Overview of the Labeling Process

1. Overview of the Labeling Process

2. Labels • Proper and accurate labeling is one of the most important aspects of the study. • Each woman, child, and man selected for the survey will have their own individual set of labels. • Each household and bakery will also have their own individual set of labels. • The label identifies the participant, household, or bakery to the sample with a unique identifying sequence of numbers and letters. • This sequence of numbers and letters matches with the barcode and provides key study information.

3. General instructions • Do not use pencils or standard ink pens to write on the label. Use a Sharpie permanent marker to complete the date information on the label. • The team supervisor will staple the labels to the questionnaire as the survey participants are identified. • The questionnaire and labels will accompany the survey participant through the interview and sample collection process. • The questionnaire with the remaining labels should be returned to the team supervisor before starting the next household assessment. • Read the labels carefully. Be sure to match the survey participant to the label and to the correct item to be labeled.

4. Labels for women W = Woman 0749 = Participant number Q = Questionnaire RT = Red Top P = Purple Top UC = Urine Cup U1, U2 = Urine 1, 2 S1, S2, S3 = Serum 1, 2, 3 S1–R = Serum 1 to Royal Hospital S2–MOH = Serum 2 to MOH labs S3–MOH = Serum 3 to MOH Labs U1–MOH = Urine 1 to MOH Labs U2–MOH = Urine 2 to MOH Labs P–MOH = Purple Top to MOH Labs

5. Labels for children C = Child 1406 = Participant number Q = Questionnaire RT = Red Top P = Purple Top S1, S2, S3 = Serum 1, 2, 3 S1–R = Serum 1 to Royal Hospital S2–MOH = Serum 2 to MOH labs S3–MOH = Serum 3 to MOH Labs P–MOH = Purple Top to MOH Labs X = Extra

6. Labels for men M = Men 3001 = Participant number Q = Questionnaire P = Purple Top P–MOH = Purple Top to MOH Labs

7. Labels for household Q = Questionnaire CL01 = Cluster 01 HH-01 = Household 01 FL1, 2, 3 = Flour 1, 2, 3 SL = Salt FL1–CL = Flour 1 to Central Lab FL2–CL = Flour 2 to Central Lab FL3–CL = Flour 3 to Central Lab SL–CL = Salt to Central Lab

8. Labels for bakery Q = Questionnaire CL-01 = Cluster 01 BK = Bakery 1 = Sample 1 2 = Sample 2 3 = Sample 3 1–CL = Sample 1 to Central Lab 2–CL = Sample 2 to Central Lab 3–CL = Sample 3 to Central Lab X = Extra

9. Team Supervisor • The team supervisor will paste the household “Questionnaire” label on the household questionnaire, and staple the rest of the household labels to the questionnaire. • The team supervisor will then pass the household questionnaire to the interviewer to start the interview.

10. Team Supervisor • The same procedure is followed for the woman, man, and child “Questionnaire” labels. • After stapling the labels to the questionnaire, the team supervisor will write the household number on the first page of the woman, man, or child questionnaire. • Pass the questionnaire to the interviewer to begin the interview.

11. Team Supervisor • When the team supervisor sees that the nurse phlebotomist is available for her first collection, the team supervisor will send a woman participant for urine and blood collection prior to questionnaire completion.   • The team supervisor will paste the woman “Questionnaire” label on the woman’s questionnaire, write the household number on the first page of the questionnaire, and staple the rest of the labels to the questionnaire. • The supervisor will then pass the questionnaire to the nurse. • After the nurse is done with the collection process, the woman’s questionnaire with the remaining labels is passed back to the team supervisor.

12. Nurse phlebotomist • For the women participants, the nurse phlebotomist will use the Red Top, Purple, Urine Cup, Urine 1, and Urine 2 labels. • The Red Top and Purple labels are to be attached after the blood is drawn. • The Urine Cup and Urine 1,2 are placed on the cup and cryovials prior to collection.

13. Nurse phlebotomist • For the child participants, the nurse phlebotomist will use the Red Top and Purple labels. • The nurse will ask the child’s name or ask a mother to identify the child before proceeding with blood collection.

14. Nurse phlebotomist For the men participants, the nurse phlebotomist will use the Purple label.

15. Nurse phlebotomist • Labels for blood collection are attached after the blood is drawn. • Labels need to be attached to the specimen tubes in a left to right manner while holding the cap in the left hand such that the label may be read. One hint is to have the bar code look like a ladder if the vial is standing up.

16. Nurse phlebotomist • Always leave the ruled part of the tube free of a label. • For example, place the label over the existing tube label. For urine, leave the graduated numbers visible on the cryovials.

17. Interviewer • The interviewer will use the flour 1, 2, 3 and salt labels to appropriately label the samples of flour and salt collected in the household.

18. Team Supervisor The remaining labels will stay attached to the questionnaires, which are given back to the team supervisor.

19. Bakery collection • The team supervisor will interview and collect flour samples from the local bakery before leaving the cluster at the end of the day. • The “Questionnaire” label will be pasted on the bakery questionnaire and up to 3 flour samples are to be collected. • The remaining labels will stay stapled to the questionnaire.