
NOT PRESENT 99994
REFUSED 99995
OTHER 99996

206. HEIGHT IN CENTIMETERS.

CENTIMETERS ___
NOT PRESENT 9994
REFUSED 9995
OTHER 9996

207. MEASURER: ENTER YOUR INTERVIEWER NUMBER.

INTERVIEWER NUMBER ___

208. CHECK 203: AGE?

15-17 YEARS 1
18-49 YEARS 2 (GO TO 210)

209. CHECK 204: MARITAL STATUS

CODE 4 (NEVER IN UNION) 1 (GO TO 216)
OTHER 2

ADULT RESPONDENT CONSENT FOR ANEMIA TEST

210. ASK CONSENT FOR ANEMIA TEST.

PROVIDE ADULT CONSENT FORM.

211. CIRCLE THE CODE AND SIGN YOUR NAME.

GRANTED 1 (SIGN)
RESPONDENT 2 (SIGN) (GO TO 212)
NOT PRESENT 3 (GO TO 212)

211A. CHECK 226 IN WOMAN'S QUESTIONNAIRE OR ASK: Are you pregnant?

YES 1
NO 2
DON'T KNOW 8

ADULT RESPONDENT CONSENT FOR DBS COLLECTION

212. ASK CONSENT FOR DBS COLLECTION.

PROVIDE CONSENT FORM.

213. CIRCLE THE CODE, SIGN YOUR NAME, AND ENTER YOUR INTERVIEWER NUMBER.

GRANTED 1 (SIGN AND ENTER YOUR INTERVIEWER NUMBER)
RESPONDENT REFUSED 2 (SIGN AND ENTER YOUR INTERVIEWER NUMBER) (GO TO 229)
NOT PRESENT 3 (GO TO 229)

ADULT RESPONDENT CONSENT FOR ADDITIONAL TESTING

214. ASK CONSENT FOR ADDITIONAL TESTING.

PROVIDE ADULT CONSENT FORM.

215. CIRCLE THE CODE AND SIGN YOUR NAME.

GRANTED 1 (SIGN) (GO TO 229)
RESPONDENT REFUSED 2 (SIGN AND GO TO 229)

216. RECORD LINE NUMBER OF PARENT/OTHER ADULT RESPONSIBLE FOR ADOLESCENT.

RECORD '00' IF NOT LISTED

LINE NUMBER OF PARENT OR OTHER RESPONSIBLE ADULT ___

PARENTAL/RESPONSIBLE ADULT CONSENT FOR ANEMIA TEST

217. ASK CONSENT FOR ANEMIA TEST FROM PARENT/ADULT.

PROVIDE PARENT/RESPONSIBLE ADULT WITH PARENTAL CONSENT.

218. CIRCLE THE CODE AND SIGN YOUR NAME.

GRANTED 1 (SIGN)
PARENT/OTHER RESPONSIBLE ADULT REFUSED 2 (SIGN) (GO TO 221)
NOT PRESENT 3 (GO TO 221)

MINOR RESPONDENT CONSENT FOR ANEMIA TEST

219. ASK CONSENT FOR ANEMIA TEST FROM RESPONDENT.

PROVIDE ADOLESCENT WITH ADOLESCENT ASSENT FORM.

220. CIRCLE THE CODE AND SIGN YOUR NAME.

GRANTED 1 (SIGN)
MINOR RESPONDENT REFUSED 2 (SIGN) (GO TO 221)
NOT PRESENT 3 (GO TO 221)

220A. CHECK 226 IN WOMAN'S QUESTIONNAIRE OR ASK: Are you pregnant?

YES 1
NO 2
DON'T KNOW 8

PARENTAL/RESPONSIBLE ADULT CONSENT FOR DBS COLLECTION

221. ASK CONSENT FOR DBS COLLECTION FROM PARENT/ADULT.

PROVIDE PARENT/RESPONSIBLE ADULT WITH PARENTAL CONSENT.

222. CIRCLE THE CODE AND SIGN YOUR NAME.

GRANTED 1 (SIGN)
PARENT/OTHER RESPONSIBLE ADULT REFUSED 2 (SIGN) (GO TO 229)
NOT PRESENT 3 (GO TO 229)

MINOR RESPONDENT CONSENT FOR DBS COLLECTION

223. ASK CONSENT FOR DBS COLLECTION FROM MINOR RESPONDENT.

PROVIDE ADOLESCENT WITH ADOLESCENT ASSENT FORM.

224. CIRCLE THE CODE, SIGN YOUR NAME, AND ENTER YOUR INTERVIEWER NUMBER.

GRANTED 1 (SIGN AND ENTER YOUR INTERVIEWER NUMBER)
MINOR RESPONDENT REFUSED 2 (SIGN AND ENTER YOUR INTERVIEWER NUMBER) (GO TO 229)
NOT PRESENT 3 (GO TO 229)

PARENTAL/RESPONSIBLE ADULT CONSENT FOR ADDITIONAL TESTING

225. ASK CONSENT FOR ADDITIONAL TESTING FROM PARENT/ADULT.

PROVIDE PARENT/RESPONSIBLE ADULT WITH PARENTAL CONSENT.

