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PMA2015/Kenya-R3 SOI

SNAPSHOT OF INDICATORS

Summary of the sample design for PMA2015/Kenya-R3:

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 county as strata, sampling across nine counties in Kenya: Nairobi, Kilifi, Nandi, Nyamira, Kiambu, Bungoma, Siaya, Kericho and Kitui. The first stage of sampling was a selection of nine of Kenya’s 47 counties, using probability proportional to size procedures. Within the nine counties, clusters were selected proportional to the urban/rural distribution. The final sample was designed to generate estimates of all women modern contraceptive prevalence rate with less than 3% margin of error at both the national and urban/rural level.

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 county 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 3
All Women Married Women
Utilization:
Contraceptive Use    
Contraceptive Prevalence Rate (CPR) 48.1 61.1
Modern Contraceptive Prevalence (mCPR) 46.5 58.8
Traditional Contraceptive Prevalence 1.6 2.2
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 14.6 17.1
Demand for family planning 62.7 78.2
Percent of all/married women with demand satisfied by modern contraception 74.2 75.3
Percent of recent birth, by intention
Wanted then 57.8 61.5
Wanted later 30.7 29.1
Wanted no more 11.5 9.3
Access, Equity, Quality and Choice:
Percent of users who chose their current method by themselves or jointly with a partner/provider 97.4 97.7
Percent of users who paid for family planning services 47.8 46.6
Method Information Index    
Percent of current users who were informed about other methods 66.5 69.0
Percent of current users who were informed about side effects 61.3 64.3
Percent of current users who were told what to do if they experienced side effects 88.8 88.7
Percent of current users who would return and/or refer others to their provider 87.6 89.4
Percent of women receiving family planning information in the past 12 months 10.5 11.9
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 PMA2015/Kenya-R3 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 subsequent year, to track progress.

PMA2014/Kenya Round 1 used a multi-stage cluster design with urban/rural and county as strata. The first stage of sampling was at the county level using probability proportional to size procedures to select nine out of 47 counties: Nairobi, Kilifi, Nandi, Nyamira, Kiambu, Bungoma, Siaya, Kericho and Kitui. Within the nine selected counties, 120 enumeration areas (EAs) were selected proportional to size with urban/rural stratification. The sample was powered to generate national and urban/rural estimates of all woman mCPR with less than 3% margin of error.

In each selected EA, field supervisors randomly selected up to three private service delivery points (SDPs) to be interviewed by an RE using the 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 designated to serve each EA (a dispensary, a health center and a referral hospital), either at the sub-county or county level.

Round 3 Sample Update

Data collection for Round 3 continued in the same 120 EAs selected in Round 1. Mapping and listing was repeated in Round 3. All households, health SDPs and key landmarks in each EA were listed and mapped by the REs to create a frame for the second stage of the sampling process. Field supervisors randomly selected 42 households using a phone-based random number-generating application. A household roster was completed and all eligible women age 15-49 were approached and asked to provide informed consent (and assent if aged 15-17) 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.

Questionnaires

PMA2020 uses standardized questionnaires for households, females and SDPs to gather data about households and individual females 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.

Three questionnaires were used to collect data from the PMA2015/Kenya-R3 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 at the Johns Hopkins Bloomberg School of Public Health in Baltimore and fieldwork materials of the 2008-09 Kenyan Demographic and Health Survey (KDHS).

All PMA2020 questionnaires are administered using Open Data Kit (ODK) software and Android smartphones. The PMA2015/Kenya-R3 questionnaires appeared in Kiswahili in addition to English. Female resident enumerators in each enumeration area (EA) administered the household and female questionnaires 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.

In each selected enumeration area, field supervisors randomly selected up to three private SDPs to be interviewed by a resident enumerator using the SDP questionnaire. The field supervisors themselves administered the SDP questionnaires at an additional three public SDPs that serve each EA. The SDP questionnaire collected information about the provision and quality of reproductive health services and products, integration of health services, and water and sanitation within the health facility.

Training, Data Collection and Processing

Training

The PMA2015/Kenya-R3 fieldwork training started with a two-week training of new 25 new field staff and was immediately followed by a two-day refresher training for returning field staff. The two-week training was conducted from May 11-20, 2015, and the refresher training was held May 21-23. 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 the support of staff from the International Centre for Reproductive Health Kenya (ICRH-K), PMA2020/Kenya's implementing partner. All the trainings took place the Kericho Tea Hotel in Kericho county, Kenya. A total of 120 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 a Kenyan obstetrician/gynecologist.

Throughout the two-week training, REs were evaluated based on their performance on several written and phone-based assessments, mock field exercises and class participation. As all questionnaires were completed on project smartphones, the training also familiarized participants with Open Data Kit (ODK) and smartphone use in general. The two-week training training included three days of field exercises, during which participants entered a mock enumeration area (EAs) to practice listing, mapping and conducting household, female and SDP interviews; recording all responses on their project phones; and submitting to a practice cloud server—a centralized data storage system. The RE trainings were conducted primarily in English, whereas some small group sessions were conducted in Kiswahili.

For the refresher training, all training participants were given instructions on survey changes to the tools since the previous round.

The REs and supervisors were all evaluated based on their performance on phone-based assessments. Similar to the two-week training, the two-day refresher trainings was conducted primarily in English, whereas some small group sessions were conducted in Kiswahili.

Data Collection and Processing

Data collection was conducted between June and July 2015. Unlike traditional paper-and-pencil surveys, PMA2020 uses 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 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 ICRH-K in Kenya and the data manager at the Gates Institute at Johns Hopkins 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 July.

Once all data were on the server, data analysts cleaned and de-identified the data, applied survey weights, and prepared the final data set for analysis using Stata® version 14 software.

Response Rates

The table below shows response rates for household and female respondents by residence (rural/urban) for PMA2015/Kenya-R3. A total of 5,040 households were selected for the PMA2015/Kenya Round 3 survey, and 4,958 households were found to be occupied at the time of the fieldwork. Of the occupied households, 4,810 (97.0%) consented to a household-level interview. The response rate at the household level was higher in rural (99.1%) than in urban (94.0%) areas.

In the occupied households that provided an interview, a total of 4,452 eligible women age 15 to 49 years were identified. Overall, 98.7% of the eligible women were available and consented to the interview. The female response rate was slightly higher in the rural (99.3%) relative to the urban (97.8%) enumeration areas (EAs). Only de facto females are included in the PMA analyses; the final completed de facto female sample size was 4,396.

The final SDP sample include 358 facility interviews, of which 348 were completed for a response rate of 97.2%.

    PMA2015/Kenya-R3
Result   Urban Rural Total
Household interviews              
Households selected   2,100 2,940 5,040
Households occupied   2,048 2,910 4,958
Households interviewed   1,925 2,885 4,810
Household response rate* (%)   94.0 99.1 97.0
             
Interviews with women ages 15 to 49
Number of eligible women**   1,709 2,743 4,452
Number of eligible women interviewed   1,671 2,725 4,396
Eligible women response rate (%)   97.8 99.3 98.7
*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 0.465 0.016 0.433 0.498
Currently using a traditional method 0.016 0.003 0.010 0.021
Currently using any contraceptive method 0.481 0.016 0.448 0.513
Currently using injectables 0.231 0.011 0.210 0.252
Currently using male condoms 0.039 0.005 0.030 0.049
Currently using implants 0.102 0.007 0.088 0.115
Chose method by self or jointly in past 12 months 0.974 0.005 0.964 0.984
Paid fees for family planning services in past 12 months 0.466 0.024 0.419 0.512
Informed by provider about other methods 0.659 0.021 0.617 0.700
Informed by provider about side effects 0.613 0.026 0.562 0.664
Satisfied with provider: Would return and refer friend/relative to provider 0.876 0.019 0.839 0.913
Visited by health worker who talked about family planning in past 12 months 0.105 0.010 0.085 0.124
Women in union age 15-49
Currently using a modern method 0.588 0.017 0.555 0.622
Currently using a traditional method 0.022 0.004 0.014 0.031
Currently using any contraceptive modern method 0.611 0.017 0.578 0.644
Currently using injectables 0.310 0.014 0.283 0.336
Currently using male condoms 0.025 0.005 0.016 0.034
Currently using implants 0.138 0.009 0.120 0.156
Chose method by self or jointly in past 12 months 0.977 0.005 0.967 0.986
Paid fees for family planning services in past 12 months 0.453 0.025 0.403 0.503
Informed by provider about other methods 0.681 0.021 0.639 0.722
Informed by provider about side effects 0.642 0.026 0.591 0.693
Satisfied with provider: Would return and refer friend/relative to provider 0.894 0.016 0.862 0.927
Visited by health worker who talked about family planning in past 12 months 0.119 0.011 0.097 0.142