Title: Male partners’ involvement in birth preparedness and complication readiness plan in Dale
district, Sidama regional state, Ethiopia, 2021
Version: 5 Date: 17 Sep 2023
Reviewer's report:
Reviewer’s Report
General comments: I would like to thank  the authors for their effort  in addressing our
previous comments. However, there are still outstanding issues that must be resolved before
the manuscript can be accepted. Most notably, there remains a need for professional English
language editing as there are language related issues here and there. Additionally, the discussion
section requires further descriptions regarding any inconsistencies between the current findings
and previous studies. Detailed comments are provided below:
1. Abstract
Background: In the first paragraph, line 18, the statement "…mainly in rural areas" may not
provide substantial information, as Birth Preparedness and Complication Readiness (BPCR)
planning is essential for women irrespective of their place of residence. Therefore, consider
removing it.
Objective: Please include the preposition "in" before "Dale district."
Method: In the last paragraph, change "multivariate" to "multivariable."
Result: The statement "……. giving birth by C/S (AOR=2.1, 95%CI 1.1, 3.8), knowledge
on BPCRP (AOR=3.5, 95%CI:3.1,6.6)" requires additional clarification to specify which type
of birth is being referred to—whether it is ever Caesarean section (C/S) or most recent C/S.
Furthermore, it is good to describe specifically whether “knowledge on BPCRP” implies partner
or women knowledge. Abbreviations should generally be avoided in the abstract.
2. Background
In the first paragraph, the sentence "Nowadays, 830 maternal deaths are occurred every day from
preventable causes of childbirth" requires revision for clarity. Instead of "nowadays," consider
specifying the year of reference. Additionally, the mention of maternal mortality in 2015 in the
subsequent line appears somewhat inconsistent with the earlier statement. If "nowadays" refers
to 2023, it may not be necessary to reference maternal mortality in 2015, unless this data provides
critical context that is not covered by more recent evidence.
In the background section, on page 3, paragraph 2, there is a discrepancy between two
statements: "Birth preparedness and complication readiness plan is a comprehensive package
aimed at promoting timely access to skilled care, active preparation, and decision making for
delivery by pregnant women and their families [4]" and "The primary elements of this package
include birth preparedness and complication readiness plan." This inconsistency should be
resolved for clarity.
3. Methods
Under operational definitions, the first line defines male involvement, but the definition does
not align with the components of Birth Preparedness and Complication Readiness Plan (BPCR).
This definition should be reviewed and revised to ensure alignment with the scope of BPCR.
Additionally, the reference used for this definition appears unrelated to the provided definition.
In the data analysis section, line 202 mentions that variables were included in the model until
they had a p-value of < 0.05. I am assuming that all variables with p-value<0.25 were entered
into multivariable logistic regression. However, from the authors descriptions, it seems as if they
constructed different model. Would you please, describe how you fit the model clearly?
4. Results
Under Socio-demographic characteristics, in line 1, the word "completely" does not add clarity
and can be omitted. Also, phrases such as "based on the table 1 report" (line 212) and "In the
same way" (line 215) do not contribute to the content and should be removed.
In the section on Reproductive characteristics of the partners' wives, consider removing the first
sentence as it does not provide new information.
Under health service characteristics, on line 235, the statement "Almost half (49%) of male
partners' wives had less than ANC visits" needs correction.
In the section on individual health characteristics, the first sentence of the first paragraph
should be corrected to ensure subject-verb agreement. Additionally, the high level of knowledge
(60.5%) regarding the retention of placenta after 30 minutes is surprising given cultural factors
and residency of the study population. It would be good to discuss this unexpected finding in
the discussion section.
Under male partner's participation in birth preparedness and complication readiness plan, the
first sentence of the first paragraph contains a typographical error that needs correction.
Throughout the manuscript, there is inconsistency in the use of "husband" and "male partner."
Would you please choose one term and use it consistently.
5. Discussion
When the author discussed the discrepancy between the current findings and previous studies,
they largely reported culture, time, and residency as the main reasons for the discrepancy.
However, it is advisable to mention (by providing at least one example) how these factors (for
example local culture) contributed to the discrepancy. Without this, the discussion may remain
shallow and potentially misleading.
In the first and second paragraphs, the author presented the rate of BPCR in the study setting in
comparison to other existing studies. For instance, it was noted that the current finding (47.6%)
is lower than the finding from Axum (51.4%) but consistent with the findings from Uganda
(42.9%) and low-income African countries (42.4%). It appears that the finding from Axum is
more similar with the current findings compared to that from Uganda. Could you please explain
the criteria used to classify these rates as high or low?
Within the section discussing the strengths and limitations of the study, it was mentioned that
"This study has the strength of assessing male partners’ participation during BPCRP for the most
affected population." However, this statement appears to relate more to the study's objective
rather than constituting a specific strength of the study.