Reviewer ’s report  
 
Title: Distant and p roximate factors associated with maternal near -miss: A nested case -control 
study in selected public hospitals of Addis Ababa, Ethiopia  
 
Version: 0 Date: 12 Nov 2017  
 
Reviewer: Theo Nwankwo  
 
Reviewer's report:  
 
1. Title: Can you modify your title to reflect many other variables found to be significantly 
associated with maternal nea r miss mortality in this study, other than chronic hypertension 
and rural residence. I think that those factors were essentially risk factors as mist immediate 
causes of near miss such as PPI, uterine rupture,  severe pre -eclampsia,  etc were not part of 
studied or identified variables. These Findings can go for risk factors.  
 
2. Methods:  
a. The criteria for hospital selection should be clearly stated.  
i. For example are there any specific  number of deliveries needed?  
ii. Is availability of intensive uni t a prerequisite?  
 
3. Inclusion criteria:  
a. I suggest you modify the use of cohort of women, to for example Patients or women that 
met one of the WHO criteria for near miss maternal death from the study centres were 
enrolled  
 
4. Selection of control:  
a. Why did you select only  those that had vaginal delivery? Caesarean delivery is not one of 
the criteria that defines near miss mortality  and they were not excluded in the cases.  
 
5. Sample size.: the study population size was adequate.  Though I  had expecte d that 
computing for sample size with the stated parameters into the Epi info software would give 
me the same figure  but  I got a small sample size. Please cross check.  
 
6. Development of Questionnaires:  
a. I expect that some of the data sought by the questionnaire should be stated. Was the 
questionnaire validated since you derived it and if so how? Please state.  
 
7. Data analysis:  
a. You made reference to literature review twice in this section, but I sugg est you focus on 
independent factors as identified in your studied population. Example. The independent 
variables identified in these patients were grouped into Distant and proximate factors.  
b. I thought that the proximate causes would be the clinical con ditions and  complications in 
the pregnancy that led to the near miss maternal mortality . E.g. PPH. Eclampsia etc but 
those were not mentioned or sought for in this study. It may be pertinent to state such if you 
have the data.  
 
8. Tables:  
a. Table one sh ould be adapted and made part of the methods as criteria for inclusion.  
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Are the methods appropriate and well described?  
If no t, please specify what is required in your comments to the authors.  
 
Yes 
 
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 recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
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