Reviewer's report
Title:Correlates of intimate partner violence among pregnant women in Rwanda
Version: 1Date:31 March 2008
Reviewer: Ann L Coker
Reviewer's report:
This is potentially an important manuscript which could influence efforts to
address IPV in prenatal populations. However, several methodologic issues need
to be addressed.
In general there are several typos or incorrect words which need identified and
corrected.
In neither the abstract nor the methods do the authors clearly present, purpose
for the study or provide the study hypotheses. I believe that the study’s main
objective is to correlated partner violence prevalence by type (physical, sexual,
verbal / psychologic abuse) with HIV status. I am guessing this is the primary
goal because the “cross-sectional” study included a half sample of HIV+ women.
If you are samplying on HIV status this suggests a case-control study design. Is
the research question, for example, “is the incidence of partner violence greater
in HIV+ pregnant women relative to HIV-women?” What attributes of partners
influence HIV status as well as IPV status. The major problem with this
manuscript is the lack of clarity in the question being asked.
In the introduction, provide a reference for the cost of partner violence.
In the methods, include the study design and justify this design to address the
study question. Depending on how the study design issue is resolved, justify the
half sample as HIV+.
Include the response rate (or at least the refusal rate) for study participation.
Include the measures of partner violence used and reference these.
Decide on terms. Either use intimate partner violence or domestic violence; do
not both interchangeably.
There is no discussion in the methods of what variables are included in models to
result in adjusted ORs. How did you decide that factors were or were not
confounders? Those variables included in multivariate models need to be listed
in Table 2. I’d like to see a justification for including confounders because many
of the factors identified are very correlated and may act synergistically to result in
IPV in pg. For example, men who drink heavily and/or have multiple sex partner
may be more likely to infect women with HIV. They may also be more likely to be
abusive to their partners in ways beyond sexual abuse to include physical and
psychologic abuse. I would encourage the authors to develop a working model to
think through how the variables of interest may individually or in combination
interact to affect risk of IPV in the past 12 month among pregnant women.
Finally, the discussion must include specific ways in which these study findings
may affect prenatal care in Rwanda. What are the implications of the high
prevalence of IPV during pregnancy? We know that both IPV and HIV have
significant implications for maternal and infant health. This needs to be
discussed. While calling for universal screening may address IPV in the long
term, are there services to address IPV in Rwanda. Further, are there efforts to
prevent IPV? What might these be? How might prenatal care providers use the
data in this report?
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests.