February 20, 2019

Subnational estimation of modern contraceptive prevalence in five sub-Saharan African countries: a Bayesian hierarchical approach

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Authors: Qingfeng Li, Thomas A. Louis, Li Liu, Chenguang Wang & Amy O. Tsui. 

Journal: BMC Public Health, 19(216). February 2019

This article proposes a Bayesian Hierarchal Model to estimate the level and trend of subnational modern contraceptive prevalence rates (mCPR) using data from PMA2020 surveys in five sub-Saharan African countries: Burkina Faso, Ethiopia, Ghana, Kenya, and Uganda. Recognizing that most global monitoring efforts have relied on national level estimates of mCPR, and that there is growing recognition for the need for subnational mCPR estimates for de-centralized governments to take policy actions, PMA2020 researchers used small area estimation techniques to monitor trends in mCPR. Researchers found:

  • Considerable narrowing of the uncertainty intervals around the Bayesian model estimates, compared to national estimates based directly on survey data;
  • Substantial variations in the estimated subnational mCPRs for the five countries, with most experiencing upward trends across the four survey rounds; and,
  • Trends in mCPR vary within regions in the countries across the four survey rounds.

Despite PMA2020 surveys being designed primarily to provide national estimates of mCPR, the model presented by the authors in this study provides an alternative opportunity to generate reliable subnational estimates using PMA2020 data on an ongoing basis. The generated subnational estimates will be used for local program planning and monitoring community demands for family planning.