226. CIRCLE THE CODE AND SIGN YOUR NAME.

GRANTED 1 (SIGN)
PARENT/OTHER RESPONSIBLE ADULT REFUSED 2 (SIGN) (GO TO 229)

MINOR RESPONDENT CONSENT FOR ADDITIONAL TESTING

227. ASK CONSENT FOR ADDITIONAL TESTING FROM MINOR RESPONDENT.

PROVIDE ADOLESCENT WITH ADOLESCENT ASSENT FORM.

228. CIRCLE THE CODE AND SIGN YOUR NAME.

GRANTED 1 (SIGN)
MINOR RESPONDENT REFUSED 2 (SIGN)

229. PREPARE EQUIPMENT AND SUPPLIES ONLY FOR THE TEST(S) FOR WHICH CONSENT HAS BEEN OBTAINED AND PROCEED WITH THE TEST(S).

230. ADDITIONAL TESTS.

IF ADULT RESPONDENT, CHECK 215; IF MINOR RESPONDENT, CHECK 226 AND 228.

IF CONSENT HAS NOT BEEN GRANTED, WRITE "NO ADDITIONAL TESTS" ON THE FILTER PAPER.

231. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET.

G/DL ___
NOT PRESENT 994
REFUSED 995
OTHER 996

232. PLACE BAR CODE LABEL.

PUT THE 1ST BAR CODE LABEL HERE.

NOT PRESENT 99994
REFUSED 99995
OTHER 99996

PUT THE 2ND BAR CODE LABEL ON THE RESPONDENT'S FILTER PAPER AND THE 3RD ON THE TRANSMITTAL FORM.

233. GO BACK TO 202 IN NEXT COLUMN OF THIS QUESTIONNAIRE OR IN THE FIRST COLUMN OF AN ADDITIONAL QUESTIONNAIRE.

WEIGHT, HEIGHT, HEMOGLOBIN MEASUREMENT AND HIV TESTING FOR MEN AGE 15-54

301. CHECK COLUMN 10 IN HOUSEHOLD QUESTIONNAIRE. RECORD THE LINE NUMBER, NAME, AGE, AND MARITAL STATUS FOR ALL ELIGIBLE MEN IN 302, 303, AND 304.

IF THERE ARE MORE THAN THREE MEN, USE ADDITIONAL QUESTIONNAIRE(S).

302. CHECK HOUSEHOLD QUESTIONNAIRE: LINE NUMBER FROM COLUMN 10.

LINE NUMBER ___
NAME ___

303. CHECK HOUSEHOLD QUESTIONNAIRE COLUMN 7 (AGE):

15-17 YEARS 1
18-49 YEARS 2

304. CHECK HOUSEHOLD QUESTIONNAIRE COLUMN 8 (MARITAL STATUS):

CODE 4 (NEVER IN UNION) 1
OTHER 2

305. WEIGHT IN KILOGRAMS.

KILOGRAMS ___
NOT PRESENT 99994
REFUSED 99995
OTHER 99996

306. HEIGHT IN CENTIMETERS.

CENTIMETERS ___
NOT PRESENT 9994
REFUSED 9995
OTHER 9996

307. MEASURER: ENTER YOUR INTERVIEWER NUMBER.

INTERVIEWER NUMBER ___

308. CHECK 303: AGE?

15-17 YEARS 1
18-54 YEARS 2 (GO TO 310)

309. CHECK 304: MARITAL STATUS

CODE 4 (NEVER IN UNION) 1 (GO TO 316)
OTHER 2

ADULT RESPONDENT CONSENT FOR ANEMIA TEST

310. ASK CONSENT FOR ANEMIA TEST.

PROVIDE ADULT CONSENT FORM.

311. CIRCLE THE CODE AND SIGN YOUR NAME.

GRANTED 1 (SIGN)
RESPONDENT 2 (SIGN)
NOT PRESENT 3

ADULT RESPONDENT CONSENT FOR DBS COLLECTION

312. ASK CONSENT FOR DBS COLLECTION.

PROVIDE CONSENT FORM.

313. CIRCLE THE CODE, SIGN YOUR NAME, AND ENTER YOUR INTERVIEWER NUMBER.

GRANTED 1 (SIGN AND ENTER YOUR INTERVIEWER NUMBER)
RESPONDENT REFUSED 2 (SIGN AND ENTER YOUR INTERVIEWER NUMBER) (GO TO 329)
NOT PRESENT 3 (GO TO 329)

ADULT RESPONDENT CONSENT FOR ADDITIONAL TESTING

314. ASK CONSENT FOR ADDITIONAL TESTING.

PROVIDE ADULT CONSENT FORM.

