Survey Text

Benin 1996 Egypt 2005 Madagascar 1992 Tanzania 1991
Burkina Faso 1993 Egypt 2008 Madagascar 1997 Tanzania 1996
Burkina Faso 1998 Egypt 2014 Malawi 1992 Tunisia 1988
Cameroon 1991 Ghana 1988 Mali 1995 Uganda 1988
Cameroon 1998 Ghana 1993 Mozambique 1997 Zambia 1992
Cote d'Ivoire 1994 Guinea 1999 Namibia 1992 Zambia 1996
Cote d'Ivoire 1998 India 1992 Niger 1992 Zimbabwe 1988
Egypt 1988 India 1998 Niger 1998 Zimbabwe 1994
Egypt 1992 Jordan 1990 Nigeria 1999
Egypt 1995 Jordan 1997 Rwanda 1992
Egypt 2000 Kenya 1993 Senegal 1992
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Benin 1996
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1011) NAME OF MEASURER __________________________
NAME OF ASSISTANT __________________________

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Burkina Faso 1993
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912. NAME OF OPERATOR _____
OPERATOR CODE _____

NAME OF ASSISTANT _____
ASSISTANT CODE _____

MOTHER 90
OTHER HOUSEHOLD MEMBER 91
OTHER PERSONS 92

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Burkina Faso 1998
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1111. NAME OF OPERATOR _____
OPERATOR CODE _____

NAME OF ASSISTANT _____
ASSISTANT CODE:

MOTHER 90
OTHER HOUSEHOLD MEMBERS 91
OTHER PERSONS 92

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Cameroon 1991
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811 NAME OF MEASURER: __________
NAME OF ASSISTANT: ___________

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Cameroon 1998
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910. RESULT:

MEASURED 1
NOT PRESENT 3
REFUSED 4
OTHER (SPECIFY) __________ 9
NAME OF MEASURER __________
NAME OF ASSISTANT __________

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Cote d'Ivoire 1994
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1011) NAME OF MEASURER______

NAME____

NAME OF ASSISTANT______

NAME____

ASSISTANT'S RELATIONSHIP TO CHILD____

MOTHER 90
OTHER MEMBERS OF HOUSEHOLD 91
OTHER PERSONS 92

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Cote d'Ivoire 1998
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1011)
NAME OF MEASURER: ___
NAME OF ASSISTANT*: ____

*CODES: IF THE ASSISTANT IS A TEAM MEMBER, RECORD HIS/HER CODE, OTHERWISE USE THE FOLLOWING CODES: MOTHER (190); OTHER MEMBERS OF THE HOUSEHOLD (191); OTHER PERSONS (192).


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Egypt 1988
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808. NAME OF MEASURER AND ASSISTANT.

NAME OF MEASURER_______
NAME OF ASSISTANT_______

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Egypt 1992
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811) NAME OF MEASURER: __________

NAME OF ASSISTANT: ___________


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Egypt 1995
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911) NAME OF MEASURER ______
NAME OF ASSISTANT ______

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Egypt 2000
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078) NAME OF MEASURE/TESTER______
NAME OF ASSISTANT______

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Egypt 2005
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TICK HERE IF CONTINUATION SHEET USED ___

215) NAME OF MEASURER/TESTER __ __
NAME OF ASSISTANT __ __

* CONSENT STATEMENT
As part of this survey, we are studying anemia among women, children and adolescents. Anemia is a serious health problem that usually results from poor nutrition, infection, or chronic disease. This survey will assist the government to develop programs to prevent and treat anemia.

We request that you (and all children under age 6, and all male and never married female adolescents aged 10-19) to participate in the anemia testing part of this survey and give a few drops of blood from a finger. The test uses disposable sterile instruments that are clean and completely safe. The blood will be analyzed with new equipment and the results of the test will be given to you right after the blood is taken. The results will be kept confidential.

May I now ask that you (and NAME OF CHILD[REN]/ADOLESCENT) participate in the anemia test. However, if you decide not to have the test done, it is your right and we will respect your decision. Now please tell me if you agree to have the test(s) done.


