Reviewer's report
Title:Prenatal care and childbirth assistance in Amazonian women before and
after the Pacific Highway Construction (2003 - 2011).
Version:2Date:25 October 2015
Reviewer: Janet Hirst
Reviewer's report:
Prenatal care…Amazonian women Oct 2015
This was a very interesting epidemiological paper showing that it takes much
more than infrastructure (roads; healthcare facilities; trained healthcare
practitioners) to encourage healthy lifestyle choices and behaviours by women
regarding pregnancy and childbirth where complex culture and tradition is
deep-routed.
The reviewing statistician can comment on statistical procedures.
All MINOR ESSENTIAL Revisions
I have never reviewed a paper with 18 authors. This may be common practice
locally; and I want everyone to be acknowledged and rewarded appropriately.
Have they really all made a contribution to the paper? Is there a way to
acknowledge those who have contributed to the study by naming them in a text
box; and have those who wrote the paper in authorship?
Parity has been overlooked in the discussion as a plausible explanation to help
us understand women’s choices; particularly place of birth. Attention to this would
enhance the paper.
In the discussion there needs more attention to how cultural shift will be achieved
as well as improving health literacy to facilitate good health choices amongst
women.
Editorial/presentation:
Line 63: To the wider world ‘brown ethnicity’ doesn’t help us understand who you
mean (this will be very offensive to some international readers) Please change
the expression.
Line 65, I appreciate this is obvious to authors but the term ‘riparian’ will not be
familiar to many readers. Could it be stated in brackets what this means in the
main body?
Line 80: could read: Access to prenatal care (remove The).
Line 87: ‘Prenatal care and childbirth coverage…’ Does this mean ‘Women
accessing prenatal care and childbirth with a trained birth attendant?
Line 88 / 174: the ‘Pact for Life’ recommended at least 6 prenatal consultations
which was more ambitious that the WHO millennium goals. It would be worth
recognising this in the background or discussion.
Line 120: the aim of the study was to…not ‘is to’. It would be good to repeat the
English proof reading.
Line 154: a mix of frequencies and frequencies and percentages in this
paragraph; please can it be both frequencies and percentages as it makes it
easier for the reader.
Line 159: please can it be clear who administered the questionnaire? Was it
self-completed or administered by a researcher; what was the proportion?
Line 170: ‘consults’; locally this term may well be familiar. Internationally
‘consultations’ would aide clarity.
Line 171 / 175 and throughout: ‘…assisted vaginal delivery…’ / ‘…delivery
assisted by a health professional…’ does this mean women birthed with a trained
birth attendant? The expression ‘assisted vaginal delivery’ will mean an
instrumental vaginal delivery to many of us i.e. forceps.
Line 284: It would help the reader to understand more about consent; right to
withdraw.
Line 294: in this paragraph it would help the international reader if more
information was given regarding who was responsible for providing antenatal
care and how they were trained e.g. doctors; nurses/midwives/ obstetric-nurses/
midwives.
Line 312: this paragraph would be easier to understand if there was some
explanation / hypothesis regarding the non-homogeneity re birth distribution.
Line 339: indigenous and non-indigenous women in this context need more
clarity at the outset for this to be easy to understand from an international
perspective.
Line 346: ‘receiving…’ do you mean accessing?
Line 392: which ethical issues could be responsible for what? It seems a little
cryptic
Line 405: why is there a two tier system?
Line 415: this last sentence confused me.
Line 418: Quality in prenatal care: this heading isn’t right. The paragraph doesn’t
tell us much about quality; it reports frequencies.
Line 445: we need to know more about cultural issues; examples would help, to
understand the point.
Line 450 “pardas”; internationally I don’t think readers will know what this means.
Line 485: not going to hospital needs deeper consideration beyond time and
travel. If women had already birthed at home and felt safe; why would they
choose hospital with strangers?
Line 493: Fetal death and still birth; these seem to be different and need some
explanation. It seems, when women are pregnant there isn’t a requirement to
access formal prenatal care. To what extent could the statistics under report?
Line 505: ‘…prenatal care didn’t show much difference…’ Does this mean the
proportion of women accessing prenatal care?
Line 508-509: is the pint that increased uptake of prenatal care and birthing with
a trained birth attendant didn’t show much difference?
Table 3:
P Value, not valor
The label: Performed prenatal, isn’t clear.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
'I declare that I have no competing interests'