Reviewer's report
Title:Prevalence and correlates of contraceptive use among female adolescents
in Ghana
Version:2Date:8 March 2015
Reviewer: Takudzwa Sayi
Reviewer's report:
This manuscript documents contraceptive prevalence among adolescents with
different characteristics, and the correlates of contraceptive use among
adolescents in Ghana. Below are some comments about the manuscript:
Major Compulsory Revisions
1. The author can make the case for adolescents stronger by highlighting how
they compare with women at other ages. Are these issues they face unique?
2. Prior to the description of methods and results, the author needs to provide
some sense of what we can expect to find, some context – a section explaining
the contraceptive situation in Ghana. Does Ghana stand out from other countries
in Africa? Have there been changes over time in the prevalence among
adolescents? Do we expect the determinants to be changing as well over time?
Has anything been done by the Ghanaian government to deal with adolescent
issues. Just placing the conversation in context.
3. This paper is descriptive. As a policymaker wishing to address this issue, one
might want to have a better sense of the context, as explained above. The
recommendations made in the final section may also make more sense if we
knew, beforehand, that young women had no source of knowledge about
menstruation….do Ghana schools teach this; or are women usually educated by
female relatives?
4. In addition, what do we know about wanted/unwanted fertility, discontinuation,
unmet need, sexual frequency…in this group of young women. Sexual frequency
may be a big issue at these ages. Which brings the question, were adolescents
not sexually active excluded from the study or kept in?
5. More citations in the introduction section for some of the statements being
made. For example, the statement on how adolescent contraceptive use is
experimental.
6. The logistic regression is appropriate for this analysis. But there are some
issues to address in the Methods section.
(i) Methods were not described very well. For instance, how did the author deal
with clustering? Inclusion of an equation for the fitted model will make it easier to
understand the modeling process.
(ii) The writing up of the methods could be better. Examples include.. Line 104:
could just indicate that the dichotomy was between users and nonusers, but not
necessarily indicating the ‘0’ and ‘1’. Line 110: ‘The data were analyzed in Stata
11’ sounds better than the passive voice used here and some other parts of the
paper (e.g. line 169).
(iii) How were the variables used in the model selected?
(iv) There was no mention throughout the paper, of how community-level
variables can affect these patterns, and why they are not included in the models?
(v) What of examining relative odds of using different methods in the multivariate
models? Even the descriptives do not tell us which methods are popular among
all women and in different groups of these women.
7. There are too many percentages in the text of the Results section (the
descriptives). Since they are also in tables, there is no need to describe all of
them in the text. Otherwise it makes the paragraphs very dense and hard to
follow.
8. The description of results would be easier to follow if we knew beforehand
what to expect for the effects of each factor. In the methods section the author
can describe the expected direction of effects as well as the evidence to support
that.
9. Table 2 includes only significant results. The author should include all results
and indicate statistical significance. On line 349, the author indicates that the
source is the DHS…This should be removed because the results are from their
own computations.
10. Some of the confidence intervals in Table 2 (e.g. for secondary/higher) are
very wide. The author needs to talk about why this is the case.
11. Line 204-207: “This may result from the fact that educated women are more
likely to be abreast of available contraceptives and are more likely to appreciate
the positive impacts contraceptives have on their lives.” Could it also be due to
accessibility, affordability, etc? In general, the discussion reasoning (and
speculations) behind the significance of different factors needs to be better
placed in the larger pool of other sub-Saharan studies.
12. In the Abstract background section, the author mentions that prevalence
among adolescents is low, and then that the paper examines prevalence among
adolescents. This part needs to be re-written so that it becomes clear what the
gap is in existing knowledge.
Minor Essential Revisions
1. Line 32 in the abstract. Strike out ‘secondary’.
2. The term ‘binary logistic’ is mentioned a lot in the paper. I would just call it
‘logistic’.
3. Line 66… knowledge of what in particular?
4. Line 101 …’from the full birth history’… could just be 'were extracted from the
dataset'.
5. Line 107: “Some of these study variables were re-coded to suit the purpose of
the study while some were used as they are in the original dataset.” Which ones?
6. Lines 110 and 111: passive voice used here. Switch to active voice.
7. Line 123…. 18 to 18?
8. Sentence beginning on line 169 to 171 can be deleted.
9. Phrase “three folds” appears many times in the manuscript. “three times”
sounds better.
10. Table 1 caption.. ’Prevalence of contraceptive use by selected variables’. In
addition, it is not obvious what the difference is between the columns ‘Percent’
and ‘Proportion’ in Table 1.
11. Line 115 is repetitive; this was already mentioned on line 103.
12. Line 132 misspelling ‘shighest’.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests.