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PMA2016/Kenya-R5 SOI

SNAPSHOT OF INDICATORS

Summary of the sample design for PMA2016/Kenya-R5:

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. In Round 5 and onwards, data collection is conducted in a new selection of EAs to reduce respondent fatigue within communities that have been surveyed multiple times. Households within the EA are randomly sampled during each round. The original Round 1 sample design summary is provided below as are Round 5 updates (scroll down to the “Sample Design” tab).

PMA2016/Kenya-R5, the fifth round of data collection in Kenya, 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 11 out of 47 counties: Nairobi, Kilifi, Nandi, Nyamira, Kiambu, Bungoma, Siaya, Kericho, Kitui, Kakamega, and West Pokot. Kakamega and West Pokot were added during this fifth survey round. Within the 11 selected counties, 151 EAs were then selected by the Kenya National Bureau of Statistics. The sample was powered to generate national estimates of all women mCPR with less than 3% margin of error. The survey was also able to generate estimates on family planning services by including a random sample of up to three private service delivery points within each EA’s boundary. In addition, three public health service delivery points that serve the EA population were also selected—a dispensary, a health center and a referral hospital, either at the sub-county or county level.

The table below provides a summary of key family planning indicators and their breakdown by respondent 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. Additional details 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 5
All Women Married Women
Utilization:
Contraceptive Use    
Contraceptive Prevalence Rate (CPR) 45.6 61.6
Modern Contraceptive Prevalence (mCPR) 44.2 59.9
Traditional Contraceptive Prevalence 1.4 1.7
Contraceptive Method Mix    
Contraceptive method mix (stacked bar charts for all/married women)    
Demand Indicators:
Unmet need for family planning 12.9 15.2
Demand for family planning 58.5 76.8
Percent of women with demand satisfied by modern contraception 75.6 77.9
Percent of recent births, by intention
Wanted then 57.1 61.3
Wanted later 27.1 24.7
Wanted no more 15.8 14.0
Access, Equity, Quality and Choice:
Percent of users who chose their current method by themselves or jointly with a partner/provider 96.4 96.6
Percent of users who paid for family planning services 47.5 46.2
Method Information Index Components    
Percent of current users who were informed about other methods 71.1 73.5
Percent of current users who were informed about side effects 60.6 62.4
Percent of current users who were told what to do if they experienced side effects 90.7 91.4
Percent of current users who would return and/or refer others to their provider 91.2 91.1
Percent of women receiving family planning information in the past 12 months 13.4 16.6

The PMA2016/Kenya-R5 Survey in Detail

Sample Design

Round 1 Sample Design

The PMA2020 survey collects data annually at the national, urban and rural, and, in some countries, selected sub-national 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 5 Sample Update

A new selection of 120 EAs in the original nine counties (Nairobi, Kilifi, Nandi, Nyamira, Kiambu, Bungoma, Siaya, Kericho, and Kitui) was done by the Kenya National Bureau of Statistics by randomly selecting EAs from the list of EAs that were geographically adjacent to Round 1-4 EAs. In two additional counties, Kakamega and West Pokot, the Kenya National Bureau of Statistics drew 31 new EAs from the master sampling using the same strategy as in Round 1.

All households, health service delivery points 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, random sample of three 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 PMA2016/Kenya-R5 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-R5 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.

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 PMA2016/Kenya-R5 fieldwork started with a two-week training of approximately 30 new field staff from the newly added counties of Kakamega and West Pokot. The two-week training and the refresher training were hold in October 2016. For both sets of trainings, staff from the International Centre for Reproductive Health Kenya (ICRH-K), PMA2020/Kenya's implementing partner, led the training with support from PMA2020 staff from the Bill & Melinda Gates Institute for Population and Reproductive Health of the Johns Hopkins Bloomberg School of Public Health.

