Reviewer’s report
Title: 
Quality of life and associated factors among women with obstetric fistula
in Ethiopia
Version: 
2 
Date: 
01 Aug 2021
Reviewer's report:
Dear Authors, 
Your manuscript entitled "Quality of life and associated factors among women
with obstetric fistula in Ethiopia" provides us with a valuable insight into this
health problem and its wide personal and social consequences. Although the
study design and results are correct and have been presented properly, there are
many expressions that could be improved: 
Introduction: 
-- Pag 4, line 8: "there remain" can be replaced by "it still remais"
-- Pag 4, line 21: "to reach health facility for labor women are suffering with this
problem". I suggest to say: "to reach health facility for labor, women frequently
suffer from obstetric fistula"
-- Pag 4, line 33: "used" can be replaced by "carried out"
-- Pag 4, line 37: "had built" means "have been built" or "were built"
-- Pag 4, line 55: when using "visit", you meant "assisted"
-- Pag 4, line 59: in each institution (not plural). 
Discussion: 
-- Pag 8, line 32: In Ethiopia, like in other remotes areas of poor countries, most
women...
-- Pag 8, line 36: also face related complications like physical or psychosocial
issues
-- Pag 8, line 43: fistula, which is commonly aggravated by sexual intercourse or
giving birth. 
-- Pag 8, line 52: "experienced" in that case, delete the word were) or "were
experiencing" (ending with -ing form).
-- Pag 9, line 3: feeling about themselves
-- Pag 9, lines 11-12: Please reword the sentence to make it understandable.
-- Pag 9, lines 20-22: Please reword the sentence to make it understandable.
-- Pag 9, lines 12-16: "might dissuade them to travel by public transport" or "to
use public transport for travelling"
-- Pag 9, lines 29-34: Pleae, use punctuation marks to make the sentence
understandable. Suggested paragraph: 
" Women with physical challenges might need assistance from husband, family
members,
relatives and community members; but a study has shown that women with
fistula are more frequently divorced
as result of this condition (21). The lack of or poor social assistance after
surgical procedures,
might lead them to anger and sadness (22, 23)".
-- Pag 9, line 35: These feelings
-- Pag 9, line 36: fulfill the traditional role of wife.
-- Pag 9, lines 40-43: This sentence is meaningless, please re-write it. 
-- Pag 9, lines 54-56: Suggested paragraph: 
"n the current study, we found that the mental health of the women were
increased by 2 in case of women who had children still alive"
-- Pag 9, lines 57-59: Suggested paragraph: 
"in this study, the presence (not plural) of anxiety symptoms affected patients'
physical, psychological and social quality of life, what might be related to stigma
"
-- Pag 10, line 1: "spend their time alone (27,28)"
-- Pag 10, lines 5-6: I cannot understand the sentence.
-- Pag 10, line 7: The sentence should be atrted " Employment increases"
-- Pag 10, lines 13-18: Suggested paragraph: 
"In most rural areas of Ethiopia, women are powerless in their married lives; so
women with fistula stop working and remain at home (22), what make them even
more dependent of their
family, and adversely affect their mental health condition".
Limitations (plural) of the study:
-- Pag 10, line 27: answers (plural)
-- Pag 10, lines 31-33: "we were unable to establish causal relationsships from
the observed results"
-- Pag 10, lines 35-37: "This study was a quantitative approach by using different
instruments or scales, but further studies will benefit from qualitative or mixed
(quantitative plus qualitative) study designs. 
Conclusion: 
-- Pag 10, line 44: In this study, (please insert comma)
-- Pag 10, line 47: A comma should be placed instead of a semicolon. 
-- Pag 10, lines 50-55: Suggested paragraph:
"We also suggest that Ministry of Health promotes community awareness about
early treatment of obstetric fistula. Moreover; the government may develop
specific programs for the victims, improving their quality of life
through job generation and stable income".
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes