{"doc_desc":{"title":"KAS_PMS","idno":"DDI-KEN-APHRC-KAS-PMS-2022-v1.0","producers":[{"name":"African Population and Health Research Center","abbreviation":"APHRC","affiliation":"","role":"Documentation of the DDI"}],"prod_date":"2024-11-11","version_statement":{"version":"Version 1.0(NOVEMBER 2024)"}},"study_desc":{"title_statement":{"idno":"DDI-KEN-APHRC-KAS-PMS-2022-v1.0","title":"Abortion Incidence and Severity of Complications in Kenya 2022","sub_title":"Prospective Morbidity Survey (PMS)","alt_title":"KAS_PMS"},"authoring_entity":[{"name":"Kenneth Juma","affiliation":"African Population and Heath Research Center"}],"oth_id":[{"name":"Ministry of Health,Kenya","affiliation":"MOH","email":"","role":"Ministerial partners "}],"production_statement":{"producers":[{"name":"Margaret Giorgio","affiliation":"Guttmacher Institute ","role":"Co-Investigator and a Senior Research Scientist "},{"name":"Yohannes Dibaba Wado","affiliation":"African Population and Heath Research Center","role":"Co-Investigator and a Senior Research Scientist "},{"name":"Jesse Philbin","affiliation":"Guttmacher Institute","role":"Senior Research Associate "},{"name":"Sherine Athero","affiliation":"African Population and Heath Research Center","role":"Research Officer "},{"name":"Esther Mutuku","affiliation":"African Population and Heath Research Center","role":"Data analyst"},{"name":"Boniface Ushie","affiliation":"African Population and Heath Research Center","role":"Co-Investigator and an expert researcher "},{"name":"Hellen Akinyi","affiliation":"African Population and Heath Research Center","role":"Data Documentarist"},{"name":"Isaiah Akuku","affiliation":"African Population and Heath Research Center","role":"Data Manager"},{"name":"Bonface Ingumba","affiliation":"African Population and Heath Research Center","role":"Data Governance Officer"}],"copyright":"Copyright \u00a9 APHRC, 2024","funding_agencies":[{"name":"Hewlett Foundation","abbreviation":"","role":"Funder"},{"name":"Norwegian Agency for Development Cooperation","abbreviation":"NORAD","role":"Funder"}]},"series_statement":{"series_name":"Demographic and Health Survey [hh\/dhs]","series_info":"N\/A"},"version_statement":{"version_date":"2024-11-11","version_notes":"N\/A"},"study_info":{"keywords":[{"keyword":"Abortion","vocab":"","uri":""},{"keyword":"Induced Abortion","vocab":"","uri":""},{"keyword":"Spontaneous Abortion","vocab":"","uri":""},{"keyword":"Safe abortion","vocab":"","uri":""},{"keyword":"Unsafe Abortion","vocab":"","uri":""}],"abstract":"Background: Unsafe abortion remains a significant cause of maternal morbidity and mortality in many African countries, including Kenya. In Kenya, abortion is legally restricted except when the life or health of a pregnant woman is in danger and in cases of rape or incest. The restrictions around abortion, pervasive stigma and negative attitudes of healthcare providers often increase the risks of unsafe abortion. Ten years ago, a study by the Ministry of Health, the African Population and Health Research Center (APHRC), and the Guttmacher Institute reported close to 464,690 induced abortions in 2012. Given the time that has passed since that study, and changes in the landscape of abortion in Kenya (e.g., the availability of medication abortion drugs, enactment of the 2017 Health Act that defined \"trained providers\" to include nurses and midwives, and the 2019 High Court ruling that reinstated the withdrawn Standards and guidelines for reduction of maternal mortality from unsafe abortion), policymakers and advocates in Kenya have raised the need for another national abortion incidence study.\nObjectives: To determine the incidence of induced abortions and the severity of abortion-related complications in Kenya.\nMethods: The proposed study will employ a quantitative cross-sectional design. The study will have four separate surveys: i) a nationally representative Health Facility Survey (HFS) to estimate the number of women who receive post-abortion care (PAC) following abortion complications, ii) a Knowledgeable Informants Survey (KIS) to collect information on the proportion of all women having abortions who receive facility-based treatment for abortion-related complications, iii) a Respondent-Driven Sampling survey (RDS) of women who have had an abortion to understand abortion incidence and safety, and iv) a Prospective Morbidity Survey (PMS) to provide the data necessary to describe characteristics of women receiving treatment for abortion complications, the severity of complications, the type of treatment received, and the delays in access to PAC. The PMS will also include a limited component involving clinical data abstraction from the medical charts\/records of PAC clients.