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PMA2016/Uganda-R4 SOI

SNAPSHOT OF INDICATORS

Summary of the sample design for PMA2016/Uganda-R4:

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. For clarity, the original Round 1 sample design summary is provided below.

PMA2020 uses a two-­stage cluster design with residential area (urban and rural) and sub-regions as strata. The first stage of sampling was a selection of clusters within each sampling stratum using probability proportional to size procedures. The sample was 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 at the national level and their breakdown by background characteristics. Disaggregation by administrative unit was done at the region level (Central, Western, Eastern, and Northern) 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 4
All Women Married Women
Utilization:
Contraceptive Use    
Contraceptive Prevalence Rate (CPR) 31.1 36.9
Modern Contraceptive Prevalence (mCPR) 27.5 32.2
Traditional Contraceptive Prevalence 3.6 4.8
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 23.8 30.5
Demand for family planning 55.0 67.4
Percent of all/married women with demand satisfied by modern contraception 50.0 47.7
Percent of recent births, by intention
Wanted then 56.2 58.6
Wanted later 27.1 25.7
Wanted no more 16.8 15.7
Access, Equity, Quality and Choice:
Percent of users who chose their current method by themselves or jointly with a partner/provider 93.0 94.4
Percent of users who paid for family planning services 38.4 36.9
Method Information Index    
Percent of current users who were informed about other methods 60.8 63.4
Percent of current users who were informed about side effects 61.7 64.6
Percent of current users who were told what to do if they experienced side effects 84.8 87.3
Percent of current users who would return and/or refer others to their provider 85.0 85.6
Percent of women receiving family planning information in the past 12 months 15.6 18.1
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 PMA2016/Uganda-R4 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.

Survey resources allowed targeting a sample size of 110 enumeration areas (EAs) and a final sample size of 4,840 households. A total of 110 EAs were sampled throughout all 10 sub-regions in Uganda selected by the Uganda Bureau of Statistics (UBOS) 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, created during the 2002 National Population and Housing Census. The EAs were selected systematically with probability proportional to size with urban/rural stratification in the 10 sub-regions. The rationale was for PMA2020 estimates to be comparable to the most recent national survey estimates. UBOS provided the selection probabilities for the PMA2020 sampled clusters for constructing weights.

In each selected EA, field supervisors randomly selected up to three private service delivery points (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 lowest, second-lowest, and third-lowest level public health SDPs designated to serve each EA.

Round 4 Sample Update

Data collection for Round 4 continued in the same EAs as all previous rounds. Mapping and listing occurred in Round 3. As Round 4 was approximately six months after the Round 3 mapping and listing activity, mapping and listing was not repeated in Round 4. Rather, the Round 3 household list was used for selection into the sample.

Field supervisors randomly selected 44 households from the original household listing. 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 a new sample of the private SDPs is selected during each round.

Questionnaires

PMA2020 uses standardized questionnaires 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. All female questionnaires were translated into the local languages based on the Uganda Bureau of Statistics (UBOS) sub-regions, and translations were reviewed for appropriateness.

The household, the female and the service delivery point (SDP) questionnaires were based on model surveys designed by PMA2020 staff at the Bill & Melinda Gates Institute for Population and Reproductive Health, the Makerere University School of Public Health, and fieldwork materials of the Uganda Demographic and Health Survey (DHS).

All PMA2020 questionnaires are administered using Open Data Kit (ODK) software and Android smartphones. The PMA2016/Uganda-R4 questionnaires were in English and could be switched into eight local languages (Luganda, Ngakarimojong, Runyankole, Runyoro-Rutoro, Luo, Lugbara, Ateso, and Lusoga) on the phone. 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 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 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 collected 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 PMA2016/Uganda-R4 fieldwork refresher training of all the continuing staff on the project – 15 field supervisors, three central staff and 110 resident enumerators (REs) – was held from March 21 to March 25, 2016. 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 the Uganda Bureau of Statistics (UBOS) and Makerere University School of Public Health (MakSPH) project staff. The training was held in Kampala City, at the Global Grand Hotel on the outskirts of Makerere University.

