JerMa88/BMC_Womens_Health_Peer_Reviews huggingface dataset:
Title: Education, Economic Autonomy and Digitalization as Factors Associated with Married
Women's Ability to Make Sexual and Reproductive Health Decisions in Sub-Saharan Africa: A
Multi- Level Analysis of 16 Countries
Version: 0 Date: 18 Dec 2023
Reviewer:  Louis Kobina Dadzie
Reviewer's report:
Dear Authors,
This paper shows great potential in the area of SRH. However, there are a few suggestions to
help strengthen the paper.
First, the terms/concepts were not defined in the text. This would be very useful especially to
lay people who would want to read the paper.
Also, some aspects of the methodology are not so clear and need to be re-looked.
I have made a few suggestions in the attached document to help with that.
The paper only has a few grammatical corrections to be made. Please go through them carefully
to address them. All the best
Title: Education, Economic Autonomy and Digitalization as Factors Associated with Married
Women's Ability to Make Sexual and Reproductive Health Decisions in Sub-Saharan Africa: A
Multi- Level Analysis of 16 Countries
Version: 0 Date: 28 Oct 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: This is an interesting and important study which is a useful addition
to the literature. It has been well conducted and the authors are to be congratulated on the care
and detail they have given to the work. The points I want to give them here are all minor and
I hope helpful.
In the background, little attention is given to the population as being a heterogenous group. This
could perhaps be given a sentence or two (or maybe as a limitation) since women within this age
group and across all these countries are hardly a unitary mass- but are rich and diverse in their
nature. This is, I think a useful acknowledgement for some of the likely readers of this paper.
Also in the background, para 2 on page 3 is rather enigmatic about the possible limitations of
digitalisation. Why not be clearer about this with a sentence or two for your readers?
In the methods, I was pleased to see that you have followed STROBE guidance (although no
table provided). However, I wondered if the section on the variables might not be better as a
table? It is a rather turgid read as it stands and might be much more manageable as a simple table?
Finally, in the discussion, para 1- how sure are you that the improvements seen in those countries
can be attributed to the NGOs that you list there? You go on to say later that causality is
something that this paper cannot contribute- and yet........perhaps just add "may" after the word
'violence' in the segment copied here- "combating gender-based violence have galvanized"
ADDITIONAL REQUESTS/SUGGESTIONS:
See above- all minor
Title: Education, Economic Autonomy and Digitalization as Factors Associated with Married
Women's Ability to Make Sexual and Reproductive Health Decisions in Sub-Saharan Africa: A
Multi- Level Analysis of 16 Countries
Version: 2 Date: 14 Mar 2025
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
Yes - current version is technically sound
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: The authors have responded very positively and comprehensively
to the referee comments. I particularly like how they have improved the methods section in
such a thoughtful way. I think the paper is now ready for publication. I have nothing to add.
Congratulations.
Title: Factors associated with Female Genital Mutilation/Cutting in Tanzania: Insights from
Tanzania Demographic and Health Survey 2022
Version: 1 Date: 27 Jul 2024
Reviewer's report:
This study used data from 7,678 women obtained from the Tanzania Demographic and Health
Survey 2022 to determine the prevalence and determinants of female genital mutilation in
Tanzania. Although, FGM is a global health issue this study doesn’t seem to add to the existing
knowledge on the topic. I suggest the authors read more literature to identify more gaps and
incorporate them into this study.
Below are more comments to be addressed:
The manuscript is poorly written. There are too many typographical and grammatical errors.
Abstract
“This secondary study used information of 7,678 women obtained using cross-sectional design
in Tanzania Demographic and Health Survey 2022. Dependent variables respondent circumcised
and independent variable were the demographic characteristics of a woman.” Please rewrite this
Methods and tools
This section is not clear.
“The determinants included all socio-demographic factors except…” please rewrite this. You
did not use all socio-demographic factors.
Methods
The study is not a secondary study it only makes use of secondary data.
What is the justification for the age interval used?
Results
The type of circumcision figures was swapped in Table 1.
Discussion
The discussion section does not need to report the odds ratio again.
Can you explain why there is a regional difference in FGM?
Limitations and strengths of the study
The use of secondary data is not the reason why you couldn’t assess a cause-effect relationship.
Title: Factors associated with Female Genital Mutilation/Cutting in Tanzania: Insights from
Tanzania Demographic and Health Survey 2022
Version: 1 Date: 02 Aug 2024
Reviewer's report:
Many thanks to the authors for the work that they have undertaken to further positive population
health.  However, I have the following comments to make:
1. The work will benefit from further language grammatical and language review to improve
the work
2. It will be better to present the types of FGM as given in the results to tally with the
classification you presented in your literature. They do not seem to tally
3. The conclusion should be written to focus only on the studied variables rather than making
recommendations that are outside the scope of the study.
