Title: Home birth and its associated factors among mothers aged 15–49 years in Somalia: A
nationwide population-based cross-sectional study
Version: 1 Date: 01 Nov 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: Thank you for the opportunity to review this manuscript after the
authors gave careful consideration to the extensive comments provided by the first reviewers.
The authors made extensive revisions and the study results are an important contribution to the
literature related to maternal mortality and morbidity. My main concern is the length of the
article, for example the results are repeated in the discussion leading to a very lengthy discussion
section.
REQUESTED REVISIONS:
Overall, I would suggest that the authors edit for conciseness, take out repeated content, shorten
the manuscript. I have a question - are homebirths in Somalia ever attended by skilled birth
attendants?
Line 14-  separated or obtained
Line 20 - clarify that these are the results from your study
Line 21 - I appreciate that you used the Anderson Model for the study. My suggestion is that
you just report the results in the abstract vs. using the components of the model. For example
instead of "External environment of being in the Northeast (AOR = 1.48, 95% CI: 1.17–1.86)"
state " living in the Northeast (AOR = 1.48, 95% CI: 1.17–1.86)"
Line 78 - rather than poor family planning state "low uptake of family planning"
Line 90 - use LMIC rather than "underdeveloped"
Line 110 - rather than "imposing" use "associated factors"
Line 163 - cooperation vs. cooperating
And finally: A major concern is the percentages. The authors use percentages based on total
population versus the population in that CATEGORY. For example – the authors report
“Nomadic residents had the greatest percentage of home birth (28.1%) compared with urban
(26.6%) and rural (20.8%, p<0.001) (see Figure 2).”
Nomadic residents actually had a percentage of 94.3% of their births occurring at home and
only 5.7% were in an institution. I derived these statistics, for example, by taking the number of
institutional births in the sample of nomadic participants divided by the total number of births
in the nomadic sample  (146/2572 – 5.7%)
ADDITIONAL REQUESTS/SUGGESTIONS:
the revisions I suggest should not take long and I do encourage the authors to carry this to
publication and congratulate them on their work