This report summarizes the findings of a household survey undertaken between September and November 2010 as part of the impact evaluation of Tupange, the Kenya Urban Reproductive Health Initiative. By providing time-series data on key indicators, the survey, carried out by Measurement, Learning & Evaluation (MLE) of the Urban Reproductive Health Initiative project, provides an evidence base for the outcomes and impact of both demand side interventions (those that increase the uptake of contraception) and supply side interventions (those that increase the quality of and access to family planning [FP] services). This survey is the first of three that are planned and provides a baseline for follow-on assessments and information that will inform program design.
A total of 13,140 households were selected for interviewing, ensuring that the sample was sufficient to allow analysis of the findings by each of the five intervention sites. With the exception of Machakos and Kakamega, the sample in each urban area was apportioned equally between formal and informal localities. All women aged 15-49 years who were either usual residents or visitors present in the sampled households on the night prior to the survey were eligible for a detailed interview. In addition, in half of the sampled households in Nairobi, Mombasa, and Kisumu, all men aged 15-59 years were asked to participate in a detailed interview. Response rates were high, at over 84 percent.
Summary of Findings
Overall, the survey found that there is significant unmet need for family planning in all cities, with the need being slightly higher in Mombasa. Unmet need was much greater for unmarried, sexually active women. For this group, unmet need ranged from a low of 22 percent in the middle quintile in Nairobi to a high of 68 percent in the poorest quintile in Mombasa.
Knowledge of contraceptive methods was found to be universally high among both women and men surveyed, although there is some variability in knowledge of specific methods. In Nairobi, Mombasa and Kisumu, use was slightly higher among women in higher (richer) wealth quintiles.
For example, while 40 percent of the poorest in Nairobi used family planning, 45 percent of the richest were users.
Kind of Data
Sample survey data [ssd]
Producers and sponsors
Kenya National Bureau of Statistics
Measurement, Learning & Evaluation
Center for Communication Programs
Marie Stopes International
National Coordinating Agency for Population and Development
Pharm Access Africa Limited
The household survey sample was drawn from the population residing in the five cities/urban centers. The most recent Population and Housing Census (2009) was used to identify clusters from which a representative sample of households for each city/urban center was drawn. A total of 13,140 households were selected for interviewing, ensuring that the sample was sufficient to allow analysis of the findings by each of the five intervention sites. Nairobi was intentionally oversampled (4,260 vs. 2,220 households) due its significantly larger size. With the exception of Machakos and Kakamega, the sample in each urban area was apportioned equally between formal and informal localities.
A two-stage cluster sampling design was used for each urban area. Stage one involved selecting a random sample of clusters in each urban area. In Nairobi, 71 clusters were randomly selected in each of the formal and informal areas (domains), for a total of 142. In Mombasa and Kisumu, 37 clusters were randomly drawn from each domain, for a total 74 per urban area. In Machakos and Kakamega, 74 clusters were randomly selected per urban area. In the second stage, a random sample of 30 households was selected within each selected cluster. Interviews with women took place in all households selected. In Nairobi, Mombasa and Kisumu, half of the households (15) in each of the selected clusters were also selected to interview men.
For each household selected, an interview with the head of the household (or his or her representative) was conducted. Each interview assessed household assets and environmental circumstances such as sanitation and housing materials, obtained a listing of usual residents of the household and asked about demographic characteristics of the head of the household.
All women aged 15-49 years who were either usual residents or visitors present in the sampled households on the night prior to the survey were eligible for a detailed interview. In addition, in half of the sampled households in Nairobi, Mombasa and Kisumu, all men aged 15-59 years were asked to participate in a detailed interview.
Interviews took place in a location where the respondent could be assured some level of privacy and were conducted by a same-sex interviewer using a paper-and-pencil questionnaire following the receipt of informed consent.
Respondents were asked about demographic characteristics, for information on current and past FP method use, fertility desires and intentions, health-seeking behaviors for themselves and their children, how they pay for health care services, exposure to FP messages, and migration patterns, using a structured questionnaire. At mid-term and end line, the objective will be to find the same female respondents, so contact information was requested to permit extensive tracking procedures at each follow -up round of data collection. Repeated cross-sections of men (not necessarily the same ones) will be interviewed at mid and end line.
Of the 13,140 households selected for inclusion in the sample, 12,565 were occupied and eligible for interviews. Of these, 10,992 households were interviewed successfully (197 declined), a response rate of 84 percent. There were a total of 10,502 eligible women, of whom 8,932 consented and participated in an interview, yielding a response rate of 85.1 percent. There were 3,815 eligible men, of whom 2,503 consented and participated in an interview, a response rate of 65.6 percent.
For the household survey, non -response was primarily due to the absence of a suitable member of the household during each of three visits (37 percent; not displayed). Non-responses during the male and female interviews were due mainly to the subject's absence at the time of the household interview (76 percent and 78 percent respectively) or at any of the three follow -up visits.