Title: Factors associated with Female Genital Mutilation/Cutting in Tanzania: Insights from
Tanzania Demographic and Health Survey 2022
Version: 2 Date: 17 Sep 2024
Reviewer's report:
This is a nice attempt. However, there are significant concerns about this study. The analysis
in this study maybe bias because according to reports,  FGM is mostly carried out on young
girls between infancy and age 15. Measuring association between current characteristics and
concluding that they suggest or are associated what happen  many years ago especially among
study participants above age is 15 does not seem right. I would suggest you change the study
population.
Indicate the age group of your study participants in the abstract.
Also, the last statement in the introduction suggests that the authors already know the result
before the analysis. Hence this shows that the study is not necessary.
The definition of the independent variables under the data analysis section is not appropriate.
Title: Factors associated with Female Genital Mutilation/Cutting in Tanzania: Insights from
Tanzania Demographic and Health Survey 2022
Version: 4 Date: 21 Nov 2024
Reviewer's report:
This manuscript addresses the important global issue of female genital mutilation/cutting (FGM/
C) using secondary data from the Tanzania Demographic and Health Survey (DHS) 2022.
However, I believe there are conceptual, methodological and reporting issues that undermine
its scientific contribution and validity.
Introduction & Objectives:
• This section could be better focused around justifying your aim and providing more detail
on the issue of FGM/C in the Tanzanian context and the suggested weaknesses of previous
prevalence studies.
• The authors claim to aim at "determining the prevalence and factors associated with female
genital mutilation in Tanzania" using DHS data. However, the DHS already provides national
prevalence estimates, making this objective redundant. The authors do not provide a clear
justification of their value addition compared to the existing DHS report or prior prevalence
studies. The statement that there is a "limited empirical literature on the prevalence of FGM and
its associated factors in Tanzania" is inaccurate considering the multiple previous DHS-based
studies.
Methodology:
• I think the authors should expand more on the study design. The description of the sampling
technique is vague. It is not clear how the stratification was conducted, what "weighted" means
in this context, or how the sample was representative of the study population when nearly half
(49.67%) of the cases were excluded from the original sample. The authors should also define
the outcome justifying this exclusion.
• The authors include variables like "frequency of accessing mass media" in their analysis
without providing any theoretical or empirical justification for their inclusion. The manuscript
fails to explain how these variables relate to FGM/C practices in the Tanzanian context.
Results:
The reporting of the results lacks clarity. More importantly, the methodological issues mentioned
previously weakens the validity and interpretability of the results.
Reference inaccuracies:
Several cited references are misaligned with the statements in the text. For example :
• References [3] and [4] do not mention prevalence rates for Tanzania.
• Reference [10], cited as evidence for Tanzanian prevalence, is actually a study conducted in
Kenya.
Also, there are several grammatical mistakes, which I’m sure the authors will be able to catch
in another thorough read.
I thank the authors for taking the time to conduct this work. While the manuscript addresses a
critical global issue, it does not provide sufficient originality or methodological rigor to justify
publication.
Title: Factors associated with Female Genital Mutilation/Cutting in Tanzania: Insights from
Tanzania Demographic and Health Survey 2022
Version: 7 Date: 16 Apr 2025
Reviewer:  Gregory Halle-Ekane
Reviewer's report:
Background; This study is of public health importance and it is contextual. It entails a secondary
analysis of data from National Bureau of Statistics (NBS)conducted in Tanzania in 2022
The background information as justification is too detailed for manuscript and could be succinct
by avoiding details that were already referenced.
Methodology;
-Sampling technique is satisfactory though a more exhaustive approach should have been an
exploratory component with individual interviews and focus group discussions.
-The regional characterization of selected areas by clusters was not justified
- The definitions  of some of the independent and dependent variables were vague (wealth index,
distance from health facility, getting permission to access health facility, FGM; to be stopped
or contnued; etc
Statistical analysis;
Analysis and interpretation of inferential statistics is satisfactory .
Limitations and strength of the manuscript;
I quote 'since the study relied on secondary data, the nature of using pre-collected information
limits the ability to assess cause-and-effect relationships'. This is worrisome as it reduces the
strength of the study as mentioned above.
Conclusion;
The absence of an exploratory component of the data collected weakens the conclusions.
However, no fault of the authors (Secondary analysis of data).
Title: Factors associated with Female Genital Mutilation/Cutting in Tanzania: Insights from
Tanzania Demographic and Health Survey 2022
Version: 9 Date: 21 Jun 2025
Reviewer's report:
I would like to thank the authors for addressing the concerns I raised on the earlier version.
However, there are just few more comments /suggested edits for the authors.  Please see below:
1) Abstract: Under ‘Methods’ –  say  ‘In this study..’ instead of ‘This study..’
2) Abstract: Under ‘Methods’ – say ‘circumcised’ instead of ‘mutilated’.