This 10-day training was followed by a three-day refresher training for the returning field staff. The objective of the refresher training was to address the gaps and errors identified during Round 3 data collection, to understand the questionnaire changes for Round 4, to refresh the knowledge and skills on questionnaire content and the art of asking questions through paired interviews. In addition, field staff were also reminded of key survey protocols they needed to abide by, including consent administration and research ethics. Both trainings both took place in Machakos county, Kenya.

For the two-week training, all training participants 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 and supervisors were evaluated based on their performance on several written and phone-based assessments, mock field exercises and class participation. The training included three days of mock field exercises, during which participants entered a mock enumeration area (EA) 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, some small group sessions were conducted in Kiswahili.

For the refresher trainings, 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 three-day refresher trainings were conducted primarily in English.

Data Collection and Processing

Data collection was conducted between November and December 2016. 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 December.

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® software. Data analysis for preliminary findings was conducted between January and March 2016. The preliminary results were released to the public in June and the national dissemination workshop of the results from the survey round was held on July 14, 2016 at Crowne Plaza Hotel, Nairobi, Kenya.

Response Rates

The table below shows response rates for household and female respondents by residence (rural/urban) for PMA2016/Kenya-R5. A total of 6,343 households were selected for the Round 5 survey; 6,239 households were found to be occupied at the time of the fieldwork. Of the occupied households, 6,073 (97.3%) consented to a household-level interview. The response rate at the household level was higher in rural (99.1%) than in urban (94.4%) areas.

In the occupied households that provided an interview, a total of 5,961 eligible women age 15 to 49 years were identified. Overall, 98.9% of the eligible women were available and consented to the interview. The female response rate was slightly higher in the rural (99.2%) relative to the urban (98.2%) enumeration areas (EAs). Only de facto females are included in the analyses; the final completed de facto female sample size was 5,894.

    PMA2016/Kenya-R5
Result   Urban Rural Total
Household interviews              
Households selected   2,436 3,907 6,343
Households occupied   2,372 3,867 6,239
Households interviewed   2,239 3,834 6,073
Household response rate* (%)   94.4 99.1 97.3
             
Interviews with women age 15 to 49
Number of eligible women**   2,102 3,859 5,961
Number of eligible women interviewed   2,064 3,830 5,894
Eligible women response rate (%)   98.2 99.2 98.9
*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 0.442 0.012 0.419 0.466
Currently using a traditional method 0.014 0.002 0.010 0.018
Currently using any contraceptive method 0.456 0.012 0.433 0.479
Currently using injectables 0.204 0.008 0.188 0.220
Currently using male condoms 0.035 0.004 0.027 0.043
Currently using implants 0.126 0.006 0.114 0.138
Chose method by self or jointly in past 12 months 0.964 0.006 0.951 0.976
Paid fees for family planning services in past 12 months 0.462 0.021 0.420 0.503
Informed by provider about other methods 0.708 0.019 0.672 0.745
Informed by provider about side effects 0.605 0.022 0.562 0.649
Satisfied with provider: Would return and refer friend/relative to provider 0.912 0.010 0.892 0.932
Visited by health worker who talked about family planning in past 12 months 0.134 0.011 0.111 0.156
Women in union age 15-49
Currently using a modern method 0.599 0.015 0.570 0.628
Currently using a traditional method 0.017 0.003 0.012 0.023
Currently using any contraceptive modern method 0.616 0.014 0.587 0.645
Currently using injectables 0.291 0.012 0.267 0.315
Currently using male condoms 0.027 0.004 0.018 0.035
Currently using implants 0.181 0.009 0.163 0.200
Chose method by self or jointly in past 12 months 0.966 0.007 0.952 0.979
Paid fees for family planning services in past 12 months 0.451 0.023 0.406 0.496
Informed by provider about other methods 0.732 0.018 0.696 0.769
Informed by provider about side effects 0.624 0.022 0.580 0.667
Satisfied with provider: Would return and refer friend/relative to provider 0.911 0.011 0.889 0.933
Visited by health worker who talked about family planning in past 12 months 0.166 0.015 0.136 0.195