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Egypt 2008
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CHECK IN THE IDENTIFICATION SECTION ON THE COVER PAGE IF THE HOUSEHOLD IS INCLUDED IN THE HEPATITIS C TESTING SUBSAMPLE:

IN THE HEPATITIS C TESTING SUBSAMPLE (GO TO 301)
NOT IN THE HEPATITIS C TESTING SUBSAMPLE (GO TO 401)

TICK IF AN ADDITIONAL HOUSEHOLD QUESTIONNAIRE USED ____

Name of Measurer __________
Name of Assistant __________


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Egypt 2014
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309. NAME OF MEASURER

__________

NAME OF ASSISTANT

___________

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Ghana 1988
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808. NAME OF MEASURER: ____
NAME OF ASSISTANT: ____

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Ghana 1993
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811 NAME OF MEASURER: __________
NAME OF ASSISTANT: ___________

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Guinea 1999
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NAME OF ASSISTANT ____

ASSISTANT CODE ____


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India 1992
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811 NAME OF MEASURER: __________
NAME OF ASSISTANT: ___________

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India 1998
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811) Can the virus the causes AIDS be transmitted from mother to a child?

YES 1
NO 2 (GO TO 813)
DK 8 (GO TO 813)

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Jordan 1990
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811) NAME OF MEASURER: __________

NAME OF ASSISTANT: ___________


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Jordan 1997
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1011. NAME OF MEASURER_____________ NAME OF ASSISTANT______________

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Kenya 1993
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910. RESULT:

MEASURED 1
NOT PRESENT 3
REFUSED 4
OTHER (SPECIFY) __________ 9
NAME OF MEASURER __________
NAME OF ASSISTANT __________

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Madagascar 1992
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811 NAME OF MEASURER: __________
NAME OF ASSISTANT: ___________

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Madagascar 1997
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910. RESULT:

MEASURED 1
NOT PRESENT 3
REFUSED 4
OTHER (SPECIFY) __________ 9
NAME OF MEASURER __________
NAME OF ASSISTANT __________

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Malawi 1992
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811 NAME OF MEASURER: __________
NAME OF ASSISTANT: ___________

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Mali 1995
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910. RESULT:

MEASURED 1
NOT PRESENT 3
REFUSED 4
OTHER (SPECIFY) __________ 9
NAME OF MEASURER __________
NAME OF ASSISTANT __________

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Mozambique 1997
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910. RESULT:

MEASURED 1
NOT PRESENT 3
REFUSED 4
OTHER (SPECIFY) __________ 9
NAME OF MEASURER __________
NAME OF ASSISTANT __________

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Namibia 1992
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811 NAME OF MEASURER: __________
NAME OF ASSISTANT: ___________

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Niger 1992
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913)

NAME OF MEASURER: ___
NAME OF ASSISTANT: ___
MOTHER 90
OTHER MEMBERS OF HOUSEHOLD 91
OTHER PERSONS 92

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Niger 1998

No questionnaire text is available for this sample.


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Nigeria 1999
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1011. NAME OF MEASURER: __________ __
NAME OF ASSISTANT: _________ __

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Rwanda 1992
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811 NAME OF MEASURER: __________
NAME OF ASSISTANT: ___________

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Senegal 1992
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811 NAME OF MEASURER: __________
NAME OF ASSISTANT: ___________

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Tanzania 1991
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811 NAME OF MEASURER: __________
NAME OF ASSISTANT: ___________

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Tanzania 1996
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910. RESULT:

MEASURED 1
NOT PRESENT 3
REFUSED 4
OTHER (SPECIFY) __________ 9
NAME OF MEASURER __________
NAME OF ASSISTANT __________

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Tunisia 1988

No questionnaire text is available for this sample.


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Uganda 1988
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808. NAME OF MEASURER AND ASSISTANT.

NAME OF MEASURER___________
NAME OF ASSISTANT___________

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Zambia 1992
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811 NAME OF MEASURER: __________
NAME OF ASSISTANT: ___________

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Zambia 1996
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910. RESULT:

MEASURED 1
NOT PRESENT 3
REFUSED 4
OTHER (SPECIFY) __________ 9
NAME OF MEASURER __________
NAME OF ASSISTANT __________

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Zimbabwe 1988
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808. NAME OF MEASURER AND ASSISTANT.

NAME OF MEASURER___________
NAME OF ASSISTANT___________

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Zimbabwe 1994
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911) NAME OF MEASURER ______
NAME OF ASSISTANT ______