1 |
Prescreening Number |
2 |
Initial of the child |
3 |
Date (according to English
calendar- DDMMYY) |
4 |
Researcher code |
5 |
Date of birth (if known), (English calendar-DDMMYY) |
6 |
Age of child (in months) |
7 |
Sex of child (1=Male, 2=Female) |
8 |
Are there any plans to migrate
within one year? |
9 |
Does the child have any acute
illness? |
10 |
Does the child have any chronic
illness? |
11 |
Does the child taking any
multivitamins that include vitamin B12 in the last one month? |
12 |
Length (in cm) |
13 |
Length for age <-1 z score |
14 |
Is the child eligible to enroll
in the study? |
15 |
If the child enrolled in the study, write CHENO |
15_txt |
If the child is not enrolled,
Specify….. |
|
|