Reviewer’s report
Title: 
Prevalence and factors associated with early discontinuation rate of
Implanon utilization among Women who ever used Implanon in Kucha District
Gamo Gofa Zone, Southern Ethiopia
Version: 
1 
Date: 
30 Jan 2020
Reviewer's report:
Abstract
1. Multistage sampling: 
How was this done and from where were women that
have ever used implanon identified
2. Odds ratios cannot be used with a discontinuation frequency of 34%. 
These
are valid for rare outcomes. 
Estimates of prevalence ratios maybe more valid
3. Many of the factors associated with discontinuation such as discussion with
partner, quality of counseling and follow up and satisfaction with insertion
service are likely to be affected by recall bias since at the time of data collection
discontinuation had already occurred
Introduction 
1. line 22: the denominator for contraceptive use is not "targeted mothers"
2. Line 33: Typo "said effects"
3. Line 40-47: 
There is need to distinguish between factors and reasons for
discontinuation. 
This should be done throughout the paper. 
Methods
1. Line 9: 
What does 23% coverage with implanon mean
2. Line 19: 
The sampling technique needs to be clarified. 
If women were
identified from the registers, then how were they located. 
How many women had
ever initiated implants from the registers and why the decision to select the
sample size. 
Of particular interest is how women who had discontinued use were
identified. 
Results
1. Important results are missing on What period did the registers cover, how
many women had reached 2.5 years so that one can rule out early
discontinuation. 
2. Line 55-55: 
The study subjects from the methods appear to be women who
initiated implanon between a certain period. 
This is more accurate than who ever
used implanon
3. 
The factor not discussing with their partners is included in results but is not in
table 2 or 3
4. Experience of side effects is also not in table 3, have fear of side effects
Discussion
1. Line 1: 
Challenging to talk about the discontinuation rate without a time
frame see comment above on methods
2. Line 1 and 21: 
Continuation rate 66% and early discontinuation of 88% does
not add up. 
Importantly to get an early discontinuation rate all continuing women
have to have reached 2.5 years. 
Otherwise we do not know if they will
discontinue early
3. Reasons why previous use of contraception associated with better continuation
need to be discussed in context first time users of contraception vs those 
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify what aspects
require further assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
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