Title: Long-acting family planning switching and associated factors among revisit women in
Toke Kutaye district of West Shoa Zone, Oromia Region public health facilities, Ethiopia: a
mixed methods study
Version: 1 Date: 18 Jul 2023
Reviewer's report:
The manuscript represent a very important topic in the field of family planning program which
is switching of FP methods, however, it does not always reflect a negative marker of the
family planning service quality as the authors show, as it could be also indicative of a high-
quality service environment in which clients are encouraged to present problems early, enabling
providers to guide women to a method with side effects that are acceptable without judgment,
with adequate range of available methods.
I could not find any information in the manuscript that could add to the existing knowledge.
The topic has been previously studied in Ethiopia and you referenced some similar studies. I
was expecting to find some data about the methods the clients switched to and whether the new
methods were used consistently and correctly, but there was none. Quantitative data directly
related to the topic is missing and difficient.
The manuscript needs Language and specially grammar editing.
You mentioned in the introduction that users of long acting methods are only 10 % in Ethiopia,
but you didn’t mention the trend from 2000 to 2016; increased, decreased,,etc to provide the
reader with the users attitudes throughout time regarding the use of these methods. It would
be also valuable to mention any data regarding causes of switching and to which methods
available in the DHS report. You can also discuss in brief the positive and negative points of
view regarding switching of FP methods.
In the methods section; study area, you mentioned the health care facilities in your study site,
but as a reader I didn’t know whether all these sites provider family planning services, especially
that you recruited your sample from 5 health care facilities only thereafter and mentioned that
they are the existing facilities in the study site. It would be more valuable to mention the health
care facilities providing LAFP.
Moreover, the number of males and females population, how did you determine such an exact
number, it changes from day to day but from minute to minute, it would be more accurate to say
“about” and mention a round figure, or delete as it does not add to the study.
It is not clear whether you conducted FGDs or in depth interviews, both are mentioned in the
manuscript without details of conduction and presenting only results of in-depth interviews??
You did not also mention that in-depth interviews were conducted with FP clients, while
providing quotes of the clients in the results section!! The number of recruited women for in
depth interviews was not also mentioned.
Please clarify the inclusion criteria and how you recruited your sample; you mentioned that “all
LAFP users who revisit the health facilities during data collection period” was your inclusion
criteria, and in another site you mentioned that “users who have been using LAFP at least once”.
It is not clear also in the tables. So, did you recruit current or ever users?? And did you include
clients who came for switching at the day of data collection?
What does this exclusion criteria mean? “Revisit long acting family planning users who had
unable to hear were excluded in the interview.”
For qualitative study, you mentioned that you conducted in depth interviews with 12 providers,
while you have previously mentioned in the study population  that “all long acting family
planning providers, health extension workers and community leaders at Toke Kutaye district
were recruited to participate for focus group discussions of qualitative data”, so did you conduct
FGDs or in-depth interviews, and did you recruit only 12 providers or did your sample included
health workers and community leaders? And how different were the points of discussion. These
points are all not clear.
It was mentioned that “Two months prior to data collection, a total of 1,024 eligible long acting
family planning clients had attended those health facilities”. How did you determine that they
were eligible for LAFP and why you needed eligible clients for LAFP use, while you are studying
switching? Why is “2 month”?
“After selecting the first sample by lottery method, every kth value=(1024/389= 3) clients from
the list were selected from each health facility by using systematic random sampling  “. If you
selected your sample from the registration files of the clients in each facility, how would you
predict their next revisit to meet and conduct the interview?
The results section of the quantitative part of the study only includes “socio-demographic data,
reproductive history & FP characteristics”. Where are the data related to the main topic which
is switching from long acting to short acting methods, distribution and causes?
“Regarding method of switching among revisit clients, 201(53.32%) of them switched to
different method. Switching from implant was 39.8 % and the rest, 13.5 %, switched from
IUCD Regarding the duration of long acting family planning use, majority of them 141 (96.5%)
switched at less than three years (Figure 1).”. This quantitative finding is mentioned under
“qualitative result”!!
In table 1, there is a considerable proportion of your sample single, divorced and widows, why
do they visit a FP clinic; as you have recruited them in a revisit?
In the question “Is your Husband aware your use of family planning?” you have 335 responses
while the married participants are only 291 !!!
What does this question mean “Do religious leaders in your area consider family planning?”?
A table showing the distribution of the sample use of different family planning methods before
and after switching should be inserted, as no data exist about the method mix used by the sample,
number of switchers, switched to which method, and causes of switching quantitatively.
Qualitative data analysis is poor and needs revision to reflect new themes than mentioned in
the previous literature.