Abstract
In two-stage cluster surveys, the traditional method used in second-stage sampling (in which the first household in a cluster is selected) is time-consuming and may result in biased estimates of the indicator of interest. Firstly, a random direction from the center of the cluster is selected, usually by spinning a pen. The houses along that direction are then counted out to the boundary of the cluster, and one is then selected at random to be the first household surveyed. This process favors households towards the center of the cluster, but it could easily be improved. During a recent meningitis vaccination coverage survey in Maradi, Niger, we compared this method of first household selection to two alternatives in urban zones: 1) using a superimposed grid on the map of the cluster area and randomly selecting an intersection; and 2) drawing the perimeter of the cluster area using a Global Positioning System (GPS) and randomly selecting one point within the perimeter. Although we only compared a limited number of clusters using each method, we found the sampling grid method to be the fastest and easiest for field survey teams, although it does require a map of the area. Selecting a random GPS point was also found to be a good method, once adequate training can be provided. Spinning the pen and counting households to the boundary was the most complicated and time-consuming. The two methods tested here represent simpler, quicker and potentially more robust alternatives to spinning the pen for cluster surveys in urban areas. However, in rural areas, these alternatives would favor initial household selection from lower density (or even potentially empty) areas. Bearing in mind these limitations, as well as available resources and feasibility, investigators should choose the most appropriate method for their particular survey context.
Highlights
Over time, the World Health Organization Expanded Program on Immunization (EPI) cluster survey design has become the default choice in the field to measure vaccination coverage and other indicators, even when a sampling frame is available
We focus on one problematic aspect of the cluster survey as it is often implemented: selection of households in the second stage
Time spent when using the Global Positioning System (GPS) method was comparable to the sampling grid method when advance preparation time was not included
Summary
The World Health Organization Expanded Program on Immunization (EPI) cluster survey design has become the default choice in the field to measure vaccination coverage and other indicators, even when a sampling frame is available. The original method called for a list of households to be selected at random from a list of all eligible households, this is not usually implemented, as such lists are rarely available, especially in settings where cluster surveys are often performed. In perhaps the most common implementation, survey teams select a random starting direction from a central location in the cluster by spinning a pen or bottle. Households lying on this transect from the center to the border of the cluster are counted and one of them is chosen at random. Proximity selection is used to select subsequent households as the " nearest" until the desired sample size is reached
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