Survey Text

Bangladesh 2011 Ethiopia 2016 Madagascar 2008 Rwanda 2014
Benin 2001 Ghana 2003 Malawi 2004 Senegal 2005
Benin 2006 Ghana 2008 Malawi 2010 Senegal 2010
Benin 2011 Ghana 2014 Malawi 2016 Senegal 2017
Burkina Faso 2003 Guinea 2005 Mali 2001 South Africa 2016
Burkina Faso 2010 Guinea 2012 Mali 2006 Tanzania 2004
Burundi 2016 India 2005 Mali 2012 Tanzania 2010
Cameroon 2004 India 2015 Mozambique 2011 Tanzania 2015
Cameroon 2011 Jordan 2002 Myanmar 2015 Uganda 2001
Congo (Democratic Republic) 2007 Jordan 2007 Namibia 2013 Uganda 2006
Congo (Democratic Republic) 2013 Jordan 2009 Nepal 2006 Uganda 2011
Cote d'Ivoire 2011 Jordan 2012 Nepal 2011 Uganda 2016
Egypt 2000 Jordan 2017 Nepal 2016 Yemen 2013
Egypt 2005 Lesotho 2004 Niger 2006 Zimbabwe 2005
Egypt 2014 Lesotho 2009 Niger 2012 Zimbabwe 2010
Ethiopia 2005 Lesotho 2014 Rwanda 2005 Zimbabwe 2015
Ethiopia 2011 Madagascar 2003 Rwanda 2010
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Bangladesh 2011
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222) RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET

G/DL _______.______
NOT PRESENT 994
REFUSED 995
OTHER 996

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Benin 2001
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50) CHECK 5, 47 AND 48:
NUMBER OF PERSONS WITH HEMOGLOBIN LEVEL BELOW THE CUTOFF POINT* **

ONE OR MORE (GIVE EACH WOMAN/PARENT/RESPONSIBLE ADULT RESULT OF HEMOGLOBIN MEASUREMENT AND CONTINUE WITH Q. 51)

NONE (GIVE EACH WOMAN/PARENT/RESPONSIBLE ADULT RESULT OF HEMOGLOBIN MEASUREMENT AND END HOUSEHOLD INTERVIEW)

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Benin 2006
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50) CHECK 47 AND 48:
NUMBER OF USUAL RESIDENTS WHOSE HEMOGLOBIN LEVEL IS LOWER THAN THE BASE CRITERIA. *

ONE OR MORE (GIVE EACH WOMAN/PARENT/RESPONSIBLE ADULT THE RESULT OF THE HEMOGLOBIN TEST AND CONTINUE WITH QUESTION 51. **)
NONE (GIVE EACH WOMAN/PARENT/RESPONSIBLE ADULT THE RESULT OF THE HEMOGLOBIN TEST AND END THE HOUSEHOLD SURVEY.)

*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.


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Benin 2011
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240. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (11)

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Burkina Faso 2003
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47) HEMOGLOBIN LEVEL (G/DL):

___

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Burkina Faso 2010
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240. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (11)

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Burundi 2016
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231) RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET:

_____G/DL
ABSENT 994
REFUSED 995
OTHER 996

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Cameroon 2004
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47) HEMOGLOBIN LEVEL (G/DL):

___

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Cameroon 2011
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511) NOTE HEMOGLOBIN HERE AND ON THE BROCHURE ON ANEMIA.

G/DL: ___

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Congo (Democratic Republic) 2007
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527 RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (9).

G/DL ________

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Congo (Democratic Republic) 2013
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240. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (11)

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Cote d'Ivoire 2011
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713) RESULT CODE FOR ANEMIA TEST

MEASURED 1
ABSENT 2
REFUSED 3
OTHER 6

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Egypt 2000
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063) HEMOGLOBIN (G/DL)

______

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Egypt 2005
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HEMOGLOBIN MEASUREMENT OF CHILDREN AGE 0- 5 YEARS

LINE NO. FROM 201 __ __

209) NAME
CHECK COLUMN (202):

_________________________

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Egypt 2014
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240. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (11)

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Ethiopia 2005
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527 RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (9).

G/DL ________

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Ethiopia 2011
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MINIMUM HEMOGLOBIN LEVELS FOR ANEMIA

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:

ALTITUDE: LESS THAN 1000 M
SEVERE: LESS THAN 7.0 g/dl
MODERATE: 7.0-9.9
MILD (NON-PREGNANT): 10.0-11.9
MILD (PREGNANT): 10.0-10.9
NOT ANEMIC (NON-PREGNANT): 12.0 OR GREATER
NOT ANEMIC (PREGNANT): 11.0 OR GREATER
ALTITUDE: 1000 M - 1499 M
SEVERE: LESS THAN 7.2 g/dl
MODERATE: 7.2-10.1
MILD (NON-PREGNANT): 10.2-12.1
MILD (PREGNANT): 10.2-11.1
NOT ANEMIC (NON-PREGNANT): 12.2 OR GREATER
NOT ANEMIC (PREGNANT): 11.2 OR GREATER
ALTITUDE: 1500 M - 1999 M
SEVERE: LESS THAN 7.5 g/dl
MODERATE: 7.5-10.4
MILD (NON-PREGNANT): 10.5-12.4
MILD (PREGNANT): 10.5-11.4
NOT ANEMIC (NON-PREGNANT): 12.5 OR GREATER
NOT ANEMIC (PREGNANT): 11.5 OR GREATER
ALTITUDE: 2000 M - 2499 M
SEVERE: LESS THAN 7.8 g/dl
MODERATE: 7.8-10.7
MILD (NON-PREGNANT): 10.8-12.7
MILD (PREGNANT): 10.8-11.7
NOT ANEMIC (NON-PREGNANT): 12.8 OR GREATER
NOT ANEMIC (PREGNANT): 11.8 OR GREATER
ALTITUDE: 2500 M - 2999 M
SEVERE: LESS THAN 8.3 g/dl
MODERATE: 8.3-11.2
MILD (NON-PREGNANT): 11.3-13.2
MILD (PREGNANT): 11.3-12.2
NOT ANEMIC (NON-PREGNANT): 13.3 OR GREATER
NOT ANEMIC (PREGNANT): 12.3 OR GREATER
ALTITUDE: 3000 M - 3499 M
SEVERE: LESS THAN 8.9 g/dl
MODERATE: 8.9-11.8
MILD (NON-PREGNANT): 11.9-13.8
MILD (PREGNANT): 11.9-12.8
NOT ANEMIC (NON-PREGNANT): 13.9 OR GREATER
NOT ANEMIC (PREGNANT): 12.9 OR GREATER
ALTITUDE: 3500 M - 3999 M
SEVERE: LESS THAN 9.7 g/dl
MODERATE: 9.7-12.6
MILD (NON-PREGNANT): 12.7-14.6
MILD (PREGNANT): 12.7-13.6
NOT ANEMIC (NON-PREGNANT): 14.7 OR GREATER
NOT ANEMIC (PREGNANT): 13.7 OR GREATER

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Ethiopia 2016
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231. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET.

G/DL ___
NOT PRESENT 994
REFUSED 995
OTHER 996

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Ghana 2003
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47) HEMOGLOBIN LEVEL (G/DL):

___

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Ghana 2008
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527 RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (9).

G/DL ________

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Ghana 2014

No questionnaire text is available for this sample.


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Guinea 2005
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47. HEMOGLOBIN LEVEL (G/DL):

G/DL ______

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Guinea 2012
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240. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (11)

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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India 2005
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SECTION 4. PREGNANCY AND POSTNATAL CARE

401 CHECK 224:

ONE OR MORE BIRTHS IN 2001 (1) OR LATER (GO TO 402)
NO BIRTHS IN 2001 (1) OR LATER (GO TO 576)

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India 2015
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368) RECORD HAEMOGLOBIN LEVEL HERE AND IN ANAEMIA PAMPHLET.

G/DL____
REFUSED 995
OTHER 996
NOT TESTED 998

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Jordan 2002
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50. CHECK 47 AND 48: NUMBER OF PERSONS WITH HEMOGLOBIN LEVEL BELOW THE CUTOFF POINT

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.)


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Jordan 2007
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226) RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET

G/DL_____

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Jordan 2009
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226) RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET

G/DL .___._

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Jordan 2012
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212. RECORD HEMOGLOBIN LEVEL HERE AND IN THE ANEMIA PAMPHLET

G/DL ___.__

NOT PRESENT 994
REFUSED 995
OTHER 996

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Jordan 2017
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231) RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET.

G/DL ___._
NOT PRESENT 994
REFUSED 995
OTHER 996

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Lesotho 2004
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47) HEMOGLOBIN LEVEL (G/DL):

___

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Lesotho 2009
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240. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (11)

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Lesotho 2014
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240) RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET

G/DL____

REFUSED 995
OTHER 996

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Madagascar 2003
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116. RECORD LEVEL OF HEMOGLOBIN

HEMOGLOBIN LEVEL _______

NOT MEASURED 996 (GO TO 121)
(SPECIFY) _______

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Madagascar 2008
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527 RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (9).

G/DL ________

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Malawi 2004
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1107. HEMOGLOBIN LEVEL (G/DL):

LEVEL___.___

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Malawi 2010
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527. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET

G/DL ___.___
NOT PRESENT 994
REFUSED 995
OTHER 996

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Malawi 2016

No questionnaire text is available for this sample.


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Mali 2001
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51) We detected a low level of hemoglobin in (your blood/the blood of NAME OF CHILD(REN)). This indicates that (you/NAME OF CHILD(REN)) have developed severe anemia, which is a serious health problem. We would like to inform the doctor at ______ about (your condition/the condition of NAME OF CHILD(REN)). This will assist you in obtaining appropriate treatment for the condition. Do you agree that the information about the level of hemoglobin in (your blood/the blood of NAME OF CHILD(REN)) may be given to the doctor?

NAME OF PERSON WITH HEMOGLOBIN BELOW THE CUTOFF POINT:

______

NAME OF PARENT/RESPONSIBLE ADULT:
(SKIP FOR WOMEN AGE 18-49)

_____

AGREES TO REFERRAL?

YES 1
NO 2

*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).


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Mali 2006
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Note: In the countries or certain survey zones at an altitude of more than 1,000 meters, information on the altitude must be collected for each zone with an altitude of more than 1,000 meters so that estimates of anemia levels can be adjusted appropriately.

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)

ONE OR MORE__
GIVE THE TEST HEMOGLOBIN RESULTS TO EACH WOMAN/PARENT/RESPONSIBLE ADULT, (GO TO 51)
If there is more than one woman or child who is below the critical threshold, read the statement in Q. 51 to each woman who is below the critical threshold and to each woman/parent/responsible adult of a child who is below the critical threshold.
NONE__
GIVE THE HEMOGLOBIN TEST RESULTS TO THE
WOMAN/PARENT/RESPONSIBLE ADULT AND FILL OUT THE HIV SHEET.

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Mali 2012
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240. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (11)

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Mozambique 2011

No questionnaire text is available for this sample.


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Myanmar 2015
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212) RECORD HEMOGLOBIN LEVEL HERE AND IN THE ANEMIA PAMPHLET.

G/DL____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Namibia 2013
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240. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (11)

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Nepal 2006
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227. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET.

G/DL ___. ___

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Nepal 2011
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212) RECORD HEMOGLOBIN LEVEL HERE AND IN THE ANEMIA PAMPHLET.

G/DL ____.__
NOT PRESENT 994
REFUSED 995
OTHER 996

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.


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Nepal 2016
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113. RECORD HEMOGLOBIN LEVEL HERE AND IN THE ANEMIA.

G/DL __. __
REFUSED 995
OTHER 996

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Niger 2006
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527 RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (9).

G/DL ________

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Niger 2012
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240. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (11)

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Rwanda 2005
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542 RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (9).

G/DL ________

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Rwanda 2010
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240. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (11)

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Rwanda 2014

No questionnaire text is available for this sample.


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Senegal 2005
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47) HEMOGLOBIN LEVEL (G/DL):

___

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Senegal 2010
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240. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (11)

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Senegal 2017
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231) RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET

G/DL
ABSENT 994
REFUSED 995
OTHER 996

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South Africa 2016

No questionnaire text is available for this sample.


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Tanzania 2004
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47) HEMOGLOBIN LEVEL (G/DL):

G/DL_____

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Tanzania 2010
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240. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (11)

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Tanzania 2015

No questionnaire text is available for this sample.


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Uganda 2001
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47) HEMOGLOBIN LEVEL (G/DL):

___

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Uganda 2006
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527 RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (9).

G/DL ________

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Uganda 2011
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238) RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPLET

G/DL __ __ . __
NOT PRESENT 994
REFUSED 995
OTHER 996

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Uganda 2016
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231) RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET.

G/DL_____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Yemen 2013
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227) RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Zimbabwe 2005
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1321) RECORD HEMOGLOBIN LEVEL

G/DL ___

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Zimbabwe 2010
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240. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (11)

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Zimbabwe 2015

No questionnaire text is available for this sample.