Survey Text

Bangladesh 2011 Ethiopia 2005 Madagascar 2008 Rwanda 2014
Benin 2001 Ethiopia 2011 Malawi 2004 Senegal 2005
Benin 2006 Ethiopia 2016 Malawi 2010 Senegal 2010
Benin 2011 Ghana 2003 Malawi 2016 Senegal 2017
Benin 2017 Ghana 2008 Mali 2001 South Africa 2016
Burkina Faso 2003 Ghana 2014 Mali 2006 Tanzania 2004
Burkina Faso 2010 Guinea 2005 Mali 2012 Tanzania 2010
Burundi 2016 Guinea 2012 Mali 2018 Tanzania 2015
Cameroon 2004 Guinea 2018 Mozambique 2011 Uganda 2001
Cameroon 2011 India 2005 Myanmar 2015 Uganda 2006
Cameroon 2018 India 2015 Namibia 2013 Uganda 2011
Congo (Democratic Republic) 2007 Jordan 2002 Nepal 2006 Uganda 2016
Congo (Democratic Republic) 2013 Jordan 2007 Nepal 2011 Yemen 2013
Congo Brazzaville 2005 Jordan 2009 Nepal 2016 Zambia 2018
Congo Brazzaville 2011 Jordan 2012 Niger 2006 Zimbabwe 2005
Cote d'Ivoire 2011 Jordan 2017 Niger 2012 Zimbabwe 2010
Egypt 2000 Lesotho 2004 Nigeria 2018 Zimbabwe 2015
Egypt 2005 Lesotho 2009 Rwanda 2005
Egypt 2014 Lesotho 2014 Rwanda 2008
Eswatini (Swaziland) 2006 Madagascar 2003 Rwanda 2010
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Bangladesh 2011
Survey form view entire document:  text 
222) RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET

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

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Benin 2001
Survey form view entire document:  text 
47) HEMOGLOBIN LEVEL (G/DL):

___

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Benin 2006
Survey form view entire document:  text 
527 RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (9).

G/DL ________

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Benin 2011
Survey form view entire document:  text 
240. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (11)

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Benin 2017
Survey form view entire document:  text 
216) Record hemoglobin level here and in anemia pamphlet

G/DL
Absent 994
Refused 995
Other 996

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Burkina Faso 2003
Survey form view entire document:  text 
47) HEMOGLOBIN LEVEL (G/DL):

___

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Burkina Faso 2010
Survey form view entire document:  text 
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
Survey form view entire document:  text 
122) RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA AND MALARIA PAMPHLET:

____G/DL
REFUSED 995
OTHER 996

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Cameroon 2004
Survey form view entire document:  text 
47) HEMOGLOBIN LEVEL (G/DL):

___

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Cameroon 2011
Survey form view entire document:  text 
512) RESULT CODE FOR ANEMIA TEST.

MEASURED 1
ABSENT 2
REFUSED 3
OTHER 6

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Cameroon 2018
Survey form view entire document:  text 
116) RECORD HEMOGLOBIN LEVEL HERE AND IN THE ANEMIA AND MALARIA PAMPHLET.

G/DL____.____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Congo (Democratic Republic) 2007
Survey form view entire document:  text 
527 RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (9).

G/DL ________

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Congo (Democratic Republic) 2013
Survey form view entire document:  text 
240. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (11)

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Congo Brazzaville 2005
Survey form view entire document:  text 
47) HEMOGLOBIN LEVEL:

(G/DL) _____.___

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Congo Brazzaville 2011
Survey form view entire document:  text 
212) RECORD THE HEMOGLOBIN LEVEL HERE AND ON THE ANEMIA BROCHURE.

G/DL_________
NOT PRESENT 994
REFUSED 995
OTHER 996

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Cote d'Ivoire 2011
Survey form view entire document:  text 
712) RECORD THE HEMOGLOBIN LEVEL HERE ON THE ANEMIA PAMPHLET.

G/DL______________

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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
Survey form view entire document:  text 
240. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (11)

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Eswatini (Swaziland) 2006
Survey form view entire document:  text 
535) RECORD HEMOGLOBIN LEVEL HERE AND IN ANAEMIA PAMPHLET.

G/DL______

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Ethiopia 2005
Survey form view entire document:  text 
527 RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (9).

G/DL ________

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Ethiopia 2011
Survey form view entire document:  text 
240. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (11)

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Ethiopia 2016
Survey form view entire document:  text 
231. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET.

G/DL ___
NOT PRESENT 994
REFUSED 995
OTHER 996

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Ghana 2003
Survey form view entire document:  text 
47) HEMOGLOBIN LEVEL (G/DL):

___

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Ghana 2008
Survey form view entire document:  text 
527 RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (9).

G/DL ________

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Ghana 2014
Survey form view entire document:  text 
240. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (11)

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Guinea 2005
Survey form view entire document:  text 
47. HEMOGLOBIN LEVEL (G/DL):

G/DL ______

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Guinea 2012
Survey form view entire document:  text 
240. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (11)

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Guinea 2018
Survey form view entire document:  text 
331) Record hemoglobin level here and in anemia pamphlet

G/DL
ABSENT 994
REFUSED 995
OTHER 996

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India 2005
Survey form view entire document:  text 
80. READ CONSENT STATEMENT FOR HIV TESTING TO (WO)MAN/PARENT/RESPONSIBLE ADULT. CIRCLE CODE (AND SIGN)
[ASK FOR WOMEN AND MEN ONLY]

GRANTED 1 (SIGN) ________
REFUSED 2 (SIGN) ________

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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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47. HEMOGLOBIN LEVEL (G/DL)

___.__

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Jordan 2007
Survey form view entire document:  text 
226) RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET

G/DL_____

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Jordan 2009
Survey form view entire document:  text 
226) RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET

G/DL .___._

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Jordan 2012
Survey form view entire document:  text 
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
Survey form view entire document:  text 
231) RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET.

