Reviewer ’s report  
 
Title: Use of contraceptives, high risk births and under -5 mortality in Sub Saharan Africa: 
Evidence from Kenyan (2014) and Zimbabwean (2011) Demographic Health Surveys  
 
Version: 3 Date: 26 Apr 2018  
 
Reviewer: Marshall Makate  
 
Reviewer's report:  
 
Title: Modern contraceptive use and its relatio nships with high risk births and child mortality in 
Sub Saharan Africa: Evidence from Kenyan (2014) and Zimbabwean (2011) Demographic 
Health Surveys.  
I commend the authors for revising their paper according to the reviewer comments. However, I 
still have s ome big concerns which I note below.  
1. Given that the analysis in this paper mirrors or was adapted from that in Maiga et al (2015), 
I am not sure why the authors failed to acknowledge this in their paper. This makes the 
originality of their analysis ques tionable, at the very least they should have acknowledged 
that the methods they adopt here are not new at all. (See this paper: <Maïga A, Hounton S, 
Amouzou A, Akinyemi A, Shiferaw S, Baya B, Bahan D, Barros AJD, Walker N, Friedman 
H: Trends and patterns o f modern contraceptive use and relationships with high -risk births 
and child mortality in Burkina Faso. Global Health Action 2015, 
8:10.3402/gha.v3408.29736>). Instead, the authors claim that they use new methods, this is 
problematic.  
 
2. In my previous co mment on the restriction of the analysis to only high risk births or under -
five mortality, it appears that the authors had trouble understanding the potential biases to 
the results they report due to such restriction. Certainly, I do appreciate and recogni ze that 
your paper is not an economics nor is it an economic evaluation paper. My point was that, 
one needs to be careful with such sample restrictions and should at least discuss the potential 
biases (from a modelling perspective) that might result which you fail to provide in this 
case.  
 
3. The authors still do not provide a brief justification to the explanatory variables used in the 
study. It's not enough to just say "previous studies have found them to be important". The 
authors need to just briefly s tate e.g. how education impacts the outcome variables and then 
provide the citation (at least one or two).  
 
4. I am not convinced with the statistical modelling conducted by the authors.  
 
5. The authors simply list the limitations to their study without a ny explanations whatsoever. 
For example "Lastly, contraceptive use was current, whilst under -five mortality and high 
risk births referred to the past 5 years".  "Fourthly, the analysis of factors associated with 
contraceptive use was restricted to women wh o had experienced high risk births or under -
five mortality".   
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are requ ired in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, 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 qua lity of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salar y from an  
organisation that may in any way gain or lose financially from the publication of this  
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2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publicati on of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has  applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
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below.  If your reply is yes to any, please give details below.  
 
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