Subnational estimation of modern contraceptive prevalence in five sub-Saharan African countries: A Bayesian hierarchical approach 11 Medical and Health Sciences 1117 Public Health and Health Services

Research output: Contribution to journalArticle

Abstract

Background: Global monitoring efforts have relied on national estimates of modern contraceptive prevalence rate (mCPR) for many low-income countries. However, most contraceptive delivery programs are implemented by health departments at lower administrative levels, reflecting a persisting gap between the availability of and need for subnational mCPR estimates. Methods: Using woman-level data from multiple semi-annual national survey rounds conducted between 2013 and 2016 in five sub-Saharan African countries (Burkina Faso, Ethiopia, Ghana, Kenya, and Uganda) by the Performance, Monitoring and Accountability 2020 project, we propose a Bayesian Hierarchical Model with a standard set of covariates and temporally correlated random effects to estimate the level and trend of mCPR for first level administrative divisions in each country. Results: There is considerable narrowing of the uncertainty interval (UI) around the model-based estimates, compared to the estimates directly based on the survey data. We find substantial variations in the estimated subnational mCPRs. Uganda, for example, shows a gain in mCPR of 6.4% (95% UI: 4.5-8.3) based on model estimates of 20.9% (19.6-22.2) in mid-2014 and 27.3% (26.0-28.8) in mid-2016, with change across 10 regions ranging from - 0.6 points in Karamoja to 9.4 points in Central 2 region. The lower bound of the UIs of the change over four rounds was above 0 in 6 regions. Similar upward trends are observed for most regions in the other four countries, and there is noticeable within-country geographic variation. Conclusions: Reliable subnational estimates of mCPR empower health departments in evidence-based policy making. Despite nationally increasing mCPRs, regional disparities exist within countries suggesting uneven contraceptive access. Raising investments in disadvantaged areas may be warranted to increase equity in access to modern contraceptive methods.

Original languageEnglish (US)
Article number216
JournalBMC public health
Volume19
Issue number1
DOIs
StatePublished - Feb 20 2019

Fingerprint

Bayes Theorem
Contraceptive Agents
Health Services
Public Health
Health
Uganda
Uncertainty
Burkina Faso
Ghana
Ethiopia
Policy Making
Kenya
Social Responsibility
Vulnerable Populations
Contraception

Keywords

  • Bayesian hierarchical model
  • Family planning
  • Sub-Saharan Africa
  • Subnational estimates

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

@article{7f953a2e2cc147d091cb64841dbc4b8a,
title = "Subnational estimation of modern contraceptive prevalence in five sub-Saharan African countries: A Bayesian hierarchical approach 11 Medical and Health Sciences 1117 Public Health and Health Services",
abstract = "Background: Global monitoring efforts have relied on national estimates of modern contraceptive prevalence rate (mCPR) for many low-income countries. However, most contraceptive delivery programs are implemented by health departments at lower administrative levels, reflecting a persisting gap between the availability of and need for subnational mCPR estimates. Methods: Using woman-level data from multiple semi-annual national survey rounds conducted between 2013 and 2016 in five sub-Saharan African countries (Burkina Faso, Ethiopia, Ghana, Kenya, and Uganda) by the Performance, Monitoring and Accountability 2020 project, we propose a Bayesian Hierarchical Model with a standard set of covariates and temporally correlated random effects to estimate the level and trend of mCPR for first level administrative divisions in each country. Results: There is considerable narrowing of the uncertainty interval (UI) around the model-based estimates, compared to the estimates directly based on the survey data. We find substantial variations in the estimated subnational mCPRs. Uganda, for example, shows a gain in mCPR of 6.4{\%} (95{\%} UI: 4.5-8.3) based on model estimates of 20.9{\%} (19.6-22.2) in mid-2014 and 27.3{\%} (26.0-28.8) in mid-2016, with change across 10 regions ranging from - 0.6 points in Karamoja to 9.4 points in Central 2 region. The lower bound of the UIs of the change over four rounds was above 0 in 6 regions. Similar upward trends are observed for most regions in the other four countries, and there is noticeable within-country geographic variation. Conclusions: Reliable subnational estimates of mCPR empower health departments in evidence-based policy making. Despite nationally increasing mCPRs, regional disparities exist within countries suggesting uneven contraceptive access. Raising investments in disadvantaged areas may be warranted to increase equity in access to modern contraceptive methods.",
keywords = "Bayesian hierarchical model, Family planning, Sub-Saharan Africa, Subnational estimates",
author = "Qingfeng Li and Thomas Louis and Li Liu and Chenguang Wang and Tsui, {Amy Ong}",
year = "2019",
month = "2",
day = "20",
doi = "10.1186/s12889-019-6545-3",
language = "English (US)",
volume = "19",
journal = "BMC Public Health",
issn = "1471-2458",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Subnational estimation of modern contraceptive prevalence in five sub-Saharan African countries

