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Microsoft Word - AMICS-29Jan2013 - Childinfo.org

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UNDER-FIVE CHILD SELECTED FOR BLOOD TEST<br />

This questionnaire is to be administered to children under five who are selected for blood test<br />

SCU<br />

SCU1. Cluster number:<br />

SCU2. Household number:<br />

___ ___ ___<br />

___ ___<br />

SCU3. Child s line number:<br />

SCU4. Interviewer name and number:<br />

___ ___ Name ___ ___<br />

SCU5. May I take blood from the child?<br />

SCU6: Have you taken sufficient blood?<br />

SCU7: Results of the haemoglobin level<br />

No ................................................................ 1<br />

Yes ............................................................. 2<br />

No ................................................................ 1<br />

Yes ............................................................. 2<br />

__ __ . __ (g/dl)<br />

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