*THE BASE CRITERIA IS 9 G/DL FOR PREGNANT WOMEN AND 7 G/DL FOR CHILDREN, MEN AND WOMEN WHO ARE NOT PREGNANT (OR WHO DO NOT KNOW IF THEY ARE PREGNANT).
** IF THERE IS MORE THAN ONE WOMAN OR CHILD WHO IS BELOW THE BASE CRITERIA, READ THE STATEMENT IN QUESTION 51 TO EACH WOMAN WHO IS BELOW THE BASE CRITERIA AND TO EACH WOMAN/PARENT/RESPONSIBLE ADULT OF THE CHILD WHO IS BELOW THE BASE CRITERIA.
LINE NO. FROM 201 __ __
209) NAME
CHECK COLUMN (202):
CHECK THE COVER PAGE OF THE HOUSEHOLD QUESTIONNAIRE FOR THE ALTITUDE MEASUREMENT OF THE HOUSEHOLD. ADJUST THE CUTOFF POINT OF THE READING FROM THE HEMOCUE MACHINE BASED ON THE ALTITUDE MEASUREMENT.
HEMOGLOBIN ADJUSTMENTS FOR ALTITUDE:
401 CHECK 224:
ONE OR MORE (GIVE EACH WOMEN/PARENT/RESPONSIBLE ADULT RESULT OF HEMOGLOBIN MEASUREMENT AND CONTINUE WITH 51)
NONE (GIVE EACH WOMAN/PARENT/RESPONSIBLE ADULT RESULT OF HEMOGLOBIN AND END HOUSEHOLD INTERVIEW.)
NAME OF PERSON WITH HEMOGLOBIN BELOW THE CUTOFF POINT:
NAME OF PARENT/RESPONSIBLE ADULT:
(SKIP FOR WOMEN AGE 18-49)
AGREES TO REFERRAL?
*The cutoff point is 9 g/dl for pregnant women and 7 g/dl for children and women who are not pregnant (or who don't know they are pregnant).
50. CHECK 47 AND 48:
NUMBER OF USUAL RESIDENTS WHOSE HEMOGLOBIN IS BELOW THE CRITICAL THRESHOLD.
The critical threshold is 9g/dl for pregnant women and 1 g/dl for children, men, and woman who are not pregnant (or who don't know if they are pregnant)
213) GO BACK TO 203 IN NEXT COLUMN OF THIS QUESTIONNAIRE OR IN THE FIRST COLUMN OF THE NEXT PAGE; IF NO MORE CHILDREN, GO TO 214.
Woman 1
Woman 2
OTHER 996
Woman 3
NUMBER OF HOUSEHOLD MEMBERS FOR WHICH THE LEVEL OF HEMOGLOBIN IS BELOW THE CUT-OFF POINTS: LESS THAN 7 G/DL FOR CHILDREN, FOR MEN, AND FOR WOMEN WHO ARE NOT PREGNANT (OR WHO DO NOT KNOW IF THEY ARE PREGNANT); LESS THAN 9 G/DL FOR PREGNANT WOMEN.
ONE OR MORE: GIVE EACH WOMEN, MAN, OR RESPONSIBLE ADULT THE RESULTS OF THE HEMOGLOBIN TEST. READ THE DECLARATION BELOW (Q.150) TO THESE PERSONS WITH HEMOGLOBIN LEVELS BELOW CUT-OFF POINTS.
NONE: GIVE EACH WOMAN, MAN, OR RESPONSIBLE ADULT THE RESULTS OF THE HEMOGLOBIN TEST.