As this was a refresher training for continuing staff, the training focused on a handful of newly added questions to the household, female and service delivery point (SDP) questionnaires and review of survey content and protocol.

Data Collection and Processing

Data collection was conducted between April and May 2016. 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 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 MakSPH in Kampala, Uganda 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 May.

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. The national dissemination workshop of preliminary results was held on August 24, 2016 at Serena Hotel, Kampala, Uganda.

Response Rates

The table below shows response rates for household and female respondents by residence (rural/urban) for PMA2016/Uganda-R4. A total of 4,839 households were selected for the survey; 4,433 households were found to be occupied at the time of the fieldwork. Of the occupied households 4,191 (94.5%) consented to a household-level interview. The response rate for the household level was higher in the rural (96.2%) relative to the urban (90.1%) enumeration areas (EAs).

In the occupied households that provided an interview, a total of 3,992 eligible women aged 15 to 49 years were identified. Overall, 95.0% of the eligible women were available and consented to the interview. The female response rate was higher in the rural (96.7%) relative to the urban (90.3%) EAs. Only de facto females are included in the PMA analyses; the final completed de facto female sample size was 3,793 (unweighted).

The final service delivery point (SDP) sample include 378 interviews, of which 350 were completed for a response rate of 92.6%.

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.

    PMA2016/Uganda-R4
Result   Urban Rural Total
Household interviews              
Households selected   1,364 3,475 4,839
Households occupied   1,217 3,216 4,433
Households interviewed   1,096 3,095 4,191
Household response rate* (%)   90.1 96.2 94.5
             
Interviews with women age 15-49
Number of eligible women**   1,078 2,914 3,992
Number of eligible women interviewed   973 2,820 3,793
Eligible women response rate (%)   90.3 96.7 95.0
*Household response rate = households completed/households occupied

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

Eligible response rate = eligible women interviewed/eligible women

Sample Error Estimates

The following table shows sample errors for the PMA2020 indicators described above. More information about PMA2020 indicators, including estimate type and base population, can be viewed here.

   
Variable Value[R] Standard Error Confidence Interval
R-2SE R+2SE
All women age 15 to 49
Currently using a modern method 0.275 0.013 0.250 0.301
Currently using a traditional method 0.036 0.005 0.027 0.045
Currently using any contraceptive method 0.311 0.014 0.284 0.338
Currently using injectables 0.149 0.009 0.132 0.166
Currently using condoms 0.034 0.005 0.024 0.044
Currently using implants 0.041 0.005 0.031 0.051
Chose method by self or jointly in past 12 months 0.914 0.016 0.883 0.945
Paid fees for family planning services in past 12 months 0.384 0.026 0.331 0.436
Informed by provider about other methods 0.608 0.030 0.548 0.668
Informed by provider about side effects 0.617 0.028 0.561 0.674
Satisfied with provider: Would return and refer friend/relative to provider 0.850 0.018 0.813 0.886
Visited by health worker who talked about family planning in past 12 months 0.156 0.017 0.121 0.190
Married women age 15 to 49
Currently using a modern method 0.322 0.016 0.290 0.354
Currently using a traditional method 0.048 0.007 0.035 0.061
Currently using any contraceptive method 0.369 0.016 0.337 0.402
Currently using injectables 0.184 0.012 0.160 0.207
Currently using condoms 0.024 0.004 0.016 0.032
Currently using implants 0.050 0.007 0.036 0.064
Chose method by self or jointly in past 12 months 0.931 0.015 0.900 0.961
Paid fees for family planning services in past 12 months 0.369 0.028 0.313 0.426
Informed by provider about other methods 0.634 0.033 0.569 0.699
Informed by provider about side effects 0.646 0.029 0.589 0.704
Satisfied with provider: Would return and refer friend/relative to provider 0.856 0.017 0.822 0.891
Visited by health worker who talked about family planning in past 12 months 0.181 0.021 0.140 0.223