Title: Exposure to different types of mass media and timing of antenatal care initiation: Insights
from the 2016 Uganda Demographic and Health Survey
Version: 0 Date: 22 Jun 2021
Reviewer:  Aduragbemi Banke-Thomas
Reviewer's report:
Dear Editor,
Thank you for inviting me for this review which I read with keen interest.
An interesting study indeed and kudos to the authors.
Here are a few comments that I believe will help to significantly improve the manuscript.
I hope the authors find this useful.
Best wishes
Title
Change title. This paper is more than about mass media exposure
Mass media exposure and timing of antenatal care initiation among women in Uganda
Type of mass media exposure and timing of antenatal care initiation among women: Insights
from the Uganda Demographic and Health Survey (UDHS) 2016
Abstract
Make changes based on those that will be done in the manuscript based on the comments below.
Introduction
The introduction is unnecessarily long, windy, and in some instances repetitive. Please focus it
properly and remove repetitions.
Specify the benefits of ANC to the women, not just write they are widely known! The other
‘benefits’ written appear to be for the health system.
Also, be clear on the specific guideline on timing and frequency of ANC.
This statement can be better phrased – “Antenatal care if well utilised ensures positive maternal
health outcomes such as reductions in stillbirths and complications in pregnancy”.
After using ANC as an abbreviation, there is no need to type out Antenatal Care afterward.
Please review for other abbreviations.
The rationale for this study needs to be clearer. There are no “different mass media exposure”,
there are different types of mass media. Review these links:
https://sendpulse.com/support/glossary/mass-media
https://study.com/academy/lesson/what-is-mass-media-definition-types-influence-
examples.html
https://en.wikipedia.org/wiki/Mass_media
https://www.admitkard.com/blog/2019/12/21/types-of-mass-media/
https://leverageedu.com/blog/types-of-mass-media/
The key question in developing the rationale should link to why is it necessary to disentangle
the ‘mass media’ variable to understand the role of TV, radio etc., especially in the context of
new media like social media? Why? This is very important and needs to come out clearly in
the introduction.
Is this an aim or an objective? Please check.
Methods
We state the study design upfront not the dataset used.
No need to state coding ‘0’ or ‘1’.
What theoretical underpinning explained your recoding here? “Women were asked whether they
read a newspaper or magazine, listen to radio or watch TV almost every day, at least once a week,
less than once a week or not at all. Responses were available from only at least once a week, less
than once a week and not at all. These variables were recoded to dichotomous variables with
response options yes ‘yes’ (for women who responded at least once a week or less than once a
week) and ‘no’ (for women who responded not at all)”. Is there no difference between “at least
once a week or less than once a week” as it relates to service utilisation? Please leverage theory
and evidence in developing a justification for your approach.
Please include years at the end of these categories? “15-24, 25-34 and 35-49” Again please try
to explain the theoretical underpinning of your Recoding. For example, age appears to link with
the risk profile of pregnant women. Right?
This is not clear “We used Complex sample analysis was performed using SPSS version 25.0
statistical software to account for the multi-stage cluster study design”. Rephrase, please.
Please cite the software as per standard practice in the literature “SPSS version 25.0 statistical
software (IBM C…, City, Country)
Results
Good and straightforward analysis.
Please use comma in between numbers a 1,000 or over
In the supportive narrative of the results, please simply state the result and then ‘discuss’ them
in the discussion. Some text here read like the discussion already. For example, “Region, age of
the women, household size and partner’s level of education were also shown to be significantly
associated with timely initiation of ANC contacts”.
Not quite sure if Supplementary file 1 is needed, but I will leave that decision to you.
Discussion
This needs significant improvement in terms of structure and approach. Please follow the
standard approach: summarise results, interpret findings (including contextualization), strengths
and limitations, implications for policy and practice.
Please avoid repeating what has been stated in the introduction.
Again, please use abbreviations and avoid repeating text that has been presented as an
abbreviation already.
Your study cannot be  “an improvement from a similar study..”. They are not the same. It is
either different or your estimate is higher, not an improvement.
It is not clear how this section supports radio being the most popular form – “Public health
facilities in rural areas which provide free services are usually less, widely apart from each other
and under staffed which negatively affect utilization of care by women [20, 21]. In such rural
settings, reaching all mothers by health workers is hard and therefore, only mass media remains
a viable option to reaching families and communities to disseminate message on the importance
of early initiation of ANC and availability of such service in their own communities [2]”.
Decide how you want to structure your paragraphs – radio, TV, newspaper all separate OR you
want to present them together while highlighting their various applicability.
Please focus the discussion really on mass media. Limit the discussion of the covariates to max
one or two paragraphs while expanding on mass media and the different components, why it
works or may not work. You already have a lot of this content somewhere in the discussion,
you just need to structure it better.
Do not just write social media as a limitation, flag it as a gap for future DHS… No need to
specify Facebook… because there are many others.
Also, please develop the implications for practice and policy very clearly. So, what now needs
to be done with radio and TV?  How does social media fit in all of this? Cite sources on the
use of social media in rural and urban communities of Uganda and how potentially it can be an
opportunity. Though it is not in UDHS… people will rather pay for a subscription for an Internet
connection than buy a newspaper.
Conclusion
Use this solely for a one-sentence summary of the results, take-home message, advocacy to key
stakeholders on what needs to be done right away, and recommendations (Please note this is
different from implications for policy and practice). Move what reads like implication into the
discussion section and use evidence from the literature to back up some of your implications
for policy and practice.
Grammar
Please check for punctuation errors in the manuscript. There are a couple. You may consider
using an application like Grammarly to make this process a bit more efficient.