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. 2011 May 23;11:141. doi: 10.1186/1471-2334-11-141

Table 1.

Mozambican screening questionnaire for blood donation and main reasons for deferral in this study (n = 71)

Questionnaire Number of persons excluded per question (n = 71)
Questions for definitive exclusion
01 Do you have more than 65 years of age? 0 (-)
02 Do you have a disease without cure (chronic)? 2 (2.6%)
03 Were you once suspected of being infected with HIV? 1 (1.3%)
04 Did you have once hepatitis/jaundice? 4 (5.1%)
05 Did you already have once a venereal disease? 22 (28.2%)
06 Do you belong to a risk group for HIV infection (injection of drugs, sexual contacts without condom, traditional vaccines with blades used for different persons, several blood transfusions)? 6 (8.5%)

Questions for temporary exclusion
07 A person with HIV can not donate blood? 4 (5.1%)
08 Were you refused before to donate blood? 1 (1.4%)
09 Do you suffer from diseases of the cardiovascular system (e. g pericardial pain)? 2 (2.6%)
10 Do you suffer from diseases of the respiratory system (e.g., asthma)? 6 (8.5%)
11 Do you suffer from diseases of the gastrointestinal system (e.g.; peptic ulcer) 1 (1.4%)
12 Do you suffer from diseases of the central nervous system (e.g. epilepsy)? 1 (1.4%)
13 Do you suffer from diseases of the muscular/skeletal system? 0 (-)
14 Do you suffer from diseases of the genital/urinary system? 0 (-)
15 Do you suffer from diseases of the endocrine system? (e.g. diabetes). 0 (-)
16 Do you suffer from diseases of the immune system? (e.g. allergy) 1 (1.4%)
17 Do you have a blood disease? (e.g. hemophilia)? 0 (-)
18 Do you have a fever? 3 (5.1%)
19 Are you pregnant /menstruating? (women) 2 (2.6%)
20 Are you taking any medication? 0 (2.6%)
21 Were you vaccinated in the last 4 weeks? 1 (1.4%)
22 Were you operated in the last 6 months? 0 (-)

Physical examination
23 Control if donor has infectious diseases 0 (-)
24 Do you have a blood pressure higher than 160/110 mmHg or lower than 120/80 mmHg? 1 (1.4%)
25 Do you have a pulse higher than 120 beats per minute (bpm) or lower than 70 bpm? 0 (-)
26 Do you have a weight below 50 kg? 5 (6.4%)
27 Do you have a hemoglobin level below 12.5 g/dl? 3 (3.8%)
28 Others 5 (7.0%)