Cote d'Ivoire Phase 2 Indicators

PMA Snapshot of Indicators (SOIs) provide a summary of key family planning indicators with breakdowns by background characteristics (age, marital status, parity, education, residence, wealth, region). The following is a description of the sample design, questionnaires, data collection, data processing, response rates and sample error estimates.

Survey Design for PMA Cote d’Ivoire- Phase 2

Performance Monitoring for Action (PMA), formerly PMA2020, builds on the previous success of PMA2020 surveys in Côte d’Ivoire and focused on collecting routine data on key global indicators in family planning and reproductive health, while expanding content area to address questions of contraceptive decision making and autonomy in order to better understand the determinants and consequences of unique contraceptive use and patterns of use in Côte d’Ivoire. These are measured through three-related data collection activities: Household and Female surveys (HQFQ) producing both cross-sectional and longitudinal data, Service Delivery Point panel surveys (SQ), and a Service Delivery Point Client Exit Interview surveys (CQ).

In Côte d’Ivoire, cross-sectional and panel Household and Female surveys (HQFQ) were conducted annually, with follow-up for the panel occurring at Year 2 and 3. The Service Delivery Point Survey (SQ) panel baseline data was collected at Year 1 and follow-up data, annually. The Service Delivery Point Client Exit Survey (CQ) was conducted biannually with a baseline and a follow-up occurring 6 months after the baseline enrollment each year.

PMA survey uses a multi-stage cluster design, with stratification at the urban and rural level and/or by region. The enumeration area (EA) is the primary sampling unit, obtained from the national statistics agency of the respective geography. Within each urban/rural or sub regional stratum, EAs are selected using probability proportional to size (PPS) method. In each of the EAs, all households and private health facilities are listed and mapped prior to baseline data collection. Listings of public health facilities that serve the selected EAs at all three levels are obtained from the Ministry of Health.

For Household and Female cross-sectional and panel surveys, resident enumerators (RE) conducted a full listing of households within each enumeration area (EA) annually. The annual listing is used to update the baseline weights to generate the cross-sectional estimates. At baseline, 35 households were randomly selected within each EA for interview. RE administered a household questionnaire, including completing a census of household members and guests who slept there the previous night for all selected households who consented to participate. Eligible female aged 15-49, who were usual members, were consented to participate in the female panel survey. Guests who slept at the households were included in the female cross-sectional survey.

PMA uses an open panel design, enrolling new eligible women at annual follow-ups (Year 2 and Year 3). Households selected at baseline and still residing in the EA were followed up in subsequent rounds. Adolescents in selected households aged 14 years in the previous round were enrolled in the panel as 15-year-olds starting in Year 2. Women aged 49 years at an earlier round were not interviewed in subsequent rounds. Households who moved out of the EA since baseline were considered lost-to-follow-up. New households residing in residential structures of households interviewed at baseline were enumerated and enrolled in the panel in subsequent rounds. New dwelling units were randomly selected from the updated household listing to replace vacant or demolished dwelling units over time.

PMA Côte d’Ivoire is led by the L'Ecole Nationale Supérieure de Statistique et d'Economie Appliquée (ENSEA) and the overall direction and support are provided the Bill & Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins University and Jhpiego. The funding is provided by the Bill & Melinda Gates Foundation.

Sample Design

PMA Cote D’Ivoire survey target sample size was determined based on the estimate of modern contraceptive prevalence rate (mCPR) among all women, with the 3% margin of error at the national level and 5% margin of error for urban and rural areas.

The Phase 2 survey includes 122 enumeration areas (EAs) selected using a multi-stage stratified cluster design with urban-rural strata. The results are representative at the national level and within urban/rural strata. The final samples include 3,830 (95.7%) households, 3,949 (96.2%) de facto females, 216 (96.4%) facilities, and 1,012 (96.9%) family planning service clients who completed the interviews. Data collection was conducted between September 2021 and December 2021.

