Title: Trends and factors contributing to health facility delivery among adolescent women in
Ethiopia: Multivariate decomposition analysis
Version: 1 Date: 29 Aug 2022
Reviewer:  Tesfahun Taddege Geremew
Reviewer's report:
Dear Author (s),
You have raised  an import issue of adolescents' sexual health and I enjoyed reading the
manuscript. However, it needs a major revision and it has a potential to be published if the
comments and suggestions are corrected.  The detail  comments and suggestions are put
hereunder and a point by point answer may be needed.
Cover page :
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Page 1, Line1-2: Title (Optional) : Trend  and factors associated with health facility delivery
among adolescent women in Ethiopia: Multilevel analysis.
Abstract
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Page 2, line 32:  ... identify factors associated with health facility ...
Page 2, line 34: ... on adolescent women obtained  ....
Page 2, Line 36: Please remove  ... "Adolescent women who gave birth in the last five years
preceding the surveys"
Page 3, Line 55:  ... interventions on access to education  and limiting children would increase
the institutional delivery .
Have you assessed access to education? I don’t think so. You have found lower educational
level has a negative influence in HF delivery. But it may not necessarily mean poor access to
education. So, rephrase it please.
Page 3 , line 57: Keywords: ...Variables ...
Putting "variables" as a keywords is not clear. What is the main purpose of putting Keywords?
Check it again please.
Background
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Page 4, line 70 (first Sentence): Better to Make it part of operational definition in the methods
section. In the place better to start bey defining or describing the problem.
Page 4, line 72:  "... health facilities (such as government, non-government, or private health
facilities)...." Do you think that the private HFs are not among the non-government HFs. Better
to rephrase it to make it more sound.
Page 4, line 79-80: "...approximately seventy thousand adolescent girls were died every year ...".
It is  outdated evidence. This estimate was before nearly 15 years. Better to refer recent evidences
to make it more sound.
Page 4, line 84: "Early Child Marriage ..." . Any difference among Child Marriage Vs Early
Marriage Vs Early Child Marriage? It seems redundancy. So better to use “Early Marriage” Or
“Child Marriage”
Page 6, line 118: "... using multilevel analysis...". Better to clarify the rationale to use multilevel
analysis for the readers to make it clearer.
Page 6, line 119: "... Women ..." Be consistent please. Adolescents, Adolescent women,
Women???
Methods
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Page 6, Lines 123-124:  The statement needs rephrasing-i.e., This study used three consecutive
Ethiopian Demographic and Health Surveys (EDHS 2005, EDHS 2011, and EDHS 2016) .
Remove  " ... and a cross-sectional study design"
Page 6, Line 124-135: The sampling technique and procedure of EDHS needs to clearly stated
for the readers. " Stratified two stage cluster sampling ….
Page 6, line 126-125: "According to the 2019 EPHC ..."
Is there Population and Housing Censuses (PHC) of Ethiopia in 2019?
No, probably you may be referring the 2007 PHC as all the EDHSs use the 2007 PHC EAs.
Please, make it clear.
Page 6, line 126-130
Please, put the official sub-national administrative names-i.e., Ethiopia is sub-divided into
nine regional states and two metropolitan cities. The regional states are Tigray, Afar, Amhara,
Oromia, Somali, Benshangul-Gumuz, Southern Nations, Nationalities, and Peoples' Region
(often abbreviated as SNNPR), Gambela, and Harari. The metropolitan cities were Addis Ababa
and Dire Dewa.
Page 6, Line 131-132: Please Remove the statement "The samples in the EDHS have been
utilized to provide estimates for key indicators in the country".
Page 7, line 141: (Ref 21): It is not clear why EDHS 2019 is cited here? Better to cite all
the EDHSs (2005, 2011, and 2016) to refer for detail methodological procedures.  Check your
reference, please.
Page 7, line 142-143: "... datasets were obtained from children's recode data or kids file (KR
file) ..." Why From KR (Children) File?  Why not from the Women’s record (IR) and Birth
Record File (BR) files?
Page 7, line 143: "... Measure DHS ...". Please, use the official and correct name of programs.
“Measure DHS Program” has been officially changed to “The DHS Program”. Currently, there
is no such Official name.
Page 7, Line 148: Remove " Below 20 Years", please. Adolescents (women aged 15-19 years)
is appropriate.
Page 8, Line 163: Is residence individual level factor or Community Level Factor?
What are the community level factors? and how they are measured? Better to clarify it for the
readers. Separate the individual and Community level factors
Page 8, line 169-170: "... Dataset was extracted..." Have you extracted the dataset or the potential
Variables? Rephrase it please?
Page 8, line 171-172 : " ...Sampling weight, which adjusted the non-response rate ...". What is
the main purpose of sampling weights in EDHS? Think beyond adjusting non-response rate.
page 9, line 181: "Multicollinearity assumption ..." Do you think multicollinearity is a critical
issue for such binary outcome variables? Please think of interactions than multicollinearity.
Page 9, line 200-201: "... a higher risk of HF delivery".  What does high risk of HF delivery
mean? I think you want to say “Higher chance of HF delivery” … Check it again please.
Results:
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Page 10, line 116-119: The first paragraph is not necessary in the results section. It may be part
of methods sections.
Page 15: Table 2: It is not clear what Regions-Large central , Small peripheral, Metropolis
Represent. Better to clarify it, you can put it in the foot note with *.
Page 15: Line 191-193: "From multivariable multilevel logistic  ..." This is also a part of the
method section. Don’t repeat the methods in results section, please.  Just put the results with
their narration.
In addition, Indicate the community level factors with their measurement.
Conclusions
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Page 20, first Sentence:  Better to restate it to make the conclusion sounder or better to conclude
as high or low, poor or good … terms other than repeating the results.
Page 20, second Sentence: "Various factors have influenced birth at health facilities among
adolescent women". Remove it, please
Page 20, Third sentence: Better to rephrase it.
Page 20, line 195-196: Remove the phrase "based on the Multi-level analysis"
Page 20, Last Sentence:  "... the government should give special attention  ..." Better not to make
it obligatory. Just better the recommendations in a kind way.