Image row (pixels)
7.3 BIOLOGICAL BASIS
The poor frequency of exercise can be attributed to the high percentage of overweight lactating women. Also, proportion of the lactating mothers (49.0%) engaged in walking type of exercise and (41.0%) took part in gardening. Most them were either involved in trading or working and as such might not have the time for other form of activities.
LIBRARY
CONCLUSIONS AND RECOMMENDATIONS Conclusions
This study was set out to assess the dietary iron intake and the nutritional status of lactating mothers. The findings in this study reveal that fruits and vegetables consumed by the mothers are high while legumes and nuts are low. The major sources of iron are food in meat and fish. The highest consumption of iron are among those with high income, education and wealth quintile. It also identified that majority of the lactating mothers are either overweight or obese. The cooking energy source is a major determinant of nutritional status of mothers.
Recommendations:
Based on the findings from this study it can be recommended that:
1. There is a need for the lactating mothers to have a common understanding of exclusive breastfeeding during this period of lactation which is the most
energetically demanding phase of human reproductive cycle and the role nutrition play in the growth and development of their infants and prevention of chronic under nutrition among them and their infantsboth in the present terms and in the future.
2. There is need to place emphasis on intervention programs such as nutrition education, food supplementation and dietary diversity during antenatal and lactation period to improve better health and nutrition outcomes..
3. There is a need for longitudinal assessment to be carried out in the study area in order to ascertain nutritional status of lactating mother over a longer period of time than just carrying out a cross sectional study frequently.
4. There is need for an assessment of the nutritional status of lactating women and their infants by other indices besides anthropometric indices of weight and height;
and the inclusion of important issues of breast feeding mother concerns based on findings from the assessment.
5. There is need for the computerized software systems of the 24 – hour dietary recall which allow the direct coding of the food reported during the interview. The potential benefits of automated software include substantial cost reductions for
LIBRARY
processing dietary data, less missing data, and greater standardization of interviews.
6. Data obtained from the use of food frequency questionnaire and 24 Hour Dietary Recall on the lactating women should be enriched through further research.
Adequate information on dietary pattern, nutrient intake, and physical activity among lactating mothers needs to be collected. Such data will help to develop approximate information and service programme in both rural and urban communities.
7. The lactating mothers should always be encouraged to continue food rich in iron in order to maintain their iron intake and forestall any iron deficiency.
8. .In response to information and adequate nutrition knowledge need of lactating mothers to improve on dietary iron intake and that of infants, more cross sectional studies like NDHS 2008; MICS should be conducted in Nigeria with the effectiveness on knowledge improvement of intervention groups
Contribution to Knowledge
This present study results have added to the pool of previous cross sectional studies on lactating women with the distinction of focusing on nutrition knowledge which is a concern due to the fact that the period of lactation is one of the critical nutrition timings in human reproductive cycle. This study further demonstrated the effectiveness of the consumption of iron – rich foods among women with higher education and women in households in the highest wealth quintile.
Further Research
In order to ensure follow up to this study it is recommended that:
1. Further research is needed to identify groups of lactating women in Owerri North who are nutritionally at risk or who could benefit from nutrition intervention programs.
2. Further research is needed to develop indicators of nutritional status for lactating mothers. Indicators are needed of both (a) risks of adverse outcomes related to the mother's dietary iron intake and (b) the potential of the mother or her nursing infant to benefit from interventions designed to improve their nutritional status or health.
LIBRARY
REFERENCES
Agha, F., Sadarrudin, A., Khan, R.A. and Ghafoor, A. 1992. Iron deficiency in adolescents. Journal of Pakistan Medical 3: 3 – 5.
Algarin, C., Peirano, P., Garrido, M., Pizarro, F. and Lozoff B. 2003. Iron deficiency anaemia in infancy: Long lasting effects on auditory and visual system functioning. Pediatric Research. 53: 217 – 23.
Allen, L. 2005. Multiple Micronutrients in Pregnancy and Lactation. An overview.
American Journal Clinical Nutrition.81: 12065.
Allen, L.H. 2012. B vitamins in Breast Milk: Relative importance of maternal status and intake and effects on infant status and function. Advanced Nutrition 3:362
Araoye, M.O. 2003. Calculation of Sample Size. Research methodology with statistics for health and social sciences. 117- 119.
