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PMA2014/Ghana-R2 SOI

SNAPSHOT OF INDICATORS

Summary of the sample design for PMA2014/Ghana-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 uses a two-­stage cluster design with residential area (urban and rural) and regions as strata. Within the strata, clusters were selected proportional to size. The final sample of 100 EAs and 4,200 households is designed to generate national estimates of all women modern contraceptive prevalence rate (mCPR) with less than 2% margin of error and urban/rural estimates at less than 3% margin of error.

The table below provides a summary of key family planning indicators and their breakdown by background characteristics. Disaggregation by administrative unit was done at the region level.

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 details 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) 16.1 19.6
Modern Contraceptive Prevalence (mCPR) 14.6 17.8
Traditional Contraceptive Prevalence 1.5 1.8
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 26.6 38.2
Demand for family planning 42.8 57.8
Percent of women with demand satisfied by modern contraception 34.3 30.8
Percent of recent births, by intention
Wanted then 59.2 62.3
Wanted later 27.7 26.5
Wanted no more 13.2 11.2
Access, Equity, Quality and Choice:
Percent of users who chose their current method by themselves or jointly with a partner/provider 88.2 88.8
Percent of users who paid for family planning services 62.4 62.6
Method Information Index    
Percent of current users who were informed about other methods 60.1 64.1
Percent of current users who were informed about side effects 49.4 53.0
Percent of current users who were told what to do if they experienced side effects 82.6 84.0
Percent of current users who would return and/or refer others to their provider 74.2 73.4
Percent of women receiving family planning information in the past 12 months 16.2 20.4
Service Environment:
Charging fees for family planning    
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/Ghana-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 the 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.

In Ghana, survey resources allowed targeting a sample size of 100 enumeration areas (EAs) and a final sample size of 4,200 households. A total of 100 EAs were sampled throughout all regions in Ghana and selected from the Ghana Statistical Service’s master sampling frame. The primary sampling units for the survey were the EAs, created during the 2010 census. The EAs were selected systematically with probability proportional to size within urban and rural strata. The Ghana Statistical Service provided the selection probabilities for the PMA2020 sampled clusters which were used to construct sample weights.

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

Round 2 Sample Update

Data collection in Round 2 continued in the same EAs selected for Round 1. One EA was dropped after data collection due to data quality concerns and not included in the final dataset. Mapping and listing in PMA2020 is generally done on an annual basis (typically during Round 1 and Round 3). As Round 2 occurred approximately six months after Round 1, the original listing frame was used for selection of households in Round 2.

Field supervisors randomly selected 42 households from the original household listing using a random number-generating mobile-phone application. A household roster was completed and all eligible women age 15-49 in selected households were approached and 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 three private SDPs are randomly selected in each round.

Questionnaires

PMA2020 uses standardized questionnaires for households and service delivery points (SDPs) to gather data that is comparable across program countries and consistent with existing national surveys. Prior to launching the survey in each country, these questionnaires are reviewed and modified by local experts to ensure all questions are appropriate to each setting.

Three questionnaires were used to collect data from the PMA2014/Ghana-R2 survey: the household questionnaire, the female questionnaire and the service delivery point (SDP) questionnaire. These questionnaires were based on model surveys designed by PMA2020 staff at the Bill & Melinda Gates Institute for Population and Reproductive Health in Baltimore at the Johns Hopkins Bloomberg School of Public Health, Kwame Nkrumah University of Science & Technology (KNUST) School of Public Health in collaboration with University of Development Studies (UDS), and fieldwork materials of the Ghana Demographic and Health Survey (DHS).

All PMA2020 questionnaires are administered using Open Data Kit software and Android smartphones. The PMA2014/Ghana-R2 questionnaires were in English on the phone and had to be translated into local languages 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 administered the household questionnaire and female questionnaire in 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 index.

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 water, sanitation 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 collected information about the provision and quality of reproductive health services and products, integration of health services, and WASH within the SDP.

Training, Data Collection and Processing

Training

The PMA2014/Ghana-R2 fieldwork training was conducted in January 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 Kwame Nkrumah University of Science & Technology (KNUST) School of Medicine project staff. The refresher training started with a one-day training of field supervisors to update them on changes to the survey protocol since the previous round. The field supervisors then became the trainers for the three subsequent resident enumerator (RE) refresher training sessions that also took place in January 2014. Four groups of training were organized for REs. The first training had REs from three regions (Volta, Brong Ahafo and Eastern region) in Kumasi 1 and Kumasi 2 for only REs in the Ashanti region, while the second and the third training were organized in Tamale-UDS for Northern, Upper East and Upper West, and Accra for Western region, Central region, and Greater Accra REs, while REs from the remaining 61 EAs completed training a week later.

All participants received training in research ethics, comprehensive instruction on how to map and list households in EAs, and instruction on how to complete the household and female questionnaires using appropriate and ethical interview skills. In addition to PMA2020 survey training, all participants received training on contraceptive methods offered by a senior consultant at Komfo Anokye Teaching hospital (KATH).

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 and community leaders and engaging the communities.

Data Collection and Processing

Data collection was conducted between February and May 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 all project smartphones. The ODK questionnaire forms are programmed with automatic skip-patterns and built-in 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 KNUST and the data manager at the Gates Institute in Baltimore 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 May.

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 12 software.

Response Rates

The table below shows response rates for household and female respondents by residence (rural/urban) for PMA2014/Ghana-R2. A total of 4,142 households were selected for the PMA2014 Round 2 survey; 3,802 households were found to be occupied at the time of the fieldwork. Of the occupied households, 3,419 (89.9%) consented to a household-level interview. The response rate at the household level was higher in rural (93.7%) than in urban (86.2%) areas.

In the occupied households that provided an interview, a total of 4,126 eligible women aged 15 to 49 years were identified. Overall, 94.3% of the eligible women were available and consented to the interview. The female response rate was equitable between the rural (94.2%) and urban (94.4%) enumeration areas (EAs). Only de facto females are included in the PMA analyses; the final completed de facto female sample size was 3,893 (unweighted).

The final SDP sample included 132 facility interviews, of which 124 were completed for a response rate of 93.9%.

    PMA2014/Ghana-R2
Result   Urban Rural Total
Household interviews              
Households selected   2,140 2,002 4,142
Households occupied   1,925 1,877 3,802
Households interviewed   1,660 1,759 3,419
Household response rate* (%)   86.2 93.7 89.9
             
Interviews with women age 15 to 49
Number of eligible women**   1,920 2,206 4,126
Number of eligible women interviewed   1,814 2,078 3,892
Eligible women response rate (%)   94.4 94.2 94.3
*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 0.146 0.011 0.125 0.168
Currently using a traditional method 0.015 0.005 0.006 0.024
Currently using any contraceptive method 0.161 0.012 0.138 0.184
Currently using injectables 0.054 0.006 0.043 0.066
Currently using male condoms 0.018 0.005 0.009 0.027
Currently using implants 0.023 0.004 0.014 0.031
Chose method by self or jointly in past 12 months 0.870 0.022 0.827 0.913
Paid fees for family planning services in past 12 months 0.624 0.037 0.549 0.699
Informed by provider about other methods 0.601 0.034 0.533 0.668
Informed by provider about side effects 0.494 0.037 0.421 0.567
Satisfied with provider: Would return and refer friend/relative to provider 0.742 0.037 0.667 0.817
Visited by health worker who talked about family planning in past 12 months 0.162 0.020 0.122 0.201
Women in union age 15-49
Currently using a modern method 0.178 0.013 0.151 0.205
Currently using a traditional method 0.018 0.006 0.005 0.030
Currently using any contraceptive modern method 0.196 0.015 0.167 0.225
Currently using injectables 0.073 0.008 0.057 0.089
Currently using male condoms 0.014 0.004 0.006 0.022
Currently using implants 0.032 0.006 0.020 0.044
Chose method by self or jointly in past 12 months 0.875 0.027 0.822 0.928
Paid fees for family planning services in past 12 months 0.626 0.040 0.546 0.705
Informed by provider about other methods 0.641 0.039 0.564 0.718
Informed by provider about side effects 0.530 0.042 0.446 0.615
Satisfied with provider: Would return and refer friend/relative to provider 0.734 0.041 0.652 0.816
Visited by health worker who talked about family planning in past 12 months 0.204 0.026 0.152 0.257