Review for 10.1186/s12876-023-02659-w (2023)

Title: FACTORS ASSOCIATED WITH DELAYED REPORTING FOR SURGICAL
CARE AMONG PATIENTS WITH SURGICAL ACUTE ABDOMEN ATTENDED AT
MUHIMBILI NATIONAL HOSPITAL – TANZANIA.
Version: 2 Date: 29 Oct 2022
Reviewer's report:
This report is timely and adds to existing knowledge being a report from Tanzania. More
descriptive studies from developing nations will aid in improving healthcare delivery.
Recognizing the factors that contribute to late presentation highlights what needs improvement
in order to improve outcomes in patients with surgical acute abdomen.
I have the following suggestions:
General:
Please do an English language editing of the paper.  There are many typographical and
grammatical errors that affect clarity. section 3.4 is not clear (do you mean two staff on duty
or two employees in the whole hospital or do you mean two surgical staff?). Table 9 is also
not clear.
See some examples of possible editing below:
1. The first paragraph of the discussion should read something like this: "Various factors
influence the time of presentation in patients with the surgical acute abdomen. This study
was conducted at......demographic, and health services related factors that contribute to late
presentation of patients with surgical acute abdomen.
2. In 2.0 METHODOLOGY:
The whole of 2.1 Study Area should be one paragraph.
For example: This study was conducted by the gastroenterology and general surgery unit
of the Muhinbili National Hospital (MNH) located in... It is a national referral hospital
that receives patients from other peripheral hospitals in Tanzania. MNH also has a research
center.....Reconstructive Surgery unit.
Specific:
1. Introduction: Be clear with the definition of 'Acute abdomen' and 'Surgical acute abdomen'.
Note that the definition can be 'time of onset before presentation' specific. Not all acute abdomen
is surgical.
Please clearly drive home the relevance of your study in the second paragraph where you
mentioned the earlier work by Mjema et al who reported delays between presentation and
treatment. Your study highlights the delay between the onset of symptoms and presentation to
the hospital which is very important to the final outcome in such patients.
2. Methodology: Be clear with where the patients presented and when the questionnaire was
administered. Patients with surgical acute abdomen rarely present to the clinic, most times they
present to the emergency department/room/unit. If you included patients at the clinic, was this
after they were discharged?
I advise that you write 2.4-2.6 as an essay, not as a list. Combine 2.4 and 2.5 into a paragraph.
Combine 2.5 -2.7 into another paragraph by detailing the variables as the type of data collected/
questions asked from the patient. Ref 2.4.1; Please clarify the exclusion of patients with severe
pain (acute abdomen includes patients with severe abdominal pain). Please add patients that did
not give consent as your first exclusion criteria.
"Statistical Analysis Plan" should not be designated as 2.7 because Data collection Method is
designated 2.7. However, if you decide to go with the suggestions above, that would be adjusted.
3. Results: With SPSS, try to generate some Bar charts and pie charts for some of the tables.
They are better at illustrating your points. For example, present table 5 as a bar chart.
One significant socio-demographic factor is missing from your results; income. You mentioned
that you collected data on income, let us know if income influenced the time of presentation of
patients. Did you stratify other factors such as age, education, type of employment, and location
based on income? What forms of payment are available for health care in Tanzania? Do the
patients pay out of pocket or is health insurance available? If this data is not available, you may
explain the reason as a limitation of the study.
4. Discussion: Please where needed, mention the name of the authors and/or the place of study
and add the reference number in parentheses.
For example, the 2nd paragraph could be written as follows: ...This was in agreement with the
study conducted by Abdi (10) and Burgess (11), this is because...
After the discussion, please write about the limitations of your study and express what further
studies may be carried out based on the findings of your study.
5. References:
Rewrite reference 2, it is not complete.
Remove reference 11, it is not contributory.
I advise that you get a few more references on the acute abdomen from other studies performed
in Africa and developing countries similar to Tanzania.
Overall, this is a great start.