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Table 2 Data acquisition questionnaire for utilization and conservation of medicinal plants in Samburu district, Kenya

From: Ethnopharmacological survey of Samburu district, Kenya

QUESTIONNAIRE
PART 1: RESPONDENTS DETAILS
Name...............................................................Sex....M/F Age...........Years.
Occupation........................................................ Level of education........................................
Location/Residence...............................................................................................................................
Efficacy/Toxicity Data
Type of Plant (Local name)..........................................................................................
Preparation method(s)..........................................................................................
Administration form (s)..........................................................................................
Part(s) of plant used..........................................................................................
Used on : Humans................................... Animals/Species.........................................
Route(s) of application..........................................................................................
Approximate dosage..........................................................................................
Response of Patient Good.........................Fair........................ Poor.........................
Duration of response Seconds......................... Minutes......................... Hours.........................
Complications
PART 2: RESPONDENTS CONSENT AGREEMENT
I.......................................................................................Hereby agree to participate in this study with my full consent and conscious and declare that to the best of my Knowledge the information that I have provided is true, accurate and complete.
Signature/Thumb print...........................................Date............./May/2007
PART 3: RESEARCHER'S DECLARATION
   1. The following research will be undertaken with respect to the indigenous knowledge and intellectual proprietary of the Samburu Community.
   2. We will at no given time initiate or conduct practices that are deemed to obtain information from the respondents by intimidation, coercion or false pretence.
   3. The respondents will be informed of the intended project elaborately prior to questionnaire administration and in confidential to eliminate any degree of conspiracy.
   4. We will be no under any obligation to edit or tamper the information provided by the respondents.
   5. Translation and transcription will be necessary for clarification due to the language barrier.
   6. The information collected will be used for the described research purpose and not any undisclosed any undisclosed intentions.
Signatory Researchers:
1. Dr. Nanyingi M.O..................2. Dr. Ogara O.W..................3. Dr. Mbaria J.M..................