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PMA2020 / PMA2015/Ethiopia-R3 SOI

PMA2015/Ethiopia-R3 SOI

SNAPSHOT OF INDICATORS

Summary of the sample design for PMA2015/Ethiopia-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/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 third round sample of 221 EAs and 7,735 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 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.

Download the full SOI tables >>

PMA2020 Standard
Family Planning Indicators

 Round 3
All Women Married Women
Utilization:
Contraceptive Use    
Contraceptive Prevalence Rate (CPR) 26.4 37.0
Modern Contraceptive Prevalence (mCPR) 25.6 35.8
Traditional Contraceptive Prevalence 0.8 1.2
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 16.5 24.4
Demand for family planning 43.0 61.4
Percent of all/married women with demand satisfied by modern contraception 59.7 58.3
Percent of recent births, by intention
Wanted then 65.7 65.8
Wanted later 22.9 23.4
Wanted no more 11.4 10.5
Access, Equity, Quality and Choice:
Percent of users who chose their current method by themselves or jointly with a partner/provider 85.6 84.9
Percent of users who paid for family planning services 22.8 21.4
Method Information Index    
Percent of current users who were informed about other methods 61.2 62.4
Percent of current users who were informed about side effects 52.4 53.1
Percent of current users who were told what to do if they experienced side effects 83.6 84.8
Percent of current users who would return and/or refer others to their provider 76.4 77.0
Percent of women receiving family planning information in the past 12 months 21.3 25.5
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/Ethiopia-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 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 area. 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 an RE 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 3 Sample Update

At the request of the Ethiopian Ministry of Health, 21 additional EAs in the Oromiya region were added in Round 3 to bring the total to 221 EAs nationally. The additional 21 EAs were selected systematically with probability proportional to size and urban or rural stratification by the CSA. The original sampling probabilities were adjusted to accommodate the additional sample of EAs.

Data collection for Round 3 continued in the same 200 EAs selected in Round 1 and the additional 21 EAs. Mapping and listing was conducted for the newly selected EAs in Oromiya. For the original 200 EAs, mapping and listing was not repeated. 35 households were randomly selected by field supervisors using a phone-based random number-generating application. All occupants in selected households were enumerated and from this list, all eligible women age 15-49 were approached and asked to give informed consent 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 and service delivery points (SDPs) to gather data about households, individual females and 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.

Three questionnaires were used to collect data from the PMA2015/Ethiopia-R3 survey: the household questionnaire, the female questionnaire and the service delivery point 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, Addis Ababa University (AAU), 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 PMA2015/Ethiopia-R3 questionnaires were in English and could be switched into the three local languages (Amharic, Afan Oromiffa and Tigrigna) 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 (REs) 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 durable goods, as well as characteristics of the dwelling unit, including wall, floor, and roof material, 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 health facility.

Training, Data Collection & Processing

Training

The PMA2015/Ethiopia-R3 fieldwork training started with two simultaneous refresher trainings for all returning field staff. Both trainings were held from April 6-8, 2015. The PMA2015/Ethiopia team increased the sample to add an additional 21 new enumeration areas (EAs) in Oromiya, although new staff to cover the additional EAs were not recruited in time for data collection. The team delayed the hiring of new staff to the start of the fourth survey round, and asked high performing resident enumerators (REs) to take on the additional EAs during this round. PMA2020 staff from the Bill & Melinda Gates Institute for Population and Reproductive Health led the training, with support from Addis Ababa University School of Public Health project staff. The concurrent trainings were held in Addis Ababa and Gondar towns; a total of 200 REs received training. All training participants were given instructions on survey changes to the tools since the previous round.

The REs and supervisors were evaluated based on their performance on phone-based assessments, practical field exercises for the SDP survey, and class participation. The RE trainings were conducted primarily in Amharic, whereas some small group sessions were conducted in Afan Oromiffa and Tigrigna.

Data Collection & Processing

Data collection was conducted April to May 2015. 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 Addis Ababa University School of Public Health in Addis Ababa 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 data set for analysis using Stata® version 14 software. The national dissemination workshop of preliminary results was held on August 25th, 2016 at Elily Hotel Addis Ababa, Ethiopia.

Response Rates

The table below shows response rates for household and female respondents by residence (rural/urban) for PMA2015/Ethiopia-R3. A total of 7,735 households were selected for the PMA2015/Ethiopia-R3 survey; 7,703 households were found to be occupied at the time of the fieldwork. Of the occupied households, 7,643 (99.2%) of the occupied households consented to a household-level interview. The response rate at the household level was similar in urban (99.1%) and rural (99.4%) enumeration areas (EAs).

In the occupied households that provided an interview, a total of 7,604 eligible women aged 15 to 49 years were identified. Overall, 99.2% of the eligible women were available and consented to the interview. The female response rate was similar in the rural (99.1%) relative to the urban (99.4%) EAs. Only de facto females are included in the PMA analyses; the final completed de facto female sample size was 7,545 (unweighted).

The final service delivery point (SDP) sample included 453 facility interviews, of which 445 were completed for a response rate of 98.2%.

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.

    PMA2015/Ethiopia-R3
Result   Urban Rural Total
Household interviews              
Households selected   3,815 3,920 7,735
Households occupied   3,803 3,900 7,703
Households interviewed   3,767 3,876 7,643
Household response rate* (%)   99.1 99.4 99.2
             
Interviews with women age 15-49
Number of eligible women**   3,872 3,732 7,604
Number of eligible women interviewed   3,847 3,698 7,545
Eligible women response rate† (%)   99.4 99.1 99.2
*Household response rate = households completed/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 0.256 0.013 0.230 0.283
Currently using a traditional method 0.008 0.002 0.004 0.012
Currently using any contraceptive method 0.264 0.014 0.238 0.291
Currently using injectables 0.175 0.011 0.152 0.197
Currently using male condoms 0.005 0.001 0.003 0.007
Currently using implants 0.053 0.005 0.043 0.064
Chose method by self or jointly in past 12 months 0.852 0.021 0.811 0.894
Paid fees for family planning services in past 12 months 0.228 0.022 0.185 0.271
Informed by provider about other methods 0.612 0.026 0.561 0.664
Informed by provider about side effects 0.524 0.029 0.466 0.582
Satisfied with provider: Would return and refer friend/relative to provider 0.764 0.021 0.722 0.805
Visited by health worker who talked about family planning in past 12 months 0.213 0.018 0.177 0.248
Women in union age 15-49
Currently using a modern method 0.358 0.019 0.320 0.396
Currently using a traditional method 0.012 0.003 0.006 0.017
Currently using any contraceptive modern method 0.370 0.020 0.330 0.409
Currently using injectables 0.249 0.016 0.217 0.281
Currently using male condoms 0.003 0.001 0.001 0.004
Currently using implants 0.075 0.008 0.060 0.090
Chose method by self or jointly in past 12 months 0.846 0.023 0.800 0.892
Paid fees for family planning services in past 12 months 0.214 0.022 0.170 0.258
Informed by provider about other methods 0.624 0.028 0.569 0.678
Informed by provider about side effects 0.531 0.031 0.470 0.592
Satisfied with provider: Would return and refer friend/relative to provider 0.770 0.022 0.728 0.813
Visited by health worker who talked about family planning in past 12 months 0.255 0.023 0.211 0.300