Title: Prevalence and Associated Factors of Teenage Childbearing among Ethiopian Women
Using Semi-parametric and Parametric Proportional Hazard and Accelerated Failure Time
Models
Version: 2 Date: 14 Mar 2024
Reviewer's report:
General comment the authors raise an important issue that is a public health challenge in the
country, which needs contextual-based evidence in the prevention of teenage pregnancy. The
authors analyzed nationally representative data, however for the national representative the DHS
recommends the utilization of weighted data for analysis, which the authors do not clarify. The
second general comment is the use of terminology in the document needs critically looked at,
clarification for example childbearing may be confused with the target group. Is that teenage
pregnancy, pregnant women, women giving birth, reproductive age group, or all women?
Specific comment
Abbreviation not recommended for the title “PH and AFT Models” needs correction
The term “Teenage Childbearing” should be in line with the objective and target group
Abstract
Line 21: the term “underdeveloped” changes to low income
The gap should be addressed and consistent with the objectives
Result: line 30-31 says “The study's key outcome variables were time to adolescent childbearing
and independent variables include ….” This Shows method and result are mixed, separating
them
Lines 32-33 “Time to teenage childbearing” not clear what was the beginning of time if
childbearing is ended. Need clear explanation of how the data is prepared for survival analysis
in the method part.
Lines 33-36 are well described in the method part remove it, in place describe the result well by
considering protective or negatively affecting predictors
Conclusion not drawn from the result or finding
Background
Need further work in the utilization of words, development of sentences, and logical organization
of the paragraphs, addressing what is known, Unknown, and gaps for example
Line 46: the sentence says “The first child's birth is the main outcome of the reproductive
process” This sentence lacks clarity
Line 55: “givebirth” correct as give birth
Line 62: says “Individually, adolescent fertility is linked to poor outcomes for mother and child
health,” The use of teenage pregnancy and fertility need to be checked, they are two different
concept
Line 69: says “To demonstrate the factors that affect how long it takes adolescents in various
countries to start having children, we conducted a survival analysis.” Not clear, further
explanation
Method
Study areas not updated, like region… need updating with the current issue
Line 95: The title is the study design the content is about the sampling technique and data
collection needs correction
The study population says “women” which is not consistent with the topic and objectives check it
Line 103: says “the response variable”, I am not clear about it, outcome variable or dependent
variable make it clear
The term “time to teenage childbearing” needs an operational definition, this can clarify why
survival analysis is utilized, how time to event is determined… and how data is prepared for
survival analysis
It is good if only the model used for the analysis is explained in detail and clearly in the method
part by considering the actual data, this gives clear information to the reader
DHS recommends to use of weighted data, but the authors nothing about it
Result
As standard a brief description of the table has to be before the table, explanation of the table
after is not recommended check, lines 204-235, also use of table and figure caption should not
be confusing, the authors need to check
Line 237-239 says “The significance of the difference in survival experience among various
parameters is examined using the log-rank test and Kaplan-Meier survival estimates.” Where
Kaplan-Meier survival estimates not clear, the table is also not mentioned for which analysis
output Kaplan-Meier survival estimates or log-rank test
Line 299: “Our study shows that, according to the AIC, using the lognormal parametric
model gives more suitable results for survival data in the presence of non-proportional hazards
assumption” Why? Need further explanation
Line 301: it is good to do a model test only for the analysis method used for this particular study,
the lognormal parametric model
Line 302: needs to title the purpose of the analysis, and also check for clear interpretation of
the result
Table 4 no sign used that indicates association or not like “An asterisk sign *” of bolding
If the analysis model is a lognormal parametric model why do the crude and adjusted
measurements differ? CHR=crude hazard ratio      ATR = Adjusted time ratio
Abbreviations in the table clarified under the table not in the table
Discussion needs further work on a scientific explanation of the result and its implication
Language edition is a critical concern