Title: Determinants of Immediate Uptake of Post-Partum Intrauterine Device Among Women
Delivered in Hospitals in West Wolegga Zone, Ethiopia
Version: 0 Date: 06 Jul 2024
Reviewer's report:
This study investigated the prevalence, and factors associate with using immediate postpartum
intrauterine device in hospitals in West Wolegga Zone, Ethiopia. The authors found the
prevalence of use is 19% and the use was associated with age, early antenatal care initiation,
planning of pregnancy, knowledge and counseling on IUD.
The authors presented a comprehensive study and collected their own data for this investigation.
However, the analysis and writing should be intensively strengthened.
For the whole manuscript
The writing is of low quality. Many statements do not have a citation. For example, “Increased
birth to pregnancy intervals to minimum of two to three years saves 893,000-1836,000 lives
per year globally”. Some sentences are not complete. For example, “has not a negative effect
on breast feeding”. Reference orders are not appropriate. Reference 5 and 6 occur at the first
paragraph of the Background section. I don’t think it is appropriate to use bullet points in the
manuscript, particularly for the strength and limitations of this study.
Abstract
‘Significance of statistical association was tested using 95% confidence interval and P-value
<0.05”: 95% CI is for estimating uncertainty of the estimate. It is not for significance test.
“Utilization of immediate postpartum intrauterine contraceptive device was low”. Based on what
standard the authors conclude the utilization of IUD is low? Is it based on women’s unmet need
or some political target?
Background
The authors focused on IUD and rarely mentioned other contraceptive method in the background
part. It gave me the impression that IUD is the only effective contraceptive method, which is
obviously not true. For example, “Unable to utilize immediate postpartum intrauterine device
leads to a high chance of having unplanned pregnancies”. What if they prefer and use other
methods?
It is not relevant for this study by writing “In Nigeria, 24% of mothers had accepted to utilize
immediate postpartum family planning and only 2% had used immediate postpartum intrauterine
device.  However, the desire to space is high for postpartum mothers; 69% among women of 0
to 5 months postpartum and 44% among women 12–23 months postpartum(15).”
There is no citation of this statement and it also seems the authors already knew the factors
associated with IUD use. So why the authors still conduct this analysis? “Low utilization of
immediate postpartum intrauterine devices is due to Socio-demographic characteristics: Age,
marital status, educational status, and occupation, residency area, and income. Reproductive
characteristics: age at marriage, age at first delivery, number of pregnancies and birth, status of
current birth, number of antenatal cares follow up, number of alive children.”
Incomplete sentence and what factors were omitted? “In addition, studies which have been
conducted in the country before on IPPIUD utilization and associated factors lacks an important
independent factors”.
In the background part, the authors focus on the prevalence and importance of IUD. It would be
better to write about the supply side of IUD, like price, stock, providers’ skills in IUD insertion
and management, which also impacts women’s use.
Method
What does systematic sample mean? The authors should demonstrate whether to use random
sampling or any stratification. And write more details of proportional allocation.
There should be a citation on why assuming the proportion of women who utilized IPPIUD as
21.9%.
What is double population proportion?
What is Lameshaw?
Results
The authors did not mention how many women they reached out before having 290 participants
responded.
“The mean for knowledge status of respondent was 58.6090”. The authors did not mention how
to calculate the knowledge score.
“The mean score for attitudinal status of respondent was 42.5282(±21.47SD) ”. There are 8
questions measuring attitude and the score of each question range from 1 to 5. Thus, the highest
total score is 5*8=40. How did the authors get a mean of 42.5?