Reviewer's report
Title:Factors Associated with Intimate Partner Violence Against Women in
Rwanda: A cross-sectional study
Version:3Date:23 June 2015
Reviewer: Kristin Dunkle
Reviewer's report:
Comments for Authors
To begin, I would like to congratulate the authors on a very much improved
manuscript. The added value from seeing both the 2005 and 2010 data analysed
side by side is apparent, and makes for a much stronger and more interesting
paper. That said, the expanded analyses raise a few more questions which I very
much hope the authors can address.
As before, these comments are offered in the spirit of strengthening the analysis
and presentation of findings for maximum value to the field.
Major compulsory revisions:
As noted by the authors, the reported lifetime prevalence of IPV in the DHS data
went from 34% in 2005 to 56% in 2010. If we accept these figures, it implies that
at least 22% (or over 1 in 5) adult women in Rwanda experienced IPV for the first
time in her life during this 5 year period, which would be a rather noteworthy
claim in any setting. This increase deserves a bit more nuanced interrogation
than is presently provided. While these data are supported by more than two fold
increase in past-year prevalence of IPV, the different variables associated with
past year IPV in the two different surveys suggest the possibility of either or both
of (a) systematic difference in survey administration and/or (b) genuine changes
in the prevalence and patterns of risk factors between surveys. There are a
couple of issues that deserve further attention in this regard, detailed below. (NB
I am the last person to disregard women’s self-reports, but I do think it is
important for those of us in the field to rigorously interrogate our own data before
subjecting it to public critique.)
(1) While the authors mention the possibility that changing public discourse
around IPV may have facilitated increased disclosure in 2010 compared to 2005,
they do need to make mention of the possibility of methodological changes in
survey administration that may have had an impact on reporting. We know that
IPV disclosure rates depend greatly on interviewer training, privacy protocols,
and a range of other methodological issues. Differences in field methods
between the two rounds of surveys need to be more explicitly mentioned as a
possible reason for at least part of the difference between years. This will be best
incorporated under the limitations section.
(2) The authors have done a great job improving their descriptions of who is
included in the analysis, However, the handling of missing data deserves further
attention. The authors note that they are using 1,888 cases from the 2005 data
for analysis, but only 1,502 to 1,520 of these cases are used in the regression
models because of casewise deletion of respondents with missing data. This
excludes approximately 20% of respondents from the multiple regression
analysis. Similarly, the regression models for 2010 use 2,027 to 2,029 out of
2,450 cases (roughly 17% of data excluded). There are a couple of ways to
handle this. One is to restrict all analyses to cases with complete data, and report
in table 1 or elsewhere on any systematic differences between included and
excluded cases. Another would be to impute values for key variables. A range of
other strategies are possible, but the authors need to choose, utilize, an justify
and appropriate strategy for dealing with this level of missing data, rather than
merely dropping 20% of the data from the regression models without further
comment. Their choice needs to be detailed in the methods section, and
drawbacks discussed in the methods section.
(3) The presentation in Table 1 on key demographic variables which differ
between women included and not included in the analysis is incredibly helpful,
and shows the reader that there are indeed some differences in both waves
between the currently and/or recently partnered women whose partners were
interviewed and those whose partners were not. In the interest of increasing the
validity and generalizability of the findings, I would strongly recommend that all
statistically significant variables in Table 1 be included in the final regression
models regardless of statistical significance in those models. This will ensure that
point estimates in those models take selection bias into account as fully as
possible.
(4) Table 2 is very helpful in understanding the differences in between 2005 and
2010 in bivariate associations. It would be most helpful if the authors could in
addition show how the prevalence of factors included in both waves changed
between 2005 and 2010. For example, there appears to be a marked increase in
the number of women who reporting a belief that a man can hit his wife. This
information could help provide part of an explanation for the increase in
prevalence between 2005 and 2010. Notable changes in these variables also
deserve some commentary in the discussion sector.
Minor Revisions
A thorough proofread is needed ( as is doubtless also the case for this review!)
I truly hope the authors have the patience for another round of revisions, as this
is becoming a really excellent paper.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests.