SNAPSHOT OF INDICATORS
Summary of the sample design for PMA2018/Uganda-R6:
In Uganda, PMA2020 is designed to create sentinel sites for data collection at the population-level and among service delivery points (SDPs). PMA2018, the sixth round of PMA2020 data collection in Uganda, used a two-stage cluster design with urban-rural as strata. For this survey round, a new set of 110 enumeration areas (EAs) were selected, adjacent to EAs used in the previous four rounds, drawn by the Uganda Bureau of Statistics from its master sampling frame. In each EA, households and health facilities were listed and mapped, with 44 households randomly selected. In Round 6, data collection is conducted in the same selection of EAs from the previous round.
Households were surveyed and occupants enumerated. All eligible females age 15 to 49 were contacted and consented for interviews. The final sample (and completion rates) included 4,559 households (96.9%), 4,227 de facto females (96.9%) and 342 health facilities (94.7%). Data collection was conducted from April to May 2018.
The sample was powered to generate national estimates of all women 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. Disaggregation by administrative unit was done at the region level (Central, Western, Eastern, and Northern) due to small sample sizes when disaggregated by sub-region.
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 year after that, to track progress.
Survey resources allowed targeting a sample size of 110 enumeration areas (EAs) and a final sample size of 4,840 households. A total of 110 EAs were sampled throughout all 10 sub-regions in Uganda selected by the Uganda Bureau of Statistics (UBOS) master sampling frame, which was representative at the national and sub-regional levels for both urban and rural areas. The primary sampling units for the survey were the EAs, created during the 2002 National Population and Housing Census. The EAs were selected systematically with probability proportional to size with urban/rural stratification in the 10 sub-regions. The rationale was for PMA2020 estimates to be comparable to the most recent national survey estimates. UBOS 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 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 lowest, second-lowest, and third-lowest level public health SDPs designated to serve each EA.
Round 6 Sample Design
For this survey round, a new set of 110 enumeration areas (EAs) from the original 10 regions were selected, adjacent to EAs used in the previous four rounds, by the Uganda Bureau of Statistics from its master sampling frame. All households, health service delivery points and key landmarks in each EA were listed and mapped by the resident enumerators to create a frame for the second stage of the sampling process. Households (44) were systematically sampled using random selection. Field supervisors used 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.
Households with eligible females of reproductive age (15-49 years) were contacted and consented for interviews. The final sample (and completion rates) included 4,559 households (96.9%), 4,227 de facto females (96.9%) and 342 health facilities (94.7%). Data collection was conducted from April to May 2018.
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, random sample of three private SDPs is selected during each round.
PMA2020 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. Three questionnaires were used to collect data from the PMA2018/Uganda-R6 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 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 PMA2020 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 PMA2020 questionnaires are administered using Open Data Kit (ODK) software and Android smartphones. The PMA2018/Uganda-R6 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 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. 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 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; and exposure to family planning messaging in the media.
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 SDP.
The PMA2018/Uganda-R6 fieldwork started with a six-day training of approximately 20 new field staff. At the end of the six-day training, the newly trained staff were joined returning staff for a combined training for an additional five-day training. The new staff training and the refresher training were held in the spring of 2018. For both sets of trainings, staff from the Makerere University School of Public Health, PMA2020/Uganda’s implementing partner, led the training with support from PMA2020 staff from the Bill & Melinda Gates Institute for Population and Reproductive Health of the Johns Hopkins Bloomberg School of Public Health.
This six-day training was followed by a five-day refresher training for the returning field staff. The objective of the refresher training was to address the gaps and errors identified during Round 5 data collection, to understand the questionnaire changes for Round 6, 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. Both trainings both took place in Kampala City, at the Global Grand Hotel on the outskirts of Makerere University.
For the six-day training, all training participants 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 a Ugandan obstetrician/gynecologist.
Throughout the new staff training 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 mock 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 English, some small group sessions were conducted in the local language groups.
The six-day training of new staff was held in the spring of 2018. PMA2020 staff led the training from the Bill & Melinda Gates Institute for Population and Reproductive Health, with support from UBOS and MakSPH project staff.
Data Collection & Processing
Data collection was conducted between April and May 2018. 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 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 PMA2020 was still active in the field. Throughout data collection, the central staff at MakSPH in Uganda and tt 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 May.
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.
This table shows response rates for household and female respondents by residence (rural/urban) for PMA2018/Uganda-R6. A total of 4,840 households were selected for the survey; 4,707 households were found to be occupied at the time of the fieldwork. Of the occupied households 4,559 (96.9%) consented to a household-level interview. The response rate for the household level was higher in the rural (97.9%) relative to the urban (94.2%) enumeration areas (EAs).
In the occupied households that provided an interview, a total of 4,364 eligible women aged 15 to 49 years were identified. Overall, 96.9% of the eligible women were available and consented to the interview. The female response rate was higher in the rural (97.8%) relative to the urban (94.5%) EAs. Only de facto females are included in the PMA analyses; the final completed de facto female sample size was 4,227 (unweighted).
The final service delivery point (SDP) sample identified 361, of which 342 were completed for a response rate of 94.7%.
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.
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 and Accountability 2020 (PMA2020) Survey Round 6, PMA2018/Uganda-R6 Snapshot of Indicators. 2018. Uganda and Baltimore, Maryland, USA.