Literal question
111. CONSENT STATEMENT FOR ANEMIA TEST FOR CHILDREN AGE 0-5 YEARS:
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 in developing programs to prevent and treat anemia.
We request that all children born in 2003 or later participate in the anemia testing part of this survey and give a few drops of blood from a finger. The equipment used in taking 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 told to you right away. The result is confidential.
Do you have any questions?
You can say 'Yes' to the test, or you can say 'No'. It is your decision.
Will you allow (NAME(S) OF CHILD(REN)) to participate in the anemia test?
CIRCLE THE APPROPRIATE CODE IN 111A AND SIGN.