REGION______
HEALTH DISTRICT ______
DISTRICT MUNICIPALITY/RURAL COMMUNITY ______
CLUSTER NUMBER ______
NAME OF HEAD OF CONCESSION ______
NAME OF HEAD OF HOUSEHOLD ______
HOUSEHOLD NUMBER IN SAMPLE ______
NAME OF LOCALITY (DISTRICT MUNICIPALITY IN DAKAR, MUNICIPALITY, RURAL COMMUNITY) ______
URBAN/RURAL (URBAN = 1, RURAL = 2) ENVIRONMENT ______
DAKAR/REGIONAL CAPITAL/OTHER CITY/RURAL
(DAKAR = 1, REGIONAL CAPITAL = 2, OTHER CITY = 3, RURAL = 4) DETAILED ENVIRONMENT ______
NAME AND LINE NUMBER OF WOMAN ______
HOUSEHOLD SAMPLE (OF THE 30 IN CLUSTER)? (YES = 1, NO = 2) ______
HOUSEHOLD CHOSEN FOR ANEMIA/MALARIA TEST? (YES = 1, NO = 2) ______