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PMA2014/Ethiopia-R2 SOI

SNAPSHOT OF INDICATORS

Summary of the sample design for PMA2014/Ethiopia-R2:

PMA2020 is designed to create sentinel sites for data collection both at the population level and among service delivery points (SDPs). Enumeration areas (EAs) selected in Round 1 are generally used for data collection in Rounds 2-4. Households within the EA are randomly sampled during each round, however the EA is consistent across rounds. The original Round 1 sample design summary is provided below.

PMA2020/Ethiopia uses a two-stage cluster design with residential area (urban and rural) and sub-regions as strata, sampling across all 11 geographic regions in Ethiopia. 95% of the target population, women of reproductive age 15-49, reside in five regions (Addis Ababa, Amhara, Oromiya, SNNP and Tigray). Other regions with a total of less than 5% of the target population are allocated to a sixth synthetic region (referred to as “other"). Given the uneven population distribution and resource limitation, regional representative samples are only taken in the five regions (Addis Ababa, Amhara, Oromiya, SNNP and Tigray). The final sample of 200 EAs and 7,000 households was designed to generate national estimates of modern contraceptive prevalence rate among all women with less than 2% margin of error and urban/rural estimates at less than 3% margin of error, and less than 5% margin of error at each of the five regional levels.

The table below provides a summary of key family planning indicators at the national level and their breakdown by background characteristics. Disaggregation by administrative unit was done at the region level for the six regions (Addis Ababa, Amhara, Oromiya, SNNP, Tigray and other) due to small sample sizes when disaggregated by sub-region.

To view the breakdown by background characteristics of the respondents, please click on the respective indicator link. Distribution of respondents by background characteristics is available here. Distribution of SDPs by background characteristics is available here.

Additional detail on sample design, data collection and processing, response rates, and standard errors are available below the indicator tables.

PMA2020 Standard
Family Planning Indicators

Round 2
All Women Married Women
Utilization:
Contraceptive Use    
Contraceptive Prevalence Rate (CPR) 24.4 35.0
Modern Contraceptive Prevalence (mCPR) 23.8 34.2
Traditional Contraceptive Prevalence 0.6 0.8
Contraceptive Method Mix    
Contraceptive method mix (stacked bar charts for all/married women)    
Demand for Family Planning and Fertility Preferences:
Unmet need for family planning 16.2 24.1
Demand for family planning 40.6 59.2
Percent of all/married women with demand satisfied by modern contraception 58.7 57.8
Percent of recent births, by intention
Wanted then 61.1 61.5
Wanted later 27.2 27.4
Wanted no more 11.7 11.1
Access, Equity, Quality and Choice:
Percent of users who chose their current method by themselves or jointly with a partner/provider 88.2 88.2
Percent of users who paid for family planning services 21.7 20.4
Method Information Index    
Percent of current users who were informed about other methods 59.4 60.2
Percent of current users who were informed about side effects 46.0 46.3
Percent of current users who were told what to do if they experienced side effects 75.3 76.7
Percent of recent/current users who would return and/or refer others to their provider 78.1 78.9
Percent of women receiving family planning information in the past 12 months 19.0 22.3
Service Environment:
Charging fees for family planning    
Contraceptive choice: Availability of at least 3 or at least 5 modern contraceptive methods    
Contraceptive choice: Availability of modern contraception, by method    
Contraceptive stock-outs, by method    
Number of new and continuing family planning visits, by method    


The PMA2014/Ethiopia-R2 Survey in Detail

Sample Design

Round 1 Sample Design

The PMA2020 survey collects data annually at the national (urban and rural) and regional levels to allow for estimation of key indicators to monitor progress in family planning. The resident enumerator (RE) model enables replication of the surveys twice a year for the first two years, and annually each year after that, to track progress.

Survey resources allowed targeting a sample size of 200 enumeration areas (EAs) and a final sample size of approximately 7,000 households, selected by the Central Statistical Agency (CSA) master sampling frame, which was representative at the national and sub-regional levels for both urban and rural areas. The primary sampling units for the survey were the EAs, which were selected systematically with probability proportional to size with urban/rural stratification in the nine regions and one administrative city (excluding Addis Ababa city, which is only urban). The rationale was for PMA2020 estimates to be comparable to the most recent national survey results. CSA provided the selection probabilities for the PMA2020 sampled clusters for constructing weights.

In each selected EA, field supervisors randomly selected up to three private SDPs to be interviewed by a resident enumerator using the service delivery point (SDP) questionnaire. The field supervisors themselves administered the SDP questionnaires at an additional three public SDPs that serve each EA; the lowest, second-lowest, and third-lowest level public health SDPs (health post, health center, and a district hospital) designated to serve each EA population.