Questionnaires

PMA uses standardized questionnaires to gather data about households, individual females, health facilities and family planning service clients that are comparable across program countries and consistent with existing national surveys. These questionnaires were based on model questionnaires designed by PMA staff at the Bill & Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, USA and L'Ecole Nationale Supérieure de Statistique et d'Economie Appliquée (ENSEA).

Four questionnaires were used to collect data in the PMA Cote d’Ivoire Phase 2 survey: the household questionnaire, the female questionnaire, the service delivery point questionnaire, and the client exit interview questionnaire. Prior to launching the survey in each country, local experts review and modify these questionnaires to ensure all questions are appropriate to each setting. In Cote d’Ivoire, the questionnaire forms were not translated into the local languages, instead language experts were onsite during the trainings to work with the REs in these languages.

PMA questionnaires are administered using Open Data Kit (ODK) software and Android smartphones. The questionnaires are in French. The REs could switch to ten local languages (Akye, Abbey, Malinke, Guere, Yacouba, Bete, Dida, Senoufo, Baoulé and Agni). The interviews were conducted in French or the local language whichever the respondent was more comfortable using.

Female resident enumerators (REs) in each 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.

The female questionnaire is used to collect information from all women aged 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; and exposure to family planning messaging in the media, migration, empowerment, and the impact of the Covid-19 pandemic on household and family planning access.

The Service Delivery Point (SDP) questionnaire collects information about the provision and quality of reproductive health services and products, integration of health services, and water and sanitation within the SDP. The Client Exit Interview collects information about family planning services and contraceptive counseling, user experience with the current method, as well as contraceptive use, discontinuation, and future use.

Training, Data Collection & Processing

Training

Training for the PMA Cote d’Ivoire Phase 2 (CIP2) survey was held from August 23, 2021 to September 8, 2021 and was led by the L'Ecole Nationale Supérieure de Statistique et d'Economie Appliquée (ENSEA) with onsite support from the Burkina Faso team (the Hub) and remote support from PMA staff at the Johns Hopkins Bloomberg School of Public Health. Resident enumerators (REs) were recruited from the selected enumeration areas included in the sample design. New REs to PMA were trained in general smartphone use, the PMA data collection platform called Open Data Kit (ODK) Collect, the art of asking questions, the ethics of survey research, and informed consent procedures. All REs were trained on the questionnaire content using a mix of lecture, paired practice, videos, and small group discussions. Throughout the training, REs and supervisors were evaluated based on their performance on several written and phone-based assessments as well as class participation. The RE trainings were conducted primarily in French, some small group sessions were conducted in local languages in which the survey may be conducted.

Data Collection & Processing

PMA 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 prevent 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 daily monitoring of data collection progress, concurrent data processing, and course corrections while PMA was still active in the field. Throughout data collection, the central staff at the L'Ecole Nationale Supérieure de Statistique et d'Economie Appliquée (ENSEA) and 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. 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 16 software.

Response Rates

A total of 4,311 households were selected for the survey; 4,154 households were found to be occupied at the time of the fieldwork. Of the occupied households 3,830 (95.7%) consented to a household-level interview. The response rate for the household interview was higher in the rural (99.0%) relative to the urban (93.4%) enumeration areas (EAs).

In the occupied dwelling units that completed a household interview, a total of 4,104 eligible women aged 15 to 49 years were identified. Overall, 96.2% of the eligible women completed the female cross-section interview. The female response rate was higher in the rural (98.0%) relative to the urban (95.0%) EAs. Only de facto females were included in the PMA analyses; the final completed de facto female sample size was 3,949.

All SOI indicator estimates are weighted. Weights are generated to account for non-response at the household and the individual level.

Sample Error Estimates

L'Ecole Nationale Supérieure de Statistique et d'Economie Appliquée (ENSEA) and the Bill & Melinda Gates Institute for Population and Reproductive Health at The Johns Hopkins Bloomberg School of Public Health. Performance Monitoring for Action (PMA) Survey Phase 2, PMA/Côte D'Ivoire-P2 Snapshot of Indicators. 2021. Abidjan, Cote d'Ivoire and Baltimore, Maryland, USA.