SNAPSHOT OF INDICATORS
Summary of the sample design for PMA2015/Kenya-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.
PMA2015/Kenya-R4, the fourth round of data collection in Kenya, used a multi-stage cluster design with urban/rural regions 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, enumeration areas (EAs) were selected proportional to size with urban/rural stratification. 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.
Round 1 Sample Design
The PMA2020 survey collects data annually at the national (urban and rural) and regional 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 4 Sample Update
Data collection for Round 4 continued in the same 120 EAs selected in Round 1. Mapping and listing was repeated in Round 4. All households, health SDPs 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 sample of the private SDPs is selected during each round.
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 PMA2015/Kenya-R4 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-R4 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.
In each selected EA, field supervisors randomly selected up to three private SDPs to be interviewed by a resident enumerator using the SDP questionnaire. The field supervisors themselves administered the SDP questionnaires at an additional three public SDPs that serve each EA. 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.
The PMA2015/Kenya-R4 fieldwork started with a three-day refresher training for the resident enumerators (REs), held October 22-24. 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 art of asking questions through paired interviews. In addition, field staff were also reminded of key survey protocol they needed to abide by including consent administration and research ethics. PMA2020 staff from the Bill & Melinda Gates Institute for Population and Reproductive Health of the Johns Hopkins Bloomberg School of Public Health provided remote support for the training, via email, Skype and other video conferencing platforms. The staff from the International Centre for Reproductive Health Kenya (ICRH-K), PMA2020/Kenya's implementing partner led the training. The refresher training took place the Kericho Tea Hotel in Kericho county, Kenya.
Throughout the refresher training, REs were evaluated based on their performance on written and phone-based assessments, mock field exercises and class participation. The training was conducted primarily in English, whereas some small group sessions were conducted in Kiswahili. Supervisors received additional training prior to and after the RE training to further strengthen their supervision skills, including instruction on conducting re-interviews, carrying out random spot checks, and other quality control measures and dealing with the local and community leaders and engaging the communities.
Data Collection and Processing
Data collection was conducted between November and December 2015. 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® version 14 software. Data analysis for preliminary findings was conducted between January and March 2016. The preliminary results were released to the public in March and the national dissemination workshop of the results from the survey round was held on June 29, 2016 at Sarova Panafric Hotel, Nairobi, Kenya.
This table shows response rates for household and female respondents by residence (rural/urban) for PMA2015/Kenya-R4. A total of 5,039 households were selected for the Round 4 survey; 4,928 households were found to be occupied at the time of the fieldwork. Of the occupied households, 4,792 (97.2%) consented to a household-level interview. The response rate at the household level was higher in rural (99.0%) than in urban (94.7%) areas.
In the occupied households that provided an interview, a total of 4,984 eligible women age 15 to 49 years were identified. Overall, 98.7% of the eligible women were available and consented to the interview. The female response rate was slightly higher in the rural (99.0%) relative to the urban (98.3%) enumeration areas (EAs). Only de facto females are included in the analyses; the final completed de facto female sample size was 4,921.
International Centre for Reproductive Health Kenya (ICRHK) 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, PMA2015/Kenya-R4 Snapshot of Indicators. 2015. Kenya and Baltimore, Maryland, USA.