\nUtility of study: Evidence generated will contribute to a greater understanding of the incidence of induced abortions and the magnitude and severity of abortion-related complications. The evidence will support investment and decision-making toward addressing the contributors of unsafe abortions and unintended pregnancies, improving access to quality PAC services, and ultimately improving adolescent and maternal health in Kenya.","coll_dates":[{"start":"2023-06-07","end":"2023-09-22","cycle":""}],"nation":[{"name":"Kenya","abbreviation":"KEN"}],"geog_coverage":"National coverage","analysis_unit":"women receiving treatment for abortion complications","universe":"Women receiving post abortion care (patient survey) and their care providers (providers' survey).","notes":"Basic Information of women receiving treatment for abortion complications\nReproductive Health History of women receiving treatment for abortion complications\nSymptoms and Care-seeking Decisions  of women receiving treatment for abortion complications\nQuality of abortion and family planning services  of women receiving treatment for abortion complications\nAbotion knowledge and attitudes of women receiving treatment for abortion complications\nGeneral Information on Patient Intake from the PMS provider\nInitial Examination and Observations from the provider\nComplication Questions from the provider\nProcedures and Medications \nLikely Abortion Questions\nFinal Outcome","study_scope":"Basic Information of women receiving treatment for abortion complications\nReproductive Health History of women receiving treatment for abortion complications\nSymptoms and Care-seeking Decisions  of women receiving treatment for abortion complications\nQuality of abortion and family planning services  of women receiving treatment for abortion complications\nAbotion knowledge and attitudes of women receiving treatment for abortion complications\nGeneral Information on Patient Intake from the PMS provider\nInitial Examination and Observations from the provider\nComplication Questions from the provider\nProcedures and Medications \nLikely Abortion Questions\nFinal Outcome"},"method":{"data_collection":{"sampling_procedure":"The sampling strategy for the PMS is drawn from  a representative sample of Levels II-IV health facilities to prospectively observe for 30 days for women admitted or seen for PAC in Kenya. Inclusion of all Level V and VI facilities. A randomized sample was drawn of Level II-IV facilities from within the Health Facility Survey  facility list. We aimed to observe 430 facilities in total for the PMS. Within the selected health facilities, all women admitted or treated for post-abortion complications during the 30 days were recruited and interviewed by relevant healthcare providers in charge of PAC. The healthcare providers recruited patients at the point of service and interview those who consent to participate about their reproductive history and their abortion pathways. Interview was also done on  their providers to explore the nature of their complications and the treatment offered. In addition, the data collectors accessed the medical charts of the PAC patients to extract data related to reported diagnoses, laboratory measurements, and management procedures undertaken.","sampling_deviation":"There were several deviations from the sample,these included facilities that were not sampled but data was collected from them and others were sampled but data was not collected. we also had other facilities that were nonresponce due to the following reasons:facility closed down, facility does not exist, facility is non operational, facility does not offer post abortion care, insecurities reason and facility does not offer sexual reproductive health services.","coll_mode":"Face-to-face [f2f]","research_instrument":"The questionnaire was written in english with a primary  purpose of the PMS was to provide the data necessary to describe the characteristics of women receiving treatment for abortion complications, the type of treatment received for complications, and the delays in access to post-abortion care.  Since the completeness of medical records for PAC patients varied from facility to facility, the PMS relied on a facility-based, prospective approach for data collection. The study population were women receiving PAC (patient survey) and their care providers (providers' survey).","act_min":"The Interview was conducted by a team of field interviewers. Each team included  6 interviewers, in addition to 1 team lead.\n\nThe supervisor's role was to coordinate field data collection and manage teams. They also assigned tasks to interviewers, spot-checked work, maintained control documents, and sent completed questionnaires and progress reports to the central data portal.\nFrequent Field visits  were made after every two weeks for period of data collection   by the Kenya abortion members","weight":"The weighting process ensured accurate representation of the universe by addressing ineligibility, nonresponse, and misclassification. The list of participating facilities was obtained from PMS, MRR, and tally sheets. Facilities at levels 5 and 6 that did not respond to the Health Facility Survey (HFS) were excluded. The universe was corrected based on the percentage of sampled facilities that did not offer PAC (Post Abortion Care), with adjustments stratified by region and level. Misclassified facilities were reassigned to their correct levels to refine the universe. Additionally, the universe was adjusted to account for ineligible facilities or those not participating in certainty-sampled levels (levels 2). Adjusted universe sizes were recalculated for each region and level using the formula: Adjusted universe size = original universe size \u00d7 (1 - ineligibility rate). Where ineligibility rate is the proportion misclassified.\nSampling weights were recalculated using the corrected universe sizes derived from the HFS sample frame. For HFS, the sample weight was calculated as sample weight = corrected universe size \/ sample size. The HFS composite weight therefore incorporated misclassification adjustment (PAC provision) and non-response weights adjustment. For PMS, the sample weight was calculated as sample weight = HFS sample size \/ PMS sample size. Participation weights were also calculated to account for facilities responding to the HFS.