SNAPSHOT OF INDICATORS
Summary of the sample design for PMA2016/Ethiopia-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. 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 years, 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 fourth round sample of 221 EAs and 7,651 households is designed to estimate modern contraceptive prevalence among all women at less than 2% margin of error at the national level, less than 3% for urban and rural estimates, and less than 5% at each of the five regional levels.
The table below provides a summary of key family planning indicators and their breakdown by background characteristics. Estimates for all indicators were collapsed by administrative region (Central, Western, Eastern, Northern) due to small sample sizes when disaggregated by background characteristics.
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 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. 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 service delivery points (SDPs) to be interviewed by an RE using the SDP questionnaire. The field supervisors themselves administered the SDP questionnaire 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 district hospital) designated to serve each EA population.
Round 4 Sample Update
At the request of the Ethiopian Ministry of Health, 21 additional EAs in Oromiya region were added in Round 3 to bring the total to 221 EAs nationally. Data collection for Round 4 was done in the same 221 EAs as Round 3. Mapping and listing was repeated to create an updated sample frame. Once listed, 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.
PMA2020 uses standardized questionnaires for households, females 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. The questionnaires were translated into three local languages.
The household questionnaire, the female questionnaire and the service delivery point questionnaire were based on model surveys designed by PMA2020 staff at the Bill & Melinda Gates Institute for Population and Reproductive 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 PMA2016/Ethiopia-R4 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. 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 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 collection 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 SDP.
The PMA2016/Ethiopia-R4 fieldwork training started with a two-week training of new 30 new field staff, including four new supervisors for the Oromiya region and was followed by a three-day refresher training for returning field staff. The two-week training was conducted from February 22 to March 4, 2016 and the concurrent refresher trainings were held March 9-11, 2016. For both sets of trainings, 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 Addis Ababa University School of Public Health project staff.
The first training took place at the Ethiopian Management Institute in Addis Ababa. In addition, concurrent refresher trainings in Addis Ababa and Mekele towns were held March 9-11; a total of 220 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 an Ethiopian 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 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 Amharic, whereas some small group sessions were conducted in Afan Oromiffa and Tigrigna.
The four new supervisors received additional training on how to oversee fieldwork and complete household re-interviews used to carry out random spot-checks in 10 percentage of the households interviewed by resident enumerators.
For the concurrent 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 Amharic, whereas some small group sessions were conducted in Afan Oromiffa and Tigrigna.
Data Collection & Processing
Data collection was conducted between March and April 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 Addis Ababa University in Ethiopia and the data manager from the Gates Institute 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 June.
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 26, 2016 at Elily Hotel Addis Ababa, Ethiopia.
This table shows response rates for household and female respondents by residence (rural/urban) for PMA2016/Ethiopia-R4. A total of 7,732 households were selected for the PMA2016-R4 survey; 7,695 households were found to be occupied at the time of the fieldwork. Of the occupied households, 7,651 households (99.4%) consented to a household-level interview. The response rate at the household level was the same in urban (99.4%) and rural (99.4%) enumeration areas (EAs).
In the occupied households that provided an interview, a total of 7,552 eligible women age 15 to 49 years were identified. Overall, 99.1% of the eligible women were available and consented to the interview. The female response rate was similar in the urban (98.9%) relative to the rural (99.2%) EAs. Only de facto females are included in the PMA analyses; the final completed de facto female sample size was 7,481.
The final service delivery point (SDP) sample included 468 interviews, of which 456 were completed, for a response rate of 97.4%.
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.
Addis Ababa University School of Public Health and The Bill & Melinda Gates Institute for Population and Reproductive Health at The Johns Hopkins Bloomberg School of Public Health. Performance Monitoring and Accountability 2020 (PMA2020) Survey Round 4, PMA2016/Ethiopia-R4 Snapshot of Indicators. 2016. Ethiopia and Baltimore, Maryland, USA.