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 Democratic Republic of Congo Survey Design - Phase 3
Performance Monitoring for Action (PMA), formerly PMA2020, builds on the previous success of PMA2020 surveys in the Democratic Republic of Congo 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 the Democratic Republic of Congo. 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 the Democratic Republic of Congo, a cross-sectional and panel Household and Female surveys (HQFQ) were conducted annually, with follow-up for the panel occurring in Years 2 and 3. The Service Delivery Point Survey (SQ) panel baseline data was collected at Year 1 and follow-up data, annually. The Service Delivery Point Client Exit Survey (CQ) was 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 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.
For Household and Female cross-sectional and panel surveys, resident enumerators (RE) annually conduct a full listing of households within each enumeration area (EA). The annual listing was used to update the baseline weights to generate the cross-sectional estimates. At baseline, 35 households were randomly selected within each EA for interview. RE administered a household questionnaire, including completing a census of household members and guests who slept there the previous night for all selected households who consented to participate. All women age 15–49-years old who slept the night before in dwelling units with completed household survey were eligible for the female cross-sectional survey.
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 were followed up in subsequent rounds. Adolescents in selected households aged 14 years in the previous round were enrolled in the panel as 15-year-olds starting in Year 2. Women aged 49 years at an earlier round were not interviewed in subsequent rounds. Households who moved out of the EA since baseline were considered lost-to-follow-up. New households residing in residential structures of households interviewed at baseline were enumerated and enrolled in the panel in subsequent rounds. New dwelling units were randomly selected from the updated household listing to replace vacant or demolished dwelling units over time.
PMA Democratic Republic of Congo is led by the University of Kinshasa School of Public Health. 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 Democratic Republic of Congo survey target sample size was determined based on modern contraceptive prevalence rate (mCPR) among all women, with the 5% margin of error for the province level.
In Kongo Central, the Phase 3 survey includes 57 enumeration areas (EAs) selected using a multi-stage stratified cluster design with urban-rural strata. The results are representative at the province level. The final samples include 1,861 (98.6%) households, 1,856 (97.9%) de facto women age 15-49, and 191 (95.0%) facilities who completed the interviews. The data was collected between December 2021 and April 2022.
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 and the University of Kinshasa School of Public Health.
Three questionnaires were used to collect data Democratic Republic of Congo (Kongo Central) 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 questionnaires were translated into French using available translations from similar population surveys and the experts in translation.
PMA questionnaires are administered using Open Data Kit (ODK) software and Android smartphones. The questionnaires are in English and could be switched French on the phone. 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 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.
Training
Training for the PMA Democratic Republic of Congo (Kongo Central) Phase 3 (CDP3) survey was held in November 2021 and was led by the University of Kinshasa School of Public Health in Kinshasa with remote support from PMA staff at the Johns Hopkins Bloomberg School of Public Health. Resident enumerators (REs) were recruited from the selected enumeration areas included in the sample design. REs new to PMA were trained in general smartphone use, the PMA data collection platform called Open Data Kit (ODK) Collect, the art of asking questions, the ethics of survey research, and informed consent procedures. All REs were trained on the questionnaire content using a mix of lecture, paired practice, videos, and small group discussions. Throughout the training, REs and supervisors were evaluated based on their performance on several written and phone-based assessments as well as class participation. The RE trainings were conducted primarily in French, some small group sessions were conducted in Lingala and other local languages in which the survey may be conducted.
Data Collection & Processing
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 University of Kinshasa School of Public Health in Kinshasa 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. 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 2,054 households were selected for the survey; 1,887 households were found to be occupied at the time of the fieldwork. Of the occupied households, 1,861 (98.6%) consented to a household-level interview.
In the occupied dwelling units that completed a household interview, a total of 1,896 eligible women aged 15 to 49 years were identified. Overall, 97.9% of the eligible women completed the female cross-section interview. Only de facto females were included in the PMA analyses; the final completed de facto female sample size was 1,856.
All SOI indicator estimates are weighted. Weights are generated to account for non-response at the household and the individual level.
Sample errors and confidence intervals for selected indicators are generated using Wilson method. Click here more information about the indicators, including estimate type and base population.
University of Kinshasa School of Public Health 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/Democratic Republic of Congo-Kongo Central-P3 Snapshot of Indicators. 2022. Kinshasa, DRC and Baltimore, Maryland, USA.