Dates of Data Collection
Data Collection Mode
Data Collection Notes
The survey sampling frame was developed by the Kenya National Bureau of Statistics (KNBS) which also planned and conducted the training for the survey field workers, collected the data and entered the data from the survey questionnaires (which can be seen in Attachment 2). The African Population and Health Research Centre (APHRC) provided in -country technical assistance to KNBS to ensure that data were gathered according to a standard, scientific protocol and participated in data analysis. Jhpiego, an international non-profit health organization affiliated with The Johns Hopkins University (and the lead partner in the country-level project consortium), provided administrative assistance and managed and carried out the dissemination of the survey results. Other partners and stakeholders of Tupange are Marie Stopes Kenya (MSK), the National Coordinating Agency for Population and Development (NCAPD), the Johns Hopkins University Center for Communications Programs (JHU/CCP), the Division of Reproductive Health (DRH) in the Ministry of Public Health and Sanitation, and Pharm Access Africa Limited (PAAL). The Tupange partners jointly provided technical inputs during the development of the survey instruments and NCAPD conducted community sensitization to help maximize response rates. The Carolina Population Center, University of North Carolina, Chapel Hill (UNC), provided the overall study design and execution for this survey and led the data analysis.
The KNBS recruited research assistants and supervisors based on a set of defined criteria, including experience with large-scale, national-level, population-based surveys.
The final team included 31 supervisors, 93 female research assistants, 27 male research assistants, 31 field editors and 12 reserves. APHRC hired six quality assurance personnel.
Training of the research team was undertaken from September 4 to September 15, 2010.
Technical and program staff from KNBS, NCAPD, MOH, MLE and APHRC served as trainers and divided participants into four groups to train them on questionnaire administration, logistics and Tupange objectives using manuals to ensure that the team was fully briefed on survey contents and procedures. A mix of training techniques including class presentations, mock interviews and practice interviews in the field was used.
Supervisors were given supplementary training on the identification of clusters and households for the survey, distribution of assignments to the research assistants, accounting for the completed questionnaires, and what to look out for when carrying out the initial editing of the questionnaires while in the field. All trainees were taken for practice interviews in households in selected clusters in the town of Nakuru. Each trainee was tasked with collecting data for two of each of the questionnaires depending on the availability of the eligible respondents at the household level. During the last day of the training, the final field teams were formed and supervisors, research assistants and field editors were identified.
The quality assurance staff received a three-day training prior to participating in the main survey training for field workers. The team was trained on various techniques of monitoring data quality and how to give feedback to the field teams on common errors found on the questionnaires.
Staff from APHRC, MOH, NCAPD, Jhpiego and KNBS participated in the fieldwork supervision. In order to ensure that the selected communities were receptive to fieldwork staff, NCAPD and KNBS district statistical officers organized and implemented a series of social mobilization activities in the clusters sampled for the survey before sampling began. Community barazas (gatherings held to raise awareness and share collective wisdom) were held with community members, the local administration and management bodies of the residential areas, and village elders were used to inform the target communities about the survey plans. Due to the short time between the social mobilization activities and the beginning of data collection, many community members did not receive information about the survey.
Three questionnaires were used to collect baseline information-one for each of the households, one for women and one for men. In Machakos and Kakamega, only women were interviewed. Questionnaires were based on the questionnaires used by the Demographic and Health Survey program in Kenya but were modified and expanded by all in-country partners to reflect MLE and Tupange objectives.
Questionnaires were translated from English into Kiswahili, Luhya, Kamba and Dholuo-the four most commonly spoken languages in the five cities. Final revisions were made to the questionnaires following extensive pre-testing and training of field staff.
The household questionnaire was administered prior to the women's and men's questionnaires to facilitate the identification of eligible household members. The methodology and questionnaires were tested in Kisumu and Nairobi August 5-8, 2010, in clusters outside the planned intervention areas to minimize chances of contamination. Survey instruments were finalized based on feedback from and lessons learned during the pre-test.
A data processing team was selected and trained at the KNBS offices in Nairobi. Most of the data processing staff were selected from the reserve members from the field survey teams. Staff from MLE and APHRC conducted the five-day training between October 26 and November 1, followed by on -the-job training for an additional four days. Fifteen data entry clerks, four office editors, one system administrator, one supervisor and one manager participated in the training. Data processing began in November 2010 and was finalized in March 2011.
To ensure that all questionnaires were processed, a “data audit” was conducted and completed at the end of March 2011. The tabulation of the survey results, particularly the program tables, was done in May 2011. Data analysts from the University of North Carolina and APHRC produced the tables and preliminary results that were shared with program teams on June 2-3, 2011.
Further analysis of the data that allowed inclusion of results regarding additional indicators was completed by July 2011 and an initial draft baseline report was prepared by mid-September 2011.
Director General, KNBS
MLE, Tupange and KNBS. 2011. Report of the Baseline Household Survey for the Kenya Urban Reproductive Health Initiative (Tupange). Measurement, Learning & Evaluation of the Urban Reproductive Health Initiative (MLE) [UNC, USA]; Kenya Urban Reproductive Health Initiative (Tupange) [Nairobi, Kenya]; and Kenya National Bureau of Statistics (KNBS) [Nairobi, Kenya].