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.
PMA Kenya Survey Design
Performance Monitoring for Action (PMA), formerly PMA2020, builds on the previous success of PMA2020 surveys in Kenya and focuses 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 Kenya. 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 Kenya, a cross-sectional and panel Household and Female surveys (HQFQ) are conducted annually, with follow-up for the panel occurring in Years 2 and 3. The Service Delivery Point Survey (SQ) panel baseline data is collected at Year 1 and follow-up data will be collected annually. The Service Delivery Point Client Exit Survey (CQ) is conducted biannually with a baseline and a follow-up occurring six 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 sub-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.
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 will be followed up in subsequent rounds. Adolescents in selected households who were aged 14 years in the previous round will be enrolled in the panel as 15-year-olds starting in Year 2. Women who were aged 49 years at an earlier round will not be interviewed in subsequent rounds. Households who moved out of the EA since baseline will be considered lost-to-follow-up. New households residing in residential structures of households interviewed at baseline will be enumerated and enrolled in the panel in subsequent rounds. In addition, when an initially sampled housing structure is vacant or demolished before Year 2 or Year 3 rounds, a new household will be randomly selected from the new household listing to replace the lost one.
PMA Kenya is led by the International Centre for Reproductive Health Kenya (ICRH-K) 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.
Summary of Phase 3 Cross-Section Sample
PMA Kenya 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 308 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 included 9,565 (95.9%) households, and 9,489 (98.5%) de facto women age 15-49and 953 facilities (91.2%) who completed the interviews. The data was collected between November and December 2021.
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; the International Centre for Reproductive Health Kenya; and Kenya National Bureau of Statistics..
Three questionnaires were used to collect data in the PMA Kenya Phase 3 survey: the household questionnaire, the female questionnaire, and the service delivery point 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.
All PMA questionnaires are administered using Open Data Kit (ODK) software and Android smartphones. The PMA KEP3 questionnaires were translated from English into Kiswahili and interviewers were conducted in the respondent’s preferred language. 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.
The PMA Kenya Phase 3 fieldwork started with a two-day training of trainers for nine supervisors in early October 2021, followed by a five-day training of new REs from October 11-15, 2021.
In addition to the new RE training, there was a refresher training for new and returning REs that took place from October 18-22, 2021, with a total of 263 enumerators trained. This refresher training was held in two waves across two separate hotels to comply with Kenya’s MoH COVID guidelines. Supervisors that were trained in early October supported the RE trainings.
The objective of the refresher training was to address the gaps and errors identified during Phase 2 data collection, to understand the questionnaire changes for Phase 3, and 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. Training content focused on the PMA study design that includes relocation protocols and tools for tracking and re-interviewing panel women. For the training, all participants were given comprehensive instruction on how to complete the household, female, and service delivery point (SDP) questionnaires.
Staff from the International Centre for Reproductive Health Kenya, PMA Kenya’s implementing partner, led all Phase 3 trainings with support from PMA staff from the Bill & Melinda Gates Institute for Population and Reproductive Health of the Johns Hopkins Bloomberg School of Public Health.
Data Collection & Processing
Unlike traditional paper-and-pencil surveys, 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 International Centre for Reproductive Health Kenya Kenya 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.
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.
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.
A total of 10,867 households were selected for the survey; 9,966 households were found to be occupied at the time of the fieldwork. Of the occupied households 9,565 (95.96%) consented to a household-level interview. The response rate for the household level was higher in the rural (97.4%) relative to the urban (93.5%) enumeration areas (EAs).
In the occupied households that provided an interview, a total of 9,629 eligible women aged 15 to 49 years were identified. Overall, 98.5% of the eligible women were available and consented to the interview. The female response rate was higher in the urban (98.9%) relative to the rural (98.5%) EAs. Only de facto females are included in the PMA analyses; the final completed de facto female sample size was 9,489.
All SOI indicator estimates are weighted. Weights are generated to account for non-response.
The International Centre for Reproductive Health Kenya 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 3, PMA/Kenya-P3 Snapshot of Indicators. 2022. Kenya and Baltimore, Maryland, USA.