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Afghanistan Mortality Survey 2010 - Measure DHS

Afghanistan Mortality Survey 2010 - Measure DHS

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Introduction and ConsentHello. My name is______________________and I am working with the Ministry of Public Health.We are conducting a survey about health all over <strong>Afghanistan</strong>.Your household was selected for the survey. The questions usually take about 30 to 45 minutes.We are collecting information on the causes of death in the community. This information will help the government to plan health services.We would very much appreciate your participation in this survey. We learned during our earlier visit that (NAME) had died recently.As part of the survey we want to ask you about the circumstances leading to the death of the deceased. Whatever information youprovide wil be kept strictly confidential. No information identifying you or the deceased will ever be released to anyone outside of thissurvey.Participation in this survey is voluntary and if we should come to any question you don't want to answer, just let me know and I will go onto the next question; or you can stop the interview at any time. However, we hope that you will participate in this survey since your answerswill help the government improve health services for Afghans.At this time, do you want to ask me anything about the survey?May I begin the interview now?Signature of interviewer:Date:RESPONDENT AGREES TO BE INTERVIEWED 1 RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 END234 | Appendix F

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