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Swaziland 2007 - (NERCHA), the Info Centre - National Emergency ...

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WEIGHT, HEIGHT, HAEMOGLOBIN MEASUREMENT AND HIV TESTING FOR MEN AGE 12 AND OLDER543 CHECK COVER:HOUSEHOLD NOT SELECTED FOR YOUTHHOUSEHOLD SELECTED FOR YOUTHRECORD LINE NUMBER, AGE, AND NAMERECORD LINE NUMBER, AGE, AND NAMEOF ALL MEN AGE 15-49OF ALL MEN AGE 12 AND OLDER(SEE COLUMNS 2, 7 AND 10) (SEE COLUMNS 2, 7, 10, 11, AND 13)IF THERE ARE MORE THAN SIX MEN, USE ADDITIONAL QUESTIONNAIRE(S).A FINAL OUTCOME FOR THE HEIGHT AND WEIGHT MUST BE RECORDED IN 547, FOR THE ANAEMIA TEST PROCEDUREMUST BE RECORDED IN 554 AND FOR THE HIV TEST PROCEDURE IN 556 FOR EACH ELIGIBLE MAN EVEN IF HE WASNOT PRESENT, REFUSED, OR COULD NOT BE TESTED FOR SOME OTHER REASON.MAN 1 MAN 2 MAN 3544 LINE NUMBER LINE LINE LINE(COLUMNS 10 AND 11) NUMBER . . . . . . . . . NUMBER . . . . . . . . . NUMBER . . . . . . . . .NAME(COLUMN 2) NAME NAME NAMEAGE(COLUMN 7) AGE IN YEARS . . . . . . . AGE IN YEARS . . . . . . . AGE IN YEARS . . . . . . .545 WEIGHTIN KILOGRAMS KG. . . . . . . . . KG. . . . . . . KG. . . . . . .546 HEIGHTIN CENTIMETRES CM. . . . . . . . . CM. . . . . . . CM. . . . . . .547 RESULT OF MEASURED . . . . . . . . . . . . . . . . . . 1 MEASURED . . . . . . . . . . . . . . . . . . 1 MEASURED . . . . . . . . . . . . . . . . . . 1WEIGHT NOT PRESENT . . . . . . . . . . . . . . . . 2 NOT PRESENT . . . . . . . . . . . . . . . . 2 NOT PRESENT . . . . . . . . . . . . . . . . 2AND HEIGHT REFUSED . . . . . . . . . . . . . . . . . . . . 3 REFUSED . . . . . . . . . . . . . . . . . . . . 3 REFUSED . . . . . . . . . . . . . . . . . . . . 3MEASUREMENT OTHER . . . . . . . . . . . . . . . . . . . . . . 6 OTHER . . . . . . . . . . . . . . . . . . . . . . 6 OTHER . . . . . . . . . . . . . . . . . . . . . . 6548 CHECK 544: AGE 12-14 YEARS . . . . . . . 1 550 12-14 YEARS . . . . . . . 1 550 12-14 YEARS . . . . . . . 115-17 YEARS . . . . . . . 2 15-17 YEARS . . . . . . . 2 15-17 YEARS . . . . . . . 218 + YEARS . . . . . . . 3 551 18 + YEARS . . . . . . . 3 551 18 + YEARS . . . . . . . 3550551549 CHECK COLUMN 8: CODE 4 (NEVER IN UNION) . . . 1 CODE 4 (NEVER IN UNION) . . . 1 CODE 4 (NEVER IN UNION) . . . 1MARITAL STATUS OTHER . . . . . . . . . . . . . . . . . . . . 2 OTHER . . . . . . . . . . . . . . . . . . . . 2 OTHER . . . . . . . . . . . . . . . . . . . . 2(GO TO 551) (GO TO 551) (GO TO 551)550 RECORD LINENUMBER OFPARENT/OTHERADULT RESPON-SIBLE FOR LINE NUMBER OF LINE NUMBER OF LINE NUMBER OFADOLESCENT. PARENT OR OTHER PARENT OR OTHER PARENT OR OTHERRECORD '00' RESPONSIBLE ADULT . RESPONSIBLE ADULT . RESPONSIBLE ADULT .IF NOT LISTED.551 READ ANAEMIA GRANTED . . . . . . . . . . . . . . . . . . 1 GRANTED . . . . . . . . . . . . . . . . . . 1 GRANTED . . . . . . . . . . . . . . . . . . 1TEST CONSENTSTATEMENT. FOR PARENT/OTHER RESPONSIBLE PARENT/OTHER RESPONSIBLE PARENT/OTHER RESPONSIBLEBOYS AGE 12-14 ADULT REFUSED . . . . . . . . . . . 2 ADULT REFUSED . . . . . . . . . . . 2 ADULT REFUSED . . . . . . . . . . . 2AND NEVER-INUNION MEN AGE RESPONDENT RESPONDENT RESPONDENT15-17, ASK REFUSED . . . . . . . . . . . . . . . . . . 3 REFUSED . . . . . . . . . . . . . . . . . . 3 REFUSED . . . . . . . . . . . . . . . . . . 3CONSENT FROMPARENT/OTHERADULT IDENTIFIED (SIGN) (SIGN) (SIGN)IN 550 BEFOREASKING RESPON-DENT'S CONSENT.(IF CODE '2' OR '3' CIRCLED,CIRCLE '3' IN 554)(IF CODE '2' OR '3' CIRCLED,CIRCLE '3' IN 554)(IF CODE '2' OR '3' CIRCLED,CIRCLE '3' IN 554)CONSENT STATEMENT FOR ANAEMIA TEST FROM MEN AGE 15 AND OLDERREAD CONSENT STATEMENT TO EACH RESPONDENT. CIRCLE CODE '1' IN 551 IF RESPONDENT CONSENTS TO THE ANAEMIA TEST ANDCODE '3' IF HE REFUSES.FOR BOYS AGE 12-14 AND NEVER-IN-UNION MEN AGE 15-17, ASK CONSENT FROM THE PARENT OR OTHER ADULT IDENTIFIED AS RESPONSIBLEFOR THE ADOLESCENT (SEE QUESTION 550) BEFORE ASKING THE ADOLESCENT FOR HIS CONSENT. CIRCLE CODE '2' IN 551 IF THE PARENT(OTHER ADULT) REFUSES. CONDUCT THE TEST ONLY IF BOTH THE PARENT (OTHER ADULT) AND THE ADOLESCENT CONSENT.As part of this survey, we are asking people all over the country to take an anaemia test. Anaemia is a serious health problem that usually results frompoor nutrition, infection, or chronic disease. This survey will assist the government to develop programs to prevent and treat anaemia.For the anaemia testing, we will need 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 anaemia immediately, and the result told to you right away. The result will be kept confidential.Do you have any questions?You can say yes to the test, or you can say no. It is up to you to decide.Will you (allow NAME OF ADOLESCENT to) take the anaemia test?362 | Appendix F

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