\nComposite weights integrated sampling, participation, and survey response adjustments. For Component 2, the composite weight incorporated weights from HFS and was calculated as PMS composite weight = PMS sample weight \u00d7 Participation weight \u00d7 HFS composite weight. This final adjusted composite weight accounted for sampling design, survey participation, and nonresponse adjustments.","cleaning_operations":"the software used was survey CTO for data colllection, the  data was later downloaded in STATA format.","method_notes":"N\/A"},"analysis_info":{"response_rate":"79.8%","sampling_error_estimates":"N\/A"}},"data_access":{"dataset_use":{"contact":[{"name":"African Population and Heath Research Center","affiliation":"APHRC","email":"datarequest@aphrc.org","uri":""}],"cit_req":"Use of the dataset must be acknowledged using a citation which would include:\n- the Identification of the Primary Investigator\n- the title of the survey (including country, acronym and year of implementation)\n- the survey reference number\n- the source and date of download","conditions":"All non-APHRC staff seeking to use data generated at the Center must obtain written approval to use the data from the Director of Research. This form is developed to assess applications for data use and facilitate responsible sharing of data with external partners\/collaborators\/researchers. By entering into this agreement, the undersigned agrees to use these data only for the purpose for which they were obtained and to abide by the conditions outlined below:\n\n1. Data Ownership: The data remain the property of APHRC; any unauthorized reproduction and sharing of the data is strictly prohibited. The user will, therefore, not release nor permit others to use or release the data to any other person without the written authorization from the Center.\n\n2. Purpose: The provided data must be used for the purpose specified in the Data Request Form; any other use not specified in the form must receive additional or separate authorization.\n\n3. Respondent Identifiers: The Center is committed to protecting the identity of the respondents who provide information in its research. All analytical data sets (both qualitative and quantitative) released by the Data Unit MUST are stripped of respondent identifiers to protect the identity of the respondents. By accepting to use APHRC data, the user is pledging that he\/she will not, under any circumstance, regenerate the identifiers or permit others to use the data to learn the identity of any individual, household or community included in any data set.\n\n4. Confidentiality pledge: The user will not use nor permit others to use the data to report any information in the data sets that could identify, directly or by inference, individuals or households.\n\n5. Reporting of errors or inconsistencies: The user will promptly notify the Head of the Statistics and Survey Unit any errors discovered in the data as soon as the errors are discovered.\n\n6. Publications resulting from APHRC data: The Center requires external collaborators to work with APHRC staff on all publications resulting from its data. In order to facilitate this, lead authors should send a detailed concept note of the paper (including the background, rationale, data, analytical methods, and preliminary findings) to the Principle Investigator (or Theme Leader) for the project (with a copy to the Director of Research), who will circulate the abstract to concerned researchers for possible expression of interest in participating in the publication as co-authors. Any exception to the involvement of APHRC staff should be approved by the Director of Research, APHRC.\n\n7. Security: The user will take responsibility for the security of the data by ensuring that the data are used and stored in a secure environment where access is password protected. This will ensure that non-authorized people should not have access to the data.\n\n8. Loss of privilege to use data: In the event that APHRC determines that the data user is in violation of the conditions for using the data, or if the user wishes to cancel this agreement, the user will destroy the data files provided to him\/her. APHRC retains the right to revoke this agreement or informs publishers to withhold publication of any work based wholly or in part on its data if the conditions for using the data are violated.\n\n9. Acknowledgement: Any work\/reports from this data must acknowledge APHRC as the source of these data. For example, the suggested acknowledgement for NUHDSS data is:\n\n\"This research uses livelihoods data collected under the longitudinal Nairobi Urban Health and Demographic Surveillance System (NUHDSS) since 2006. The NUHDSS is carried out by the African Population and Health Research Center in two slums settlements (Korogocho and Viwandani) in Nairobi City.\"\n\nAdditionally all funders, the study communities that provided the data, and staff who collected and analyzed or processed the data should be acknowledged.\n\n10. Deposit of Reports\/Papers: The user should submit electronic and paper copies of all publications generated using APHRC data to the Policy Engagement and Communications Department, with copies to the Director of Research.\n\n11. Change of contact details: The user will promptly inform the Director of Research of any change in your personal details as contained on this data request form.","disclaimer":"The user of the data acknowledges that APHRC and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses."}}}}