PMA2018/Ethiopia Round 6 Indicators

Round 1 Sample Design

The PMA2020 survey collects data annually at the national (urban and rural) and regional levels to allow for 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 of 200 enumeration areas (EAs) and a final sample size of approximately 7,000 households, selected by the Central Statistical Agency (CSA) master sampling frame. The primary sampling units for the survey were the EAs, which were selected systematically with probability proportional to size with urban/rural stratification in the nine regions and one administrative city (excluding Addis Ababa city, which is only urban).The rationale was for PMA2020 estimates to be comparable to the most recent national survey results. CSA 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 an RE using the SDP questionnaire. The field supervisors themselves administered the SDP questionnaire at an additional three public SDPs that serve each EA; the lowest, second lowest and third lowest-level public health SDPs (health post, health center, and district hospital) designated to serve each EA population.

Round 6 Sample Design

In Ethiopia, the PMA2020 survey collects data at the national level to allow for the estimation of key indicators to monitor progress in family planning - both at the population and the service delivery points (SDPs) levels. The resident enumerator (RE) model enables replication of the surveys on an annual basis, or more frequently.

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 included 7,621 households, 7,429 de facto females and 465 SDPs (99.2%, 98.6% and 97.7% response rates respectively). Data collection was conducted between June and July 2018.

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. 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 PMA2018/Ethiopia-R5 survey data: the household questionnaire, the female questionnaire and the service delivery point questionnaire.

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 at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, USA, Addis Ababa University (AAU) in Ethiopia, and fieldwork materials of the 2011 Ethiopian Demographic and Health Survey (EDHS).

All PMA2020 questionnaires are administered using Open Data Kit software and Android smartphones. The PMA2018/Ethiopia-R6 questionnaires appeared in the three local languages (Amharic, Afan Oromiffa and Tigrigna), in addition to English. 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 enumeration area (EA) administered the household and female questionnaires in the selected households, and the SDP questionnaire for sampled private SDPs. Field supervisors administered the SDP questionnaire in public SDPs.

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.

Training

The PMA2018/Ethiopia-R6 fieldwork training started with a refresher training of the entire field staff. The refresher training was held in the spring of 2018 in Addis Ababa. The training was led by staff PMA2020 staff from the Bill & Melinda Gates Institute for Population and Reproductive Health and Addis Ababa University. 

Throughout the training, resident enumerators were evaluated based on their performance on several written and phone-based assessments and class participation. All training participants were given instructions on survey changes to the tools since the previous round.

The resident enumerator training was conducted primarily in Amharic, whereas some small group sessions were conducted in Afan Oromiffa and Tigrigna.

Data Collection & Processing

Data collection was conducted between June and July 2018. Unlike traditional paper-and-pencil surveys, PMA2020 uses Open Data Kit 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 Open Data Kit 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, the central staff at AAU in Ethiopia and the data manager at 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/Ethiopia-R6. A total of 7,734 households were selected for the PMA2018-R6 survey; 7,679 households were found to be occupied at the time of the fieldwork. Of the occupied households, 7,621 (99.2%) of the occupied households consented to a household-level interview. The response rate at the household level was similar in urban (99.2%) relative to the rural (99.3%) enumeration areas (EAs).

In the occupied households that provided an interview, a total of 7,532 eligible women aged 15 to 49 years were identified. Overall, 98.6% of the eligible women were available and consented to the interview. The female response rate was similar in the rural (98.8%) and the urban (98.5%) EAs. Only de facto females are included in the PMA analyses; the final completed de facto female sample size was 7,429 (unweighted).

The final SDP sample included 476 facility interviews, of which 465 were completed for a response rate of 97.7%.

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.

To view the sample errors for the PMA2020 indicators described above, download the full SOI report here. For more information about PMA2020 indicators, including estimate type and base population, click here.