Arora, S., McJunkin, C., Wehrer, J., Huhn, P. 2000. Major factorsinfluencing breastfeeding rates: Mother‘s perception offather‘s attitude and milk supply.
Pediatrics 106(5):E67.
Ayana, G., Haidar, J., Muroki, N.M. and Omwega, A.M. 2003. Malnutrition and Iron Deficiency in Lactating Women in Urban Slum Communities from Addis Ababa, Ethiopia.. East African Medical Journal. 80: 4.
Barbara, A. 2001. Global nutrition agenda: The role of International Union of Nutritional Sciences (IUNS). African Journal of Food and Nutrition Science.1: 53 – 55
Binns, C.W. and Scott, J.A. 2002. Breastfeeding:, reasons for starting, reasons for stopping and problems along the way. Breastfeeding Review 10(2): 13–19.
LIBRARY
Bodnar, L.M., Cogswell, M.E. and Scallon, K.S. 2002. Low income postpartum women are at risk of iron deficiency. Journal of Nutrition. 132: 2298 – 302.
Bodnar, L.M., Scallon, K.S., Freedman, D.S., Siega – Riz, A.M., Cogswell, M.E. 2001.
High prevalence of postpartum anemia among low – income women in the United States. American Journal of Obstetrics & Gynecology. 185: 438 – 45.
Bodnar, L.M., Siega – Riz, A.M., Miller, W.C., Cogswell, M.E. and McDonald T. 2002.
Who should be screened for postpartum anemia? An evaluation of current recommendations. American Journal of Epidemiology156: 903 – 12.
Bothwell, T.H. 1995. Overview and mechanism of iron regulation. Nutrition Review.53:
237 – 45.
Broadfoot, M., Britten, J., Tappin, D.M. and MacKenzie, J.M. 2005. The Baby Friendly Hospital Initiative and breast feeding rates in Scotland [electronic version]. Arch Disease Child Fetal Neonatal Edition.90:F114-F116.
Brown, K.H. Dewy. 1990. Effects of common illnesses on infants‘ energy intakes from breast milk and other foods during longitudinal community- based studies in Huascar (Lima), Peru . American Journal Clinical Nutrition. 52: 1005 – 13.
Butte, N.F. and Hopkinson, J.M. 1998. Body composition changes during lactation are highly variable among women. Journal of Nutrition. 128: 381S – 385S.
Butte N.F. 2001. The role of breastfeeding in obesity. Pediatric Clinical Nutritionist of America. 48: 189 – 98.
Caire-Juvera, G., Ortega M, Casanueva, E., Bolanos, A, de la Barca, A. 2007. Food components and dietary patterns of two different groups of Mexican lactating women. Journal of American College of Nutrition. 26(2):156-62.
LIBRARY
Countdown to 2015 decade report (2000 – 2010). Taking stock of maternal, newborn and child survival. World Health Organization and UNICEF, Washington, D.C.
Cunha, J., Macedo da Costa, T. and Ito M.K. 2005. Influences of maternal dietary intake and suckling on breast milk lipid and fatty acid composition in low-income women from Brasilia, Brazil. Early Human Development. 81(3): 303-11.
Childhood Sexual Abuse (CSA), Macro International. 2001. Ethiopia demographic health survey. Addis Ababa, Ethiopia and Claverton, Maryland, USA, Page 287.
Data from the Inter – Agency Child Mortality Estimation Group, published in the CAH website assessed on 19 April 2010.
Demissie, T., Mekonen, Y., Haider, J. 2003. Agro-ecological comparison levels and correlate of nutritional status of women. Ethiopian Journal of Health Development. 17:189–196.
Desalu, O.O., Salami, A.k., Oluboye, P.O. and Olarinoye, J.K. 2008. Prevalence and socio-demographic determinants of obesity among adults in an urban Nigerian population. Sahel Medical Journal. 11(2):61-64
Davies, M.K. 2001. Breastfeeding and chronic disease in childhood and adolescence.
Pediatric Clinical Nutrition of American. 48: 125 – 42.
Dewy, K.G and Brown, K.H. 2003. Update on technical issue concerning complementary feeding of young children in developing countries and implications for intervention programs. Food Bulletin.24: 5 – 28.
