Reviewer ’s report  
 
Title: Magnitude, trends and causes of maternal mortality a mong reproductive aged women in 
Kersa Health and Demographic Surveillance System, Eastern Ethiopia  
 
Version: 2 Date: 05 Feb 2018  
 
Reviewer: Marie Hélène Bouvier -Colle  
 
Reviewer's report:  
 
Regarding the "necessary controls": in this description of maternal deaths there is no need of 
controls in the comm on sense. But as a consequence there is not evidence or proof of any 
scientific rsesult.  
 
 
The discussion does not pinpoint accurately the bizarre increase of MMR in 2011, though not 
statistically significant. Conversely the decrease during 2013 2014 is not  clearly explained.  
 
 
For example are there different data collections by years : better in 2011 or worse in 2014 ?  
Or climatic events every where in Ethiopia or starvation or ...?  
 
 
I don't understand what the authors want to say  (p 9 l 56) when they explai ned "sharp rise in 
MMR might be the result of the aggregate effect of maternal mortality causes".  
 
 
p10 l35, it is not surprising that obstetric causes of this survey varied from other studies as the 
number of deaths were so small. It is to be regretted th at  numbers by causes were not shown at 
all in complement of their MMR ; confidence interval of these MMR would be interesting (fig4).   
 
 
The authors might aggregate causes of maternal death by 2 or 3 years to try to underline 
changing patterns of causes.  
 
 
About dystocia : It is usual that different examinators classify differently causes of maternal 
deaths. In particular when assessed on verbal autopsy !  
 
 
For example, generally the mothers do not die directly from dystocia but from postpartum 
haemorrhage res ulting from prolonged labor.  
 
p10 l44 sq, the long development on the partner violence is not justified as well as no precise 
results were presented on this matter in the present paper. The authors need to prepare other 
analyses on this important subject w ith the appropriate data.  
 
 
p11 l4 -28 For me these comments are hors subject;  
 
 
 
Are the methods appropriate and w ell described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is rec ommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
 
 
 
 
 
 
 
 
 
 
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