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Appendix 2: Questionnaire for enrolling the children<br />

9C Ar.gr13r<br />

Itt JursrtRs ltrLt w nREllr@ .Irf aIRIcr @r:rDElfcE.<br />

trttrE <strong>of</strong> ciltd.<br />

Drte <strong>of</strong> bl,rth <strong>of</strong> child.<br />

ltacloaall,Cy... ,.......o. r.......<br />

w/drRl'<br />

IIas he/she lrad a col.d or chest infection in tfte lasc month? tE8./TO<br />

Ilas fie./she evet iad astlrCIa? tt lraercltc .tlr tlrrt dtrgraroct.. W9|TO<br />

Does Jre./slre have asthna non? YE$/XO<br />

Ilas ie./slra ever wheezed?(a& r r.trjrtllng touact oa Draetlrtng out) W9/tW<br />

ooes ielslre cough. . . lrgvER. . . sodBgr.tE$. . . om8F. . . coilSmilrur.<br />

Has he./she ever been prescribed 9entolin or BricanyJ?<br />

If lcrrxbcn?.. ...,<br />

Itas he/she ever had eczena?<br />

ffas helshe ersr had ftay fcver?<br />

Docs he/shc have eczena/hayfevet no*?<br />

Oocs he./s[e have any other cfiest cotplalnt? prc.lsa n rrc......<br />

Does anyone eJse jn the .faniy harre any <strong>of</strong> tie followittg:<br />

aschnd Y$S/XO if yes uho?,, a . . , ,<br />

ecsenr VES/NO lt yes who?.......<br />

iayfever ws/No tf yes nha?.<br />

tlrrr glvr r.Ltl'orrtlp tc tb cl.tll<br />

Do you have any pets? Jf pr plcrsc n nc cJar.<br />

Does anyone in the family snoke?.<br />

wslTo<br />

YE9/TO<br />

t:Es/fro<br />

t]3g/xO<br />

rc8/NO<br />

Note: the spelling error noted in the heading <strong>of</strong> these sheets was only noted after we had delivered<br />

most <strong>of</strong> the questionnaires to the participating school - in view <strong>of</strong> that and as this how most <strong>of</strong> the<br />

collected forms remain - | have left it in.<br />

272

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