Literal question
Declaration of consent for anemia and malaria 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.
Within the framework of the survey, we are also doing a survey of malaria among children under age 5. As you may know, malaria is a serious health problem that results from an exposure to mosquito bites.
This survey will assist the government to develop and set up programs to prevent and treat anemia and malaria.
We ask that all children born in 2006 or later take part in anemia and malaria testing in this survey and give a few drops of blood from a finger or heel. For this test, 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 and malaria 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 member of our survey team.
Do you have any questions?
You can say yes to the test, or you can say no. It is your decision.
611a) ASK FOR CONSENT FOR THE ANEMIA TEST FROM THE PARENT/OTHER ADULT IDENTIFIED IN 610 AS RESPONSIBLE FOR CHILD.
Request for consent for anemia test.
Will you allow (NAME(s) of child(ren)) to participate in the anemia test?
611b)
GRANTED 1- (SIGN) _________
REFUSED 2- (SIGN) ___________
