| Variables in SCREENING FORM (SCR) | ||||
| Question# | Question | Field name | Responses nature | Response options |
| 1 | Screening Number | scr_1 | ### | |
| 2 | Initials of the pregnant mother’s name | scr_2 | XX | |
| 3 | Date
of interview (according to English calendar) |
scr_3 | ##-XXX-## | dd-mmm-yy |
| 4 | Researcher code | scr_4 | ## | |
| 5 | Age
of pregnant mother (completed years) |
scr_5 | ## | |
| 6 | Date
of Last Menstruation Period (LMP) (according to English calendar) |
scr_6 | ##-XXX-## | dd-mmm-yy (99/999/99 if not known) |
| 7 | Gestation of pregnancy by LMP (weeks) | scr_7 | ## | |
| 8 | Gestation
of pregnancy according to USG report (weeks) |
scr_8 | ## | |
| 9 | Date
of USG scanning (according to English calender) |
scr_8.i | ##-XXX-## | dd-mmm-yy (99/999/99 if not known) |
| Evaluation for inclusion in the study (Code: 1=Yes, 2=No, 9=Not applicable). The pregnant mother is eligible to participate in the study if following answers are YES (code 1) | ||||
| 10 | Pregnant mother’s age between 20 to 40 years? | scr_9 | # | 1=Yes, 2=No |
| 11 | Pregnancy <15 weeks of gestation? | scr_10 | # | 1=Yes, 2=No |
| 12 | Pregnant mother plans to live in the study area for the next 2 years? | scr_11 | # | 1=Yes, 2=No |
| 13 | Pregnant mother/family consented for participation in the study? | scr_12 | # | 1=Yes, 2=No, 9= Not applicable |
| Evaluation for exclusion (Code: 1=Yes, 2=No, 9=Not applicable). The pregnant mother is eligible to participate in the study if following answers are NO (code 2) | ||||
| 14 | Any acute illness (eg fever, diarrhea/ vomiting, acute respiratory infection etc) ? | scr_13 | # | 1=Yes, 2=No |
| 15 | Any chronic illness / under any medication now (eg Hypertension, HIV, Tuberculosis, Diabetes, Thyroid disorder, Epilepsy, Chronic diarrhea etc)? | scr_14 | # | 1=Yes, 2=No |
| 16 | If yes, specify. | scr_14 txt | TXT | TEXT
if scr_14=1 NA if scr_14=2 |
| 17 | H/O pregnancy complications like recurrent abortion? | scr_15 | # | 1=Yes, 2=No |
| 18 | Suffering from any condition that requires treatment with vitamin B12? | scr_16 | 3 | 1=Yes, 2=No |
| 19 | Taking or planning to take multivitamins that include vitamin B12? | scr_17 | 3 | 1=Yes, 2=No |
| 20 | If yes, specify reason. | scr_17 txt | TXT | TEXT
if scr_14=1 NA if scr_14=2 |
| 21 | Any problem on clinical examination? | scr_18 | # | 1=Yes, 2=No, 9= Not applicable |
| 22 | If yes, specify. | scr_18 txt | TXT | TEXT
if scr_14=1 NA if scr_14=2 |
| 23 | Is current pregnancy a high risk? | scr_19 | # | 1=Yes, 2=No, 9= Not applicable |
| 24 | If yes specify. | scr_19 txt | TXT | TEXT
if scr_14=1 NA if scr_14=2 |
| 25 | Is hemoglobin level <7 g/dl or any other abnormal findings on blood test? | scr_20 | # | 1=Yes,
2=No, 9= Not applicable if no lab report |
| 26 | Mid upper arm circumference (MUAC) (cm)? | scr_21 | ##.# | ##.#
if measured 99.9 if not measured |
| 27 | Height of pregnant mother (cm) | scr_21_a | ###.# | ###.#
if measured 99.9 if not measured |
| 28 | Weight of pregnant mother (kgs) | scr_21_b | ##.## | ##.##
if measured 99.9 if not measured |
| 29 | Is BMI (weight/height2) <18.5 or >30 Or MUAC <21cm? | scr_21_c | # | 1=Yes,
2=No, 9= Not applicable if scr_21_a and scr_21_b are not measured |
| 30 | Participant Identification Number (As on the packet with supplement.) | scr_22 | ### | ###
if eligible to participate and given participation number 999 if ineligible to participate |
| 31 | Remarks | TXT | ||