Reviewer’s report
Title: 
Measuring barriers to fistula care: investigating composite measures for targeted fistula
programming in Nigeria and Uganda
Version: 
2 
Date: 
26 Oct 2020
Reviewer's report:
MEASURING BARRIERS TO FISTULA CARE: INVESTIGATING COMPOSITE MEASURES FOR
TARGETED FISTULA PROGRAMMING IN NIGERIA AND UGANDA
Manuscript Number: BMWH-D-20-00847
Comments
Participant sample and methods
1. "Given the study only interviewed 'emancipated minors'…" why did the study interview only this type of
minors? Was it a deliberate attempt to avoid seeking parental consent or was it accidental? This has the
potential for selection bias and its effect on the study should be discussed.
Measurements 
2. "…a 4-point Likert scale with increasing options from 'strongly disagree', to 'disagree', to 'agree', to
'strongly agree.' In Uganda, the scale was administered as a 5-point Likert with a 'neutral' category." What
necessitated the use of different scales at the different study sites especially since this had to be corrected
using your discretion (neutral added to agree) during the analysis? Kindly explain how this impacts on
your findings.
Results 
3. "The sub-scales of Limited Awareness, Social Abandonment, and Internalized Stigma also demonstrated
moderate to high internal consistency (0.69-0.77; 0.864-0.88; 0.73-0.91, respectively)" I recommend you
state all figures to 2 decimal places for consistency.
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Declaration of competing interests
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If you can answer no to all of the above, write 'I declare that I have no competing interests' below. If your
reply is yes to any, please give details below.
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Is the study design appropriate to answer the research question (including the use of appropriate controls),
and are the conclusions supported by the evidence presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free from apparent
manipulation?
Yes