T2 - A Bayesian hierarchical approach 11 Medical and Health Sciences 1117 Public Health and Health Services

AU - Li, Qingfeng

AU - Louis, Thomas

AU - Liu, Li

AU - Wang, Chenguang

AU - Tsui, Amy Ong

PY - 2019/2/20

Y1 - 2019/2/20

N2 - Background: Global monitoring efforts have relied on national estimates of modern contraceptive prevalence rate (mCPR) for many low-income countries. However, most contraceptive delivery programs are implemented by health departments at lower administrative levels, reflecting a persisting gap between the availability of and need for subnational mCPR estimates. Methods: Using woman-level data from multiple semi-annual national survey rounds conducted between 2013 and 2016 in five sub-Saharan African countries (Burkina Faso, Ethiopia, Ghana, Kenya, and Uganda) by the Performance, Monitoring and Accountability 2020 project, we propose a Bayesian Hierarchical Model with a standard set of covariates and temporally correlated random effects to estimate the level and trend of mCPR for first level administrative divisions in each country. Results: There is considerable narrowing of the uncertainty interval (UI) around the model-based estimates, compared to the estimates directly based on the survey data. We find substantial variations in the estimated subnational mCPRs. Uganda, for example, shows a gain in mCPR of 6.4% (95% UI: 4.5-8.3) based on model estimates of 20.9% (19.6-22.2) in mid-2014 and 27.3% (26.0-28.8) in mid-2016, with change across 10 regions ranging from - 0.6 points in Karamoja to 9.4 points in Central 2 region. The lower bound of the UIs of the change over four rounds was above 0 in 6 regions. Similar upward trends are observed for most regions in the other four countries, and there is noticeable within-country geographic variation. Conclusions: Reliable subnational estimates of mCPR empower health departments in evidence-based policy making. Despite nationally increasing mCPRs, regional disparities exist within countries suggesting uneven contraceptive access. Raising investments in disadvantaged areas may be warranted to increase equity in access to modern contraceptive methods.

AB - Background: Global monitoring efforts have relied on national estimates of modern contraceptive prevalence rate (mCPR) for many low-income countries. However, most contraceptive delivery programs are implemented by health departments at lower administrative levels, reflecting a persisting gap between the availability of and need for subnational mCPR estimates. Methods: Using woman-level data from multiple semi-annual national survey rounds conducted between 2013 and 2016 in five sub-Saharan African countries (Burkina Faso, Ethiopia, Ghana, Kenya, and Uganda) by the Performance, Monitoring and Accountability 2020 project, we propose a Bayesian Hierarchical Model with a standard set of covariates and temporally correlated random effects to estimate the level and trend of mCPR for first level administrative divisions in each country. Results: There is considerable narrowing of the uncertainty interval (UI) around the model-based estimates, compared to the estimates directly based on the survey data. We find substantial variations in the estimated subnational mCPRs. Uganda, for example, shows a gain in mCPR of 6.4% (95% UI: 4.5-8.3) based on model estimates of 20.9% (19.6-22.2) in mid-2014 and 27.3% (26.0-28.8) in mid-2016, with change across 10 regions ranging from - 0.6 points in Karamoja to 9.4 points in Central 2 region. The lower bound of the UIs of the change over four rounds was above 0 in 6 regions. Similar upward trends are observed for most regions in the other four countries, and there is noticeable within-country geographic variation. Conclusions: Reliable subnational estimates of mCPR empower health departments in evidence-based policy making. Despite nationally increasing mCPRs, regional disparities exist within countries suggesting uneven contraceptive access. Raising investments in disadvantaged areas may be warranted to increase equity in access to modern contraceptive methods.

KW - Bayesian hierarchical model

KW - Family planning

KW - Sub-Saharan Africa

KW - Subnational estimates

UR - http://www.scopus.com/inward/record.url?scp=85061963341&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061963341&partnerID=8YFLogxK

U2 - 10.1186/s12889-019-6545-3

DO - 10.1186/s12889-019-6545-3

M3 - Article

C2 - 30786895

AN - SCOPUS:85061963341

VL - 19

JO - BMC Public Health

JF - BMC Public Health

SN - 1471-2458

IS - 1

M1 - 216

ER -