Title: A systematic review and meta-analysis of urinary incontinence following successful
obstetric fistula repair: findings from five countries in sub-Saharan Africa
Version: 1 Date: 16 Feb 2025
Reviewer:  Francis G. Muriithi
Reviewer's report:
Reviewer comments
Thank you for the opportunity to review your research.
Abstract
In the last sentence of the background.
You state, “There are approximately two million women suffering from urinary incontinence
due to utero-genital fistula repair, most of whom are primarily in Africa.”
Please revise the sentence as it implies that obstetric fistula repair is the cause of urinary
incontinence. I think a better way to rephrase is “…………urinary incontinence after obstetric
fistula repair or following fistula repair…….”
Also, you use the term “utero-vaginal fistula repair” – Please consider using the term  “obstetric
fistula repair” throughout the manuscript for consistency.
Introduction
A few typos – Please review entire manuscript. Allow me to recommend using the MS Word
function Review editor to crosscheck the final manuscript.
Typo e.g. “Women with obstetric fistulas often experience a distressing conditions, including
major psychosocial impact”  - The letter “a” should be excluded.
I would exclude the word “theoretical” in the sentence “Theoretically, obstetric fistulas are
completely preventable by the provision of adequate and timely obstetric care, however, the
condition continues to be a considerable cause of morbidity worldwide.” As it implies that it
is not practical or proven that obstetric fistulas can be completely preventable. I believe that is
not the case.
“Surgery is the most commonly preferred approach to treat women with Obstetric fistula; yet,
once a fistula has developed, surgical correction is challenging to achieve, with reported success
rates between 50 to 90 percent” – What about conservative management with a foleys catheter?
I would say “Surgery is a common approach…” Unless you have data to support the proportion
that prefer surgical management – in which case please state it.
Typo … in the words “closer” and transvaginal” in this sentence  “…. includes fistula closer
through transabdominal, trasvaginal and advanced technique procedures that involves robotic
or laparoscopic surgical repair techniques”
Methods
Search strategy
You mention that you aimed to study sub-Saharan Africa.
How did you define sub-Saharan Africa?
Also, you then searched for 5 sub-Saharan African countries – What was the rationale for only
including Burkina Faso, DRC, Ethiopia, Guinea, and Malawi and excluding the rest?
If there is no feasible explanation for including only five countries, I suggest not using the term
sub-Saharan Africa. If indeed you intended to study sub-Saharan Africa, I suggest including
every single sub-Saharan African country in your search strategy, not just five. This will improve
the reliability of your findings (internal validity) and external validity.
Exclusion criteria: sub-Saharan Africa is multi-lingual – I feel that excluding articles written in
other languages, e.g. French and Arabic, may exclude some potential articles.
Apart from MS Excel, any other software used in article processing? – If so, please state.
Study selection and extraction
You repeat information that is already on the search strategy.
RESULTS
You state the software EndNote in the results section.
I believe this should be in the methods section.
Please also cite the software and version, e.g. EndNote version xx  (Clarivate Philadelphia, PA,
USA)  etc. Same for all other software
What software was used for the meta-analysis -please state and cite as above.
Discussion:
In your findings, were there any findings on the type of urinary incontinence?
If not in your findings, what about in published literature?
e.g. is it Stress or overactive bladder or both?
There are published articles (systematic reviews) on the same topic from other parts of the world.
How do these compare to your findings? Please discuss your findings in light of the existing
literature from the rest of the world and if there is none, within Africa.
Thank you.
I will be delighted to review a revised version of your manuscript.