Round 2 Sample Update

Data collection for Round 2 (approximately six months after Round 1) continued in the original 200 EAs selected in Round 1. Mapping and listing was repeated to create an updated sample frame. All households, health service delivery points (SDPs) and key landmarks in each enumeration area (EA) were listed and mapped by the resident enumerators (REs) to create a frame for the second stage of the sampling process. This mapping and listing process took place in the first week of data collection in each EA.

Field supervisors randomly selected 35 households from the household. A household roster was completed and all eligible women age 15-49 in selected households were asked to provide informed consent (and assent if aged 15-17 years) to participate in the study.

The majority of SDPs are repeated in each round, forming a panel survey. If an EA had more than three private SDPs identified during the listing process, then a new sample of the private SDPs is selected during each round.

For more on PMA2020's sampling strategy, download the PMA2020 General Sampling Strategy Memo: in English, in French.

For more on PMA2020's SDP sampling, download the PMA2020 SDP Sampling Memo: in English.

Questionnaires

PMA2020 uses standardized questionnaires for households and service delivery points (SDPs) to gather data about households, individual females and health service delivery points (SDPs) that are comparable across program countries and consistent with existing national surveys. Prior to launching the survey in each country, local experts review and modify these questionnaires to ensure all questions are appropriate to each setting. The questionnaires were translated into three local languages.

The household questionnaire, the female questionnaire and the service delivery point questionnaire were based on model surveys designed by PMA2020 staff at the Bill & Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Addis Ababa University, and fieldwork materials of the 2011 Ethiopian Demographic and Health Survey (EDHS).

All PMA2020 questionnaires are administered using Open Data Kit (ODK) software and Android smartphones. The PMA2014/Ethiopia-R2 questionnaires were in English and could be switched into the three local languages (Amharic, Afan Oromo and Tigrigna) on the phones. The questionnaires were translated using available translations from similar population surveys and experts in translation. The interviews were conducted in the local language, or English in a few cases when the respondent was not comfortable with the local language. Female resident enumerators in each enumeration area (EA) administered the household and female questionnaires in the selected households.

The household questionnaire gathers basic information about the household, such as ownership of livestock and durable goods, as well as characteristics of the dwelling unit, including wall, floor, and roof materials, water sources, and sanitation facilities. This information is used to construct a wealth quintile.

The first section of the household questionnaire, the household roster, lists basic demographic information about all usual members of the household and visitors who stayed with the household the night before the interview. This roster is used to identify eligible respondents for the female questionnaire. In addition to the roster, the household questionnaire also gathers data that are used to measure key water, sanitation and hygiene (WASH) indicators, including regular sources and uses of WASH facilities used and prevalence of open defecation by household members.

The female questionnaire is used to collect information from all women age 15 to 49 who were listed on the household roster at selected households. The female questionnaire gathers specific information on education; fertility and fertility preferences; family planning access, choice and use; quality of family planning services; exposure to family planning messaging in the media; and the burden of collecting water on women.

The SDP questionnaire is used to collect information about the provision and quality of reproductive health services and products, integration of health services, and water and sanitation within the SDP.

Training, Data Collection and Processing

Training

The PMA2014/Ethiopia-R2 fieldwork training started with a two-week training of new 42 new field staff and was followed by a five-day refresher training for returning field staff. The two-week training was conducted from September 29 to October 10, 2014 and the concurrent refresher trainings were held from October 13-17, 2014. PMA2020 staff from the Bill & Melinda Gates Institute for Population and Reproductive Health of the Johns Hopkins Bloomberg School of Public Health led the training, with support from Addis Ababa University School of Public Health project staff.

The first training took place at the Ethiopian Management Institute in Addis Ababa. In addition, concurrent refresher trainings in Addis Ababa, Gondar, and Mekele towns were held October 13-17; a total of 200 resident enumerators (REs) received training. All training participants at the two-week training were given comprehensive instruction on how to complete the household, female, and service delivery point (SDP) questionnaires. In addition to PMA2020 survey training, all participants received training on contraceptive methods by an Ethiopian obstetrician/gynecologist.

Throughout the training, REs and supervisors were evaluated based on their performance on phone-based assessments, practical field exercises for the SDP survey, and class participation. The two-week training included three days of field exercises, during which participants entered a practice enumeration area (EA) to practice listing, mapping and conducting household, female and SDP interviews. The RE trainings were conducted primarily in Amharic, whereas some small group sessions were conducted in Afan Oromo and Tigrigna.

For the concurrent refresher trainings, all training participants were given instructions on survey changes to the tools since the previous round. Similar to the two-week training, the five-day refresher trainings were conducted primarily in Amharic, whereas some small group sessions were conducted in Afan Oromo and Tigrigna.

Supervisors received additional training prior to and after the RE training to further strengthen their supervision skills, including instruction on conducting re-interviews, carrying out random spot checks, and dealing with the local/community leaders and engaging the communities.

Data Collection and Processing

Data collection was conducted between October and December 2014. Unlike traditional paper-and-pencil surveys, PMA2020 uses Open Data Kit (ODK) Collect, an open-source software application, to collect data on mobile phones. All the questionnaires were programmed using this software and installed onto project smartphones. The ODK questionnaire forms are programmed with automatic skip-patterns and built-in response constraints to reduce data entry errors.

The ODK application enabled REs and supervisors to collect and transfer survey data to a central ODK Aggregate cloud server. This instantaneous aggregation of data also allowed for concurrent data processing and course corrections while PMA2020 was still active in the field. Throughout data collection, central staff at Addis Ababa University School of Public Health in Addis Ababa, Ethiopia and the data manager at the Gates Institute at Johns Hopkins in Baltimore, Maryland routinely monitored the incoming data and notified field staff of any potential errors, missing data or problems found with form submissions on the central server. The use of mobile phones combined data collection and data entry into one step; therefore, data entry was completed when the last interview form was uploaded at the end of data collection in December.

Once all data were on the server, data analysts cleaned and de-identified the data, applied survey weights, and prepared the final dataset for analysis using Stata® version 14 software. The national dissemination workshop of preliminary results was held on March 31, 2015 at the Elily Hotel, Addis Ababa, Ethiopia.

Response Rates

The table below shows response rates for household and female respondents by residence (rural/urban) for PMA2014/Ethiopia-R2. A total of 6,997 households were selected for the PMA2014 survey; 6,927 households were found to be occupied at the time of the fieldwork. 98.4% of the occupied households (6,813) consented to a household-level interview. The response rate for the household level was higher in the rural (98.5%) relative to the urban (98.2%) enumeration areas (EAs).

In the occupied households that provided an interview, a total of 6,793 eligible women age 15 to 49 years were identified. Overall, 97.9% of the eligible women were available and consented to the interview. The female response rate was slightly higher in the rural (98.1%) relative to the urban (97.6%) EAs. Only de facto females are included in the PMA analyses; the final completed de facto female sample size was 6,648 (unweighted).

The final service delivery point (SDP) sample included 407 facility interviews, of which 398 were completed for a response rate of 97.8%.

Weights were adjusted for non-response at the household and individual levels and applied to all household and individual estimates in this report. SDP estimates are not weighted

    PMA2014/Ethiopia-R2
Result   Urban Rural Total
Household interviews              
Households selected   3,602 3,395 6,997
Households occupied   3,566 3,361 6,927
Households interviewed   3,502 3,311 6,813
Household response rate* (%)   98.2 98.5 98.4
             
Interviews with women age 15 to 49
Number of eligible women**   3,615 3,178 6,793
Number of eligible women interviewed   3,529 3,119 6,648
Eligible women response rate (%)   97.6 98.1 97.9
*Household response rate=number of household interviews/households occupied

**Eligible women response rates include only women identified in completed household interviews

†Eligible women response rate = eligible women interviewed/eligible women

Sample Error Estimates

The following table shows sample errors for the PMA2020 indicators described above. For more information about PMA2020 indicators, including estimate type and base population, click here.

   
Variable Value[R] Standard Error Confidence Interval
R-2SE R+2SE
All women age 15-49
Currently using a modern method 0.238 0.014 0.211 0.265
Currently using a traditional method 0.006 0.001 0.003 0.008
Currently using any contraceptive method 0.244 0.014 0.217 0.271
Currently using injectables 0.165 0.011 0.144 0.186
Currently using male condoms 0.003 0.001 0.002 0.005
Currently using implants 0.050 0.006 0.038 0.061
Chose method by self or jointly in past 12 months 0.881 0.018 0.845 0.917
Paid fees for family planning services in past 12 months 0.217 0.021 0.174 0.259
Informed by provider about other methods 0.594 0.025 0.545 0.643
Informed by provider about side effects 0.460 0.029 0.404 0.517
Satisfied with provider: Would return and refer friend/relative to provider 0.781 0.020 0.740 0.821
Visited by health worker who talked about family planning in past 12 months 0.190 0.019 0.153 0.228
Women in union age 15-49
Currently using a modern method 0.342 0.022 0.300 0.384
Currently using a traditional method 0.008 0.002 0.005 0.012
Currently using any contraceptive modern method 0.350 0.022 0.308 0.393
Currently using injectables 0.240 0.017 0.207 0.274
Currently using male condoms 0.002 0.001 0.001 0.004
Currently using implants 0.072 0.009 0.054 0.089
Chose method by self or jointly in past 12 months 0.884 0.019 0.847 0.921
Paid fees for family planning services in past 12 months 0.204 0.022 0.160 0.248
Informed by provider about other methods 0.602 0.025 0.552 0.652
Informed by provider about side effects 0.463 0.030 0.403 0.522
Satisfied with provider: Would return and refer friend/relative to provider 0.789 0.021 0.747 0.831
Visited by health worker who talked about family planning in past 12 months 0.223 0.022 0.180 0.267