Standard Operating Procedure for POP Sampling in Breast Milk

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Standard Operating Procedure for POP Sampling in Breast Milk Page 15 of 20 10. Annex 6: Questionnaire For donors of breast milk for the analysis of Persistent Organic Pollutants CONFIDENTIAL! Questionnaire 1. Country: 2. Area (city or region within the country): 3. Identification code of composite sample: XXXXXXX ZZ-XX 4. Sample identification code: 5. Start and end of extraction 6. Date of mother’s birth: ZZ-XX___ From: DD/MM/YY To: DD/MM/YY DD/MM/YY 7. Mother’s age in years: 8. Mother’s height in cm: 9. Mother’s weight before pregnancy in kg 10. Mother’s current weight in kg: 11. Area of residence in the last 10 years: Urban Rural 12. Previous area of residence: Years urban rural And earlier Years urban rural 13. Child’s age in weeks at start of sampling: 14. Child’s sex: Boy 15. Child’s birthweight in grams: 16. Child’s weight at sampling in grams First day: Girl en Last day:
Standard Operating Procedure for POP Sampling in Breast Milk Page 16 of 20 17. Mother’s feeding habits before pregnancy: Varied diet Vegetarian, but includes milk and eggs Only vegetarian Others Description: _________________________________________ 18. Has the mother changed her feeding habits significantly Yes No since she got pregnant If yes, describe how:___________________________________________________________ ___________________________________________________________________________________ 19. How often (as an average) did the mother consume fish during pregnancy Never Less than once a week Once a week Twice a week More than twice a week Every day Describe the species more frequently consumed by the mother: ___________________________________________________________________________________ ____________________________________________________________________________________ 20. How often (as an average) did the mother consume sea food during pregnancy Never Less than once a week Once a week Twice a week More than twice a week Every day Describe the species more frequently consumed by the mother: _______________________________________________________________________________ _______________________________________________________________________________
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Standard Operating Procedure for POP Sampling in Breast Milk

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