SNAPSHOT OF INDICATORS
Survey design for PMA Uganda-Phase 2:
Performance Monitoring for Action (PMA), formerly PMA2020, builds on the previous success of PMA2020 surveys in Uganda 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 Uganda. 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 Uganda, a cross-sectional and panel Household and Female surveys (HQFQ) are conducted annually, with follow-up for the panel occurring at Year 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 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 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 14 years in the previous round will be enrolled in the panel as 15-year-olds starting in Year 2. Women who were 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 Uganda is led by Makerere University School of Public Health at the College of Health Sciences 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.
PMA Uganda Phase 2 Household and Female survey collects data on knowledge, practice, and coverage of family planning services in 141 enumeration areas (EAs) selected using a multi-stage stratified cluster design with urban-rural strata. Of the 141 enumeration areas, 19 new enumeration areas were added for a CIFF (Children’s Investment Fund Foundation) sponsored study that are now part of the PMA Uganda cross-sectional sample. The results are representative at the national level and in the urban/rural areas. The results are representative at the national level and within urban/rural strata. The final sample included 4,399 (96.0%) households and 4,346 (96.0%) women who completed the interviews for the cross-sectional survey. The data was collected between September and November 2021.
The sample was powered to generate national estimates of all women’s modern contraceptive prevalence rate (mCPR) with less than a 2% margin of error and urban/rural estimates at less than a 3% margin of error. Weights were adjusted for non-response and applied to all estimations at the household and individual levels in the presented tables. The table provides a summary of key family planning indicators for the cross-sectional survey at the national level and their breakdown by background characteristics. Disaggregation by the administrative unit was done at the region level (Central, Western, Eastern, and Northern) due to small sample sizes when disaggregated by sub-region.
PMA uses standardized questionnaires to gather data about households, individual females and health facilities that are comparable across program countries and consistent with existing national surveys. Five questionnaires were used to collect data from the PMA Uganda Phase 2 survey: the household questionnaire, the female panel questionnaire, the female cross-sectional 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. All female questionnaires were translated into the eight local languages based on the UBOS sub-regions, and translations were reviewed for appropriateness.
The household, female, and health facility questionnaires were based on model surveys designed by PMA staff at the Bill & Melinda Gates Institute for Population and Reproductive Health, the Makerere University School of Public Health, and fieldwork materials of the Uganda Demographic and Health Survey.
All PMA questionnaires are administered using Open Data Kit (ODK) software and Android smartphones. The PMA Uganda Phase 2 questionnaires were in English and could be switched into eight local languages (Luganda, Ngakarimojong, Runyankole-Rukiga, Runyoro-Rutoro, Luo, Lugbara, Ateso, and Lusoga) 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, or English in a few cases when the respondent was not comfortable with the local 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 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; 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 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 Uganda Phase 2 fieldwork started with a five-day training of 28 new REs from August 23-27, 2021. Twenty supervisors and 9 quality control supervisors were trained from August 30-31, 2021. Ahead of these trainings, a needs assessment was performed by the central PMA Uganda team to identify gaps in RE knowledge and establish topics to cover and emphasize in the trainings.
In addition to the new RE training held in August, there was a refresher training held that was attended by 137 REs in total. This refresher training was held in two waves across two separate hotels to comply with Uganda’s MoH COVID guidelines. Supervisors that were trained in August supported this RE training.
The objective of the refresher training was to address the gaps and errors identified during Phase 1 data collection, to understand the questionnaire changes for Phase 2, 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 Makerere University School of Public Health, PMA Uganda’s implementing partner, led all Phase 2 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
Data collection was conducted between September and November 2021. 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 MakSPH in Uganda 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 in November.
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 table shows response rates for household and female respondents by residence (rural/urban) for PMA Uganda Phase 2. A total of 4,939 households were selected for the survey; 4,566 households were found to be occupied at the time of the fieldwork. Of the occupied households 4,399 (96.3%) consented to a household-level interview. The response rate for the household level was higher in the rural (98.5%) relative to the urban (92.8%) enumeration areas (EAs).
In the occupied households that provided an interview, a total of 4,536 eligible women aged 15 to 49 years were identified. Overall, 95.8% of the eligible women were available and consented to the interview. The female response rate was higher in the rural (97.7%) relative to the urban (92.6%) EAs. Only de facto females are included in the PMA analyses; the final completed de facto female sample size was 4,346 (unweighted).
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.
To view the sample errors for the PMA indicators described above, download the full SOI report here. For more information about PMA indicators, including estimate type and base population, click here.
Makerere University, School of Public Health at the College of Health Sciences 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/Uganda-P2 Snapshot of Indicators. 2021. Uganda and Baltimore, Maryland, USA.