Title: Traditional menstruation practices among Nepalese women living in Japan
Version: 1 Date: 08 Apr 2022
Reviewer's report:
1. Importance of submission: What are the manuscript's strengths? Is it significant? Does it
contain new and unique information?
The manuscript addresses a significant issue of Nepalese women adapted the traditional
menstruation practices to their living environment.  The purpose of the manuscript is not explicit
and could benefit from rewriting for clarity so that the manuscript objectives are clear. Having
the purpose written on the abstract and then carried out on the main manuscript would be helpful
to help center the reader on the intentions of the authors. Background could benefit from a
literature review that shows significance of the study. As is, background only covers current
status of practice without literature review grounding.
Topic is important one; understanding how traditional practices around menstruation can help
guide women’s health practice in various settings to advance health of Nepalese women.
Situating the manuscript to maximize intended audience would be helpful. The conclusion
speaks about school settings which does not seem to fit the findings of the study. If authors want
to reduce the traditional practices in Nepalese, addressing the consequences for women would
be important.
.
2. Theoretical evaluation: Is the manuscript logical? Is the theory parsimonious? Complete?
Useful?
Manuscript is well written and logical.  There is no theoretical grounding offered by the authors.
The methods seem appropriate. It is not clear how the comments included in the findings
were elicited. Authors state that surveys were used to collect data. Were the comments elicited
as written comments on the surveys? What was the language used? Was there translation of
surveys? What was the approach used to analyze the comments? Was it content analysis? Who
completed the content analysis? How did the authors validate the major themes of the comments?
Approach of data analysis for the survey tool seems appropriate except for the narrative
comments. Theoretical framework guiding the study is not articulated. More elaborate
engagement of the theory is needed in throughout the manuscript; introducing the theoretical
framework underpinning the study early could better position the authors’ findings.
3. Methodological assessment: It appears that the methods applied were non-probability
snowball sampling for a cross sectional study. Comments included on the table need to be
expanded on with excerpts in the text of the manuscript. It is not clear what the numbers in
the brackets after the comments on the table are. Indicating if the numbers indicate age of the
participants would be helpful. If truly qualitative data was elicited for the study then this would
be a mixed methods study and methods for each approach would need to be described. Sample
size seems appropriate.
In discussion, focusing the discussion on the findings relative to the purpose of the study and
engaging theoretical grounding would be helpful. Explicit discussion of cultural implications
are important not only for Nepalese women in Japan but other places. If the authors could
expound on the traditional practices implications for healthcare workers, public health and other
community environments such as schools, etc would be helpful. Focusing the manuscript on
aim to change traditional practices is not practical but helping others understand the practices
and how best to support the women would be helpful.
4. Adherence to ethical standards?
Ethical standards adherence was ensured
5. Manuscript style and format: (Please evaluate writing style, organization, clarity, grammar,
appropriate citations, etc.). Is this manuscript unnecessarily long?
Manuscript is well written, is of appropriate length, and logical but could benefit from evidence
and theoretical grounding. Having a clear purpose of the study would be a helpful guide for
the study.