3) Abstract: Under ‘Results’ – say what ‘aOR’ and ‘CI’ stand for where they first appeared
before using abbreviations
4) Abstract: Under ‘Conclusion’ – say ‘…FGM among women aged 15-49 years in Tanzania..’ ,
FGM also affects girls aged 0 -14 years – the group not considered in the current study. So,
need to be more specific.
5) Main body: Table 1 was not properly labelled.
6) Main body:  Table 3 – extremely high uncertainty (very wide margin of 95% CI of 96.8 –
980.30?) for secondary and beyond. There needs to be an explanation if is not a typo.
Title: Factors associated with Female Genital Mutilation/Cutting in Tanzania: Insights from
Tanzania Demographic and Health Survey 2022
Version: 10 Date: 14 Jul 2025
Reviewer's report:
1. Theoretical Framework: The manuscript would benefit from a more explicit discussion of the
theoretical or conceptual framework guiding the study at the outset.
2. Methodological Details: Additional details on the logistic regression model specification and
justification for the selection of independent variables would strengthen the methodology.
3. Discussion of Unexpected Findings: The results section and discussion could be enriched by a
more thorough exploration of any unexpected findings or the absence of anticipated associations.
4. Impact of Exclusions: A discussion on the potential impact of excluding cases with missing
data on the study's findings is needed to assess the robustness of the results.
Overall, the manuscript makes a valuable contribution to understanding the socio-demographic
factors associated with FGM/C in Tanzania. Addressing the identified flaws would enhance its
clarity, depth, and scholarly contribution.
Title: Negative experiences of breastfeeding beyond the infancy age of one year in public – a
deductive content analysis of a cross-sectional global sample
Version: 4 Date: 07 Mar 2025
Reviewer's report:
I appreciate the opportunity to review “Negative experiences of breastfeeding beyond the
infancy age of one year in public- a deductive content analysis of a cross-sectional global
sample” which was a very strong paper with critical implications to the breastfeeding field and
recommendations to increase breastfeeding duration past 1-year.
With minimal revision given the below feedback, I feel this paper would be publication-ready.
Abstract
Try not to start sentences with a number (2,562 women…)
Background
Brief, but strong review of the current context in light of recommendations
Methods
Please provide more details about your purposive sampling strategy.  For example, how many
social media groups did you contact vs. your yield, did the parenting groups have a breastfeeding
focus (and then as a limitation or area of discussion later on, how might this have impacted your
findings).  Over what time period?  What platforms etc…
As parental support groups may include non-breastfeeding partners, regardless of gender
identity, can you clarify in your paper your eligibility criteria and who was excluded?
To clarify your coding process, beyond the first 100 entries, there was not dual-coding?
Was all coding done by-hand (no use of software or AI)?
Your title includes “deductive” but you don’t discuss that much in the methodology.  Could you
please elaborate on this process?
Where there any comments that were dual-coded into multiple categories or are these responses
mutually exclusive?
Are there other responses from the quantitative portion of the survey that may have influenced
the results but are not presented here (ie parity, religion, region etc)?
There are vast regional/cultural normative differences across these areas.  You might want to
highlight whether any major differences were seen by region (or list further as a limitation).
Inclusion of results across themes is very poignant.  Thank you.
Discussion
Very strong discussion with relevant evidence-based comparative literature presented.
One additional thought is to include research about implicit bias in breastfeeding as it relates
to breastfeeding norms:
Schindler-Ruwisch J, Aluc A. The Relationship of Race and Ethnicity to the Perception of Visual
Images of Breastfeeding Mothers. Breastfeed Med. 2022 May;17(5):459-465. doi: 10.1089/
bfm.2021.0296. Epub 2022 Feb 17. PMID: 35180357.
Also, while geographically variable, policy implications to legally protect breastfeeding in
public and to promote safe spaces for breastfeeding with relevant implications may be helpful.
Title: Knowledge, Attitude, and Practice of Polycystic Ovarian Syndrome Diagnosis among
Health Care Providers in Addis Ababa, Ethiopia
Version: 1 Date: 09 Feb 2025
Reviewer's report:
The authors did not mention how they assessed knowledge, Attitude, and Practice in their
methods. They mentioned the operational definition twice in the MS and as additional files.
The definition is not the method. We need to know how they assessed these factors.
Title: Knowledge, Attitude, and Practice of Polycystic Ovarian Syndrome Diagnosis among
Health Care Providers in Addis Ababa, Ethiopia
Version: 1 Date: 09 Feb 2025
Reviewer's report:
Thank you for asking me to review this manuscript entitled “Knowledge, Attitude, and Practice
of Polycystic Ovarian Syndrome Diagnosis and Management Among Health Care Providers in
Addis Ababa, Ethiopia”
Abstract
It is well written with all the components of an abstract; however, the grammar seems to be very
poor as there is a mix-up of both American and British English spellings in the entire manuscript,
thus, I strongly recommend grammar editing of the manuscript
Introduction well written
Materials and methods
This was also well-written
The data analysis will be better if a composite analysis is done rather than analyzing each
question separately!