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

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Lesotho 2004
Survey form view entire document:  text 
47) HEMOGLOBIN LEVEL (G/DL):

___

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Lesotho 2009
Survey form view entire document:  text 
227 RECORD HAEMOGLOBIN LEVEL HERE AND IN ANAEMIA PAMPHLET

G/DL ___ ___.___

NOT PRESENT 994
REFUSED 995
OTHER 996

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Lesotho 2014
Survey form view entire document:  text 
240) RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET

G/DL____

REFUSED 995
OTHER 996

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Madagascar 2003
Survey form view entire document:  text 
116. RECORD LEVEL OF HEMOGLOBIN

HEMOGLOBIN LEVEL _______

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

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Madagascar 2008
Survey form view entire document:  text 
527 RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (9).

G/DL ________

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Malawi 2004
Survey form view entire document:  text 
1107. HEMOGLOBIN LEVEL (G/DL):

LEVEL___.___

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Malawi 2010
Survey form view entire document:  text 
527. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET

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

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Malawi 2016
Survey form view entire document:  text 
231. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET.

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

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Mali 2001
Survey form view entire document:  text 
47. HEMOGLOBIN LEVEL (G/DL):

G/DL _____

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Mali 2006
Survey form view entire document:  text 
47. HEMOGLOBIN LEVEL (G/DL)

___

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Mali 2012
Survey form view entire document:  text 
240. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (11)

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Mali 2018
Survey form view entire document:  text 
231) RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET

G/DL
ABSENT 994
REFUSED 995
OTHER 996

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Mozambique 2011
Survey form view entire document:  text 
240. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (11)

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Myanmar 2015
Survey form view entire document:  text 
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
Survey form view entire document:  text 
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
Survey form view entire document:  text 
227. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET.

G/DL ___. ___

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Nepal 2011
Survey form view entire document:  text 
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
Survey form view entire document:  text 
113. RECORD HEMOGLOBIN LEVEL HERE AND IN THE ANEMIA.

G/DL __. __
REFUSED 995
OTHER 996

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Niger 2006
Survey form view entire document:  text 
527 RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (9).

G/DL ________

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Niger 2012
Survey form view entire document:  text 
240. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (11)

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Nigeria 2018
Survey form view entire document:  text 
231. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET.

Woman 1

G/DL _____
NOT PRESENT 994
REFUSED 995
OTHER 996

Woman 2

G/DL _____
NOT PRESENT 994
REFUSED 995

OTHER 996

Woman 3

G/DL _____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Rwanda 2005
Survey form view entire document:  text 
542 RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (9).

G/DL ________

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Rwanda 2008
Survey form view entire document:  text 
138) HEMOGLOBIN LEVEL (G/DL) ______ . ____

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Rwanda 2010
Survey form view entire document:  text 
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
Survey form view entire document:  text 
211) RECORD HEMOGLOBIN LEVEL HERE AND IN THE ANEMIA PAMPHLET.

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

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Senegal 2005
Survey form view entire document:  text 
47) HEMOGLOBIN LEVEL (G/DL):

___

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Senegal 2010
Survey form view entire document:  text 
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
Survey form view entire document:  text 
210) Ask for consent for anemia test.

As part of this survey, we are asking people all over the country to take an anemia test. 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.

For the anemia testing, we will need a few drops of blood from a finger. The equipment used to take the blood is clean and completely safe. It has never been used before and will be thrown away after each test. The blood will be tested for anemia immediately, and the result will be told to you right away. The result will be kept strictly confidential and will not be shared with anyone other than members of our survey team.

Do you have any questions?
You can say yes to the test, or you can say no. It is up to you to decide.

Will you take the anemia test?


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South Africa 2016
Survey form view entire document:  text 
113) RECORD HAEMOGLOBIN LEVEL HERE AND IN THE CHILD HEALTH INFORMATIONAL BROCHURE.

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

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Tanzania 2004
Survey form view entire document:  text 
47) HEMOGLOBIN LEVEL (G/DL):

G/DL_____

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Tanzania 2010
Survey form view entire document:  text 
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
Survey form view entire document:  text 
231. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET.

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

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Uganda 2001
Survey form view entire document:  text 
47) HEMOGLOBIN LEVEL (G/DL):

___

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Uganda 2006
Survey form view entire document:  text 
527 RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET (9).

G/DL ________

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Uganda 2011
Survey form view entire document:  text 
238) RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPLET

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

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Uganda 2016
Survey form view entire document:  text 
113) RECORD HEMOGLOBIN LEVEL HERE AND IN THE ANEMIA AND MALARIA PAMPHLET.

G/DL___
NOT PRESENT 994
REFUSED 995
OTHER 996

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Yemen 2013
Survey form view entire document:  text 
227) RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET

G/DL ____
NOT PRESENT 994
REFUSED 995
OTHER 996

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Zambia 2018
Survey form view entire document:  text 
241. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET.

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

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Zimbabwe 2005
Survey form view entire document:  text 
1321) RECORD HEMOGLOBIN LEVEL

G/DL ___

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Zimbabwe 2010
Survey form view entire document:  text 
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
Survey form view entire document:  text 
231. RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPHLET.

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