Dewey, K.G., Cohen, R.J., and Rollins, N.C. 2004.Feeding of nonbreastfed children from 6 to 24 months of age in developing countries. WHO Technical Background Paper. Food Nutrition Bulletin 25: 377-406, 2004.
LIBRARY
Dykes, F., Williams, C., 1999. Falling by the wayside: a phenomenological exploration of perceived breast-milk inadequacy in lactating women. Midwifery. 15(4):232–
246.
Edmond, M.E. 2007. Effects of early infant practices on infection – neonatal
mortality: an investigation of the causal links with observational data from rural Ghana.American Journal of Clinical Nutrition. 86: 1126 – 31
Ekejindu, I.M., Udigwe, G.O., Chijioke, I.R.C. 2006. Malaria and anaemia in pregnancy in Enugu, Southeast, Nigeria. African. Journal of Medical.
Sciences. 35(1): 1- 3
Eskeland, B., Malterud, K., Ulvik, R.J. and Hunskaar, S. 1997. Iron supplementation in pregnancy: is less enough? A randomized placebo controlled trial of low dose iron supplementation with or without heme iron. Acta Obsteteristic
&Gynaecology Scand. 76: 822 – 6. for assessing breast-feeding practices: Report of informal meeting, Geneva.
Feldman, M., Friedman, L., Brandt, L.,Slazenger, and Fordtran's.2009. Gastrointestinal and Liver Disease - Pathophysiology, Diagnosis, Management. 9. Elsevier
Furberg, H. 1999. Lactation and breast cancer risks. International Journal of Epidemiology. 28: 396 -402.
Global Report. 2009. Investing in the future: A united call to vitamins and mineral
Deficiencies .Retrieved
fromhttp://www.unitedcalltoaction.org/documents/investing in the future.
Haidar, J., Nekatibeb, H. and Urga, K. 1999. Iron deficiency anaemia status in
pregnant and lactating mothers of various staple areas in rural Ethiopia. East African Medical Journal.76: 618 – 622.
Hamedani, P., Raza, R., Bachand, R., Manji, M. and Hasmi, K. 1999. Laboratory
LIBRARY
diagnosis of iron deficiency in a developing country. Pakistan Journal of Internal Medicine 19: 4 -5.
Hass, J.D., Brownlie, T. 2001. Iron deficiency and reduced work capacity: A critical review of the research to determine a causal relationship. Journal of Nutrition. 13:
1 (2S-2): 676S – 88S; discussion 688S – 90S.
Haynes, R.B., Taylor, D.L., Sackett, D.L. 1979.Compliancein health care.
Baltimore, MD: Johns Hopkins University Press
Hector, D., King, L., Webb, K. 2004.State of food and nutrition in NSWseries: Overview of recent reviews of interventions to promote and support breastfeeding. Sydney:
NSW Department ofHealth.
Hector, D., Webb, K., Lymer, S.2004 (Revised 2005). State of food and nutrition in NSW series: Report on breastfeeding in NSW. Sydney. NSW Department of Health.
Hector, D., King, L. and Webb, K. 2005. Factors affecting breastfeeding practices applying a conceptual framework. NSW Public Health Bulletin. 16: 3 – 4.
Iannotti, L.L., Tielsch, J.M., Black, M.M. and Black R.N. 2006. Iron Supplementation in early childhood: Health benefits and risks. American Journal of Clinical Nutrition. 84: 1261 – 76.
Idowu, O,, Mafiana, A.C.F., Dapo, S. 2005. Anaemia in pregnancy: a Survey of pregnant women in Abeokuta, Nigeria; African Health Science 5(4):295-9
Ijarotimi O.S. 2010. Assessing exclusive breastfeeding practices, dietary intakes and body mass index (BMI) of nursing mothers in Ekiti State of Nigeria. Nutrition Research and Practice.4(3):222-228.
Institute of Medicine. 1997. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board. Dietary Reference Intakes for
LIBRARY
Calcium, Phosphorous, Magnesium, Vitamin D, and Fluoride, National Academy Press,
Institute of Medicine. 1998. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board.Dietary Reference Intakes for B Vitamins. National Academy Press,
Institute of Medicine, U.S. 1998. Dietary reference intakes for thiamine, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin and choline.
Washington, D.C. National Academics Press.
Institute of Medicine. 2000. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board.Dietary Reference Intakes for Vitamins C2, Vitamin E, Selenium, and Carotenoids. National Academy Press, Institute of Medicine. 2001. Dietary reference intakes for Vitamin A, Vitamin K, Arsenic,
Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium and Zinc. National Academy Press, Washington D.C.
Institute of Medicine, U.S. 2002. Dietary reference intakes for energy, carbohydrates, fiber, fat, protein and amino acid (macronutrients). Washington, D.C. National Academics Press.
Jernstrom, H.. 2004. Breastfeeding and the risk of breast cancer in BRCA1 and
BRCA2 mutation carriers. Journal of the National Cancer Institut. 96: 1094 – 1096.
Jones, G., Steketee, R.W., Black, R.E., Bhutta, Z.A., Morris, S.S. and Bellagio. 2003.
Child Survival Study Group. How many child deaths can we prevent this year?
Lancet 362(9377):65-71.
Jones, K.D.J., Berkley, J.A. and Warner, J.O. 2010. Perinatal nutrition and immunity to infection. Paedatric Allergy and Immunology. 21:564-576.
LIBRARY
Kalkwarf, H.J. and Harrast, S.D.1998. Effects of calcium supplementation and lactation on iron status.American Journalof Clinical Nutrition67: 1244–1249
Kinra, S., Nelder, R.P. and Lewendon, G.J. 2000. ‗Deprivation and childhood obesity: a cross sectional study of 20,973 children in Plymouth, United Kingdom‘. Journal of Epidemiology Community Health. 54:456-60.
Kulkarni, B., Shatrugna, V., Nagalla, B. and Rani, U. 2011. Regional body composition changes during lactation in Indian women from the low-income group and their relationship to the growth of their infants. Journal of American College of Nutrition. 30(1):57-62.
Kramar, M.S., Kakuma, R. 2009. The optimal duration of exclusive breastfeeding (Review). The Cochrane Collaboration.
Kramar, M.S. and Kakuma, R. 2001. The optimal duration of exclusive breastfeeding: A Systematic review. The World Health Organization, Geneva.
Lee, R, Nieman, D.C. 2002. Nutritional Assessment, Third Edition, McGraw-Hill.
Lisa, C.S. and Lawrence, H. 2000. Explaining child malnutrition in developing countries:
A cross-country analysis. Research Report. 111:4.
Lozoff, B., Jimenez, E. and Wolf, A.W. 1991. Long – term developmental outcome of infants with iron deficiency. New English Journal of Medicine. 687 – 94.
Lozoff, B., Jimenez E. and Wolf, A.W. 2000. Poorer behavioral and developmental outcome more than 10 years of after treatment of iron deficiency in infancy.
Pediatrics. 105: E51.
LIBRARY
Maduforu,A.N.and Onuoha R.O. 2011. Relativities of Exclusive Breastfeeding between Urban and Rural Women in Imo State. ―Retrieved June 1, 2011, from www.transcampus.org/journals.‖
Marcos, A., Nova, E. and Montero A. 2003. Changes in the immune system are conditioned by nutrition. European Journal of Clinical Nutrition57:S66-S69 Mahdavi, R., Nikniaz L. and Arefhosseini S. 2009. Energy, fluids intake and beverages
consumption pattern among lactating women in tabriz, Iran. Pakistan Journal of Nutrition 8(1):69-73.
McLennan, J.D. 2001. Early termination of breast-feeding in periurban Santo Domingo, Dominican Republic: mothers‘ community perceptions and personal practices.
Revised PanamSalud Publication9(6): 362–367.
Merten, S., Dratva, J. and Ackermann-Liebrich, U. 2005. Do Baby-Friendly hospitals influence breastfeeding duration on a national level? Pediatrics. 116(5):e702-e708.
Molbak, K. 1994. Prolonged breastfeeding, diarrhoel disease, and survival of children in Guinea- Bissau. British Medical Journal.308: 1403 – 06.
Moore, E.R., Andersen, G.C. and Bergman, N. 2009. Early skin- to- skin contact for mothers and their healthy newborn infants (Review). Cochrane Collaboration.
Müller, O. and Krawinkel, M. 2005. Malnutrition and health in developing countries.
2005. Canadian Medical Association Journal (CMAJ). 173:279-86 MICS (Multiple Indicator Cluster Survey). 2011
NHNES (National Health and Nutritional Examination Survey) 1988 – 1994. Data on the prevalence of iron deficiency, anaemia, and iron deficiency anaemia among U.S women aged 20 – 40 who were 0 – 6 months postpartum.
LIBRARY
NDHS (Nigeria Demographic and Health Survey). 2003. Federal Office of Statistics Lagos, Nigeria. ORC Macro, Calverton, Maryland, USA.
NDHS (Nigeria Demographic and Health Survey).2008. Abuja, Nigeria: National Population Commission and ICF Macro..Calverton, Maryland, USA.
NDHS (Nigeria Demographic andHealth Survey 2013.Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF I
Nigeria Food Consumption and Nutrition Survey (NFCNS). 2001 – 2003. Summary.
National Population Commission [Nigeria]. 2009. Final results of 2006 census.
Abuja, Nigeria: National Population Commission.
Okwu, G.N. and Ukoha, A.I 2008. Studies on the Predisposing Factors ofIron Deficiency Anaemia among Pregnant women in a Nigeriancommunity.Pakistan Journal of Nutrition.. 7(1):151-158.
Retrieved from Http://www/pjbs.org/pjnonline/index.htm
Okwu, G.N. 2011. Studies on the predisposing factors of iron deficiency anemia among lactating women in Owerri, Nigeria. International Research Journal of Biochemistry and Bioinformatics 1(11): 304 – 309.
Onyango, A.W. 1999. Continued Breastfeeding in the second year of life: a prospective cohort study in Western Kenya. Lancet 354: 2041 – 45.
Pala, K. and Dundar, N. 2008. Prevalence and risk factors of anemia among women of reproductive age in Bursa Turkey. Indian Journal of Medical Research 128(3):
282 – 6.
Pehrsson, P.R., Moser – Veillon, P.B., Sims, L.S., Suitor, C.W. and Russek C.E. 2001.
Postpartum iron status in nonlactating participants and nonparticipants in the
LIBRARY
Special Supplemental Nutrition Program for Women, Infants, and Children.
American Journalof Clinical Nutrition.73: 86 – 92.
Philipp, B.L., Malone, K.L, Cimo, S. and Merewood, A. 2003. Sustained breastfeeding rates at a US Baby-Friendly hospital. Pediatrics, 112(3, pt 1):e234-e236.
Picciano, M.F. 2001. Nutrient composition of Human milk.Pediatric Clinics of North America48(1):53–67.
Pourghassem, B., Kimiagar, G.S., Ablfathi, A.A. 2000. Prevalence of iron
deficiency anaemia in high school students in Jolfa, East Azerbaijan. Food &
Nutrition, Bulletin.21: 301 – 304.
Ramakrishnan, U. and Yip, R. 2002. Experiences and challenges in industrialized countries: control of iron deficiency in industrialized countries. Journal of Nutrition. 132: 820S – 824S.
Rasmussen, K.M. and McGuire, K.M. 1996. Effects of breastfeeding on maternal health and well-being. Foodand Nutrition Bulletin. 17:4.
Rempel, L. March 2000.Breastfeeding reasons predict breastfeeding decisions. University of Queensland Family CentreNewsletter.
Renolds, A. Breastfeeding and brain development. 2001. Pediatrics Clinical Nutrition of American Journal.48: 159 – 72.
Sackett D.L. and Haynes R.B.1976.Compliance with therapeuticregimens.Baltimore MD: Johns Hopkins University Press.
Sanusi, R.A. and Falana, O.A. 2009. The nutritional status of mothers practicing breastfeeding in Ibadan, Nigeria. African Journal of Biomedical Research. 12(2):
107-112.
Shils, M., Olson,.J, Shike, M., Ross, C.A 1999. Modern Nutrition in Health and Disease, 9th Ed. Lipincott, Williams & Wilkins,
LIBRARY
Simondon K.B. 2001. Breastfeeding is associated with improved growth in length, but not weight in rural Senegalese toddlers. American Journal of Clinical Nutrition, 72: 957 – 67.
Special Role of Maternity Services. Geneva, Switzerland: World Health Organization.
Switzerland.2007.Retrieved from May 7, 2007 http://www.popline.org/docs/1513/274914.html.
Sylvia, B. and Mary, D.S. 2002. The Nursing Mother‘s Diet. The art of successful breastfeeding: A Mother’s Guide.
Thompson, F.E. and Subar, A.F. 2001. Dietary assessment methodology. Academic Press. San Diego, CA. 1: 3 - 30
Ukegbu, P.O. 2012. Effect of maternal nutrition and body composition on lactation performance and breast milk composition. PhD Thesis, Michael Okpara University of Agriculture, Umudike Abia State Nigeria.
Ukegbu, P.O. and Uwaegbute, A.C. 2012. Body composition changes among lactating mothers in Abia State, Nigeria. American Journal of Food and Nutrition .2(1): 21-25.
Ukegbu, P.O. 2014. A study of the nutritional status and dietary intake of lactating women In Umuahia, Nigeria. American Journal of Health Research.2 (1): 20 – 26.
Umeora, O. and Egwuatu V. 2008. Age at menache and menstrual pattern of Igbo women of South East Nigeria.African Reproductive Health. 12(1):90-5.
UNICEF/WHO Geneva (2006): Report on Breastfeeding and Nutrition.
United States Department of Agriculture. 2000. United States Department of Health and Human Services. Dietary Guidelines for Americans, National Academy Press.
LIBRARY
Vikram, K., Hood, W.A., Stapleton, J.R. 2013. Nutritional Assessment Status in Adults.
American College of Gastroenterology,
World Health Organization/UNICEF. 1989. Protecting, Promoting and Supporting Breast-feeding:
World Health Organization. 1995. Physical status: The use and interpretation of anthropometry. WHOTechnical Report Series. 854:375-409.
World Health Organization. 1998. Evidence for the ten steps for successful breastfeeding (Revised).
World Health Organization. 1999. Division of Diarrhoeal and Acute Respiratory Disease Control. Indicators
World Health Organization. 2000. Collaborative Team: The Role of Breastfeeding on the Prevention of Infant Mortality. Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis.Lancet 355: 451: 55.
World Health Organization & Micronutrient Initiative. 2001. Iron deficiency anemia.
Assessment, prevention and control. A guide for programme managers.
World Health Organization/UNICEF.2003. Global Strategy for Infant and Young Child Feeding. Geneva, Switzerland: World Health Organization.
World Health Organization. 2005. Guiding principles for feeding nonbreastfed children 6-24 months ofage. Geneva, Switzerland: World Health Organization.
World Health Organization/UNNICEF. 2007. Global Strategy for Infant and Young Child Feeding. Geneva, Switzerland: World Health Organization.
World Health Organization/Center for Disease Control and Prevention. 2008 World prevalence of anaemia 1993 – 2005: WHO Global Database of Anaemia. World Health Organization, Geneva.
LIBRARY
APPENDIX 1
DIETARY IRON INTAKE AND ASSESSMENT OF THE NUTRITIONAL STATUS OF LACTATING WOMEN AND THEIR INFANTS IN OWERRI NORTH LGA, IMO
STATE NIGERIA CONSENT FORM
Dear respondent,
I am ONYEKACHI McKENTEGAN, NLEMADIM,a student of the Department of Human Nutrition, Faculty of Public Health, College of Medicine, University of Ibadan;
we are conducting a study on the DIETARY IRON INTAKE AND ASSESSMENT OF THE NUTRITIONAL STATUS OF LACTATING WOMEN AND THEIR INFANTS IN OWERRI NORTTH LGA . The findings from this research can cause improvement of breastfeeding intervention and management on Breastfeeding and Nutrition.
I wish to inform you that there is no right or wrong answers to the questions I will ask you. Please, be informed also that participation is voluntary. Your identity, responses and opinions will be kept confidential and no name is required in filling the questionnaire.
Please try and give honest responses to the questions this questionnaire will require about 30 minutes. And circle the option that best applies to you and your child. You are free to ask questions as the interview progresses.
Thank you for your cooperation.
RESPONDENT‘S SIGNATURE DATE
____________________ ______________________
WITHNESS SIGNATURE DATE
______________________ _______________________
LIBRARY
APPENDIX 2