Results
This was poorly presented as tables were not properly formatted as in scientific journals where
all the lines within the tables should be removed and results narration should be well presented
making adequate reference to the table.
Discussion
The discussion was also poorly written, the findings were reported and compared to previous
works but no cogent reasons were raised to support their finding or support the reasons for
agreement or variance
The discussion was more of a laundry of results than a discussion of findings from a research
work.
Conclusion
Conclusions should be precise, and not in more than one paragraph! Conclusion is not a
recommendation please?
Title: Knowledge, Attitude, and Practice of Polycystic Ovarian Syndrome Diagnosis among
Health Care Providers in Addis Ababa, Ethiopia
Version: 1 Date: 13 Feb 2025
Reviewer:  Fullaila Onozare Aliyu
Reviewer's report:
NO ETHICAL APPROVAL NUMBER
Do each hospital have a different criteria for diagnosing PCOS or it varies by physicians
practicing in each hospital??
You mentioned the Rotterdam criteria for diagnosing PCOS, is this what was used in the study
questionnaire?
Who pre-tested the questionnaire? How was the questionnaire validated?
Knowledge questions
How many total knowledge questions are there? Why is 20 used as a benchmark for good score?
The 20% or higher score used in the knowledge score, has it been standardized? Why was it
used?
How was the knowledge questions standardized and validated?
The questionnaire used in the study how was it validated? Was the Cronbach alpha score
calculated?
Attitude questions
How many total attitude question are there? Why use 31 as good attitude score and less than 31
as poor attitude score? How was it standardized and validated?
Practice questions
How was the practice questions standardized and validated?
Why choose 8 as the benchmark for good practice score?
Characteristics of the study participants
Are midwives meant to see and treat patients in the facilities? Kindly include reasons for their
inclusion in the study
Table 1
The hospital policy for diagnosing and treating patients with PCOS was not clearly stated
American Society for Reproductive medicine (ARRM) was used in the diagnostic criteria for
PCOS good knowledge but was not included in the theoretical diagnostic criteria used in the
study
Table 2 & 3
Other indicated include?
Title: Knowledge, Attitude, and Practice of Polycystic Ovarian Syndrome Diagnosis among
Health Care Providers in Addis Ababa, Ethiopia
Version: 2 Date: 09 Mar 2025
Reviewer:  Fullaila Onozare Aliyu
Reviewer's report:
Thank you for the review, substantial review has been made, however here are some areas that
need further review, other comments are embedded in the work
1. If google form was used, sampling method would no longer be convenient sampling technique.
Authors should include how the healthcare providers were approached and if target participants
were already pre-selected or snowballed
2. HOW MANY CORRECT ANSWERS WERE IN THIS 8 MCQ? SHOULD AN
INCORRECT ANSWER DE DEDUCTED OR GIVEN A ZERO SCORE? YOU WILL NEED
TO ELABORATE MORE ON THIS, 8 MCQs WITH A TOTAL OF 20 POINTS? HOW MANY
MCQs UNDER EACH QUESTION?
3. Supplementary file 5 and 6 can be combined into one table and labelled as socio-demographics
4. DISCUSSION STILL NOT ROBUST, KINDLY COMPARE WITH OTHER STUDIES ON
KNOWLEDGE ATTITUDE AND PRACTICE OF HEALTHCARE PROVIDERS WORKING
WITH PCOS WITH YOUR CURRENT STUDY
5. DISCREPANCY FROM YOUR STUDY RESULT WHICH INDICATED A LACK OF
KNOWLEDGE
Title: Knowledge, Attitude, and Practice of Polycystic Ovarian Syndrome Diagnosis among
Health Care Providers in Addis Ababa, Ethiopia
Version: 2 Date: 28 Mar 2025
Reviewer's report:
I really enjoyed reading this article.
1- In the introduction, it should be emphasized that in addition to the endocrine and metabolic
effects of PCOS, it is also important to predict psychological outcomes. Emphasizing the
psychological impact will provide a more comprehensive understanding of the syndrome. This
aspect can benefit from the insights provided by recent studies on the subject (PMID: 38655994,
PMCID: PMC11042827, DOI: 10.1590/1806-9282.20230918).
2- While supporting the emphasis on gaps in the diagnosis and management of PCOS, the article
effectively emphasizes the importance of addressing metabolic disorders. However, systemic
oxidative stress markers with metabolic effects have recently been shown to be potentially
supportive for diagnosis in selective cases. Recent studies on this topic should be reviewed to
provide additional information (PMID: 36599370, DOI: 10.1080/09513590.2022.2163234).