315. CIRCLE THE CODE AND SIGN YOUR NAME.

GRANTED 1 (SIGN) (GO TO 329)
RESPONDENT REFUSED 2 (SIGN AND GO TO 329)

316. RECORD LINE NUMBER OF PARENT/OTHER ADULT RESPONSIBLE FOR ADOLESCENT.

RECORD '00' IF NOT LISTED

LINE NUMBER OF PARENT OR OTHER RESPONSIBLE ADULT ___

PARENTAL/RESPONSIBLE ADULT CONSENT FOR ANEMIA TEST

317. ASK CONSENT FOR ANEMIA TEST FROM PARENT/ADULT.

PROVIDE PARENT/RESPONSIBLE ADULT WITH PARENTAL CONSENT.

318. CIRCLE THE CODE AND SIGN YOUR NAME.

GRANTED 1 (SIGN)
PARENT/OTHER RESPONSIBLE ADULT REFUSED 2 (SIGN) (GO TO 321)
NOT PRESENT 3 (GO TO 321)

MINOR RESPONDENT CONSENT FOR ANEMIA TEST

319. ASK CONSENT FOR ANEMIA TEST FROM RESPONDENT.

PROVIDE ADOLESCENT WITH ADOLESCENT ASSENT FORM.

320. CIRCLE THE CODE AND SIGN YOUR NAME.

GRANTED 1 (SIGN)
MINOR RESPONDENT REFUSED 2 (SIGN) (GO TO 321)
NOT PRESENT 3 (GO TO 321)

PARENTAL/RESPONSIBLE ADULT CONSENT FOR DBS COLLECTION

321. ASK CONSENT FOR DBS COLLECTION FROM PARENT/ADULT.

PROVIDE PARENT/RESPONSIBLE ADULT WITH PARENTAL CONSENT.

322. CIRCLE THE CODE AND SIGN YOUR NAME.

GRANTED 1 (SIGN)
PARENT/OTHER RESPONSIBLE ADULT REFUSED 2 (SIGN) (GO TO 329)
NOT PRESENT 3 (GO TO 329)

MINOR RESPONDENT CONSENT FOR DBS COLLECTION

323. ASK CONSENT FOR DBS COLLECTION FROM MINOR RESPONDENT.

PROVIDE ADOLESCENT WITH ADOLESCENT ASSENT FORM.

324. CIRCLE THE CODE, SIGN YOUR NAME, AND ENTER YOUR INTERVIEWER NUMBER.

GRANTED 1 (SIGN AND ENTER YOUR INTERVIEWER NUMBER)
MINOR RESPONDENT REFUSED 2 (SIGN AND ENTER YOUR INTERVIEWER NUMBER) (GO TO 329)
NOT PRESENT 3 (GO TO 329)

PARENTAL/RESPONSIBLE ADULT CONSENT FOR ADDITIONAL TESTING

325. ASK CONSENT FOR ADDITIONAL TESTING FROM PARENT/ADULT.

PROVIDE PARENT/RESPONSIBLE ADULT WITH PARENTAL CONSENT.

326. CIRCLE THE CODE AND SIGN YOUR NAME.

GRANTED 1 (SIGN)
PARENT/OTHER RESPONSIBLE ADULT REFUSED 2 (SIGN) (GO TO 329)

MINOR RESPONDENT CONSENT FOR ADDITIONAL TESTING

327. ASK CONSENT FOR ADDITIONAL TESTING FROM MINOR RESPONDENT.

PROVIDE ADOLESCENT WITH ADOLESCENT ASSENT FORM.

328. CIRCLE THE CODE AND SIGN YOUR NAME.

GRANTED 1 (SIGN)
MINOR RESPONDENT REFUSED 2 (SIGN)

329. PREPARE EQUIPMENT AND SUPPLIES ONLY FOR THE TEST(S) FOR WHICH CONSENT HAS BEEN OBTAINED AND PROCEED WITH THE TEST(S).

330. ADDITIONAL TESTS.

IF ADULT RESPONDENT, CHECK 315; IF MINOR RESPONDENT, CHECK 326 AND 328.

IF CONSENT HAS NOT BEEN GRANTED, WRITE "NO ADDITIONAL TESTS" ON THE FILTER PAPER.

331. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET.

G/DL ___
NOT PRESENT 994
REFUSED 995
OTHER 996

332. PLACE BAR CODE LABEL.

PUT THE 1ST BAR CODE LABEL HERE.

NOT PRESENT 99994
REFUSED 99995
OTHER 99996

PUT THE 2ND BAR CODE LABEL ON THE RESPONDENT'S FILTER PAPER AND THE 3RD ON THE TRANSMITTAL FORM.

333. GO BACK TO 302 IN NEXT COLUMN OF THIS QUESTIONNAIRE OR IN THE FIRST COLUMN OF AN ADDITIONAL QUESTIONNAIRE.

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING BIOMARKERS

SUPERVISOR'S OBSERVATIONS

EDITOR'S OBSERVATIONS

Data Cart

Your data extract

0	variables
0	samples