Title: Pregnant women’s perception of midwifery-led continuity care model in Ethiopia: A
qualitative study
Version: 0 Date: 28 Dec 2022
Reviewer:  Karin A. Stanzel
Reviewer's report:
Thank you for asking me to review the manuscript ‘Pregnant women’s perception of midwifery-
led continuity care in Ethiopia: A qualitative study’.
This is an important contribution to addressing the high maternal and infant morbidity and
mortality in low- and middle-income countries. I congratulate the authors on this work.
There are a number of improvements though that ought to be addressed before being considered
for publication in an English-speaking peer- reviewed journal.
The manuscript ought to be reviewed and edited to ensure scientific-writing that is required for
English speaking publications. Some expressions are ambiguous and as a result the paper lacks
clarity and conciseness.
Methods:
Page 4 line 89 attat Hospital – if attat is the name please commence the name with a capital
letter e.g. Attat
Page 4 line 91. You state that ‘The antenatal care, childbirth, and postnatal care service provision
in attat hospital is covered by midwives.’ Are there no doctors who provide maternity care at
this hospital? And if so, if a midwife requires additional medical support for the care that she
provides, who would that be and where do they work.
Page 5 – line 98. You describe that you recruited the women for the interview from the hospital.
This is not clear in the women who participated in the FGD. Please provide more detail how
recruitment for the FD took place.
Page 5 – line 101. ‘Then after, he invited women to participate in this study.’ Was that a male
midwife?
Page 5 – line 114-115. ‘Those three authors (AM, YF, and AZ) facilitate the process of group
discussion without any interference with the idea of the participants.’
This sentence lacks clarity and readers will find it difficult to follow your descriptions.
Data analysis:
Page 6 – line 122-123
‘All audiotaped data from in-depth interviews and FGD and field notes were independently
transcribed verbatim to Amharic (the local language)…’
Where the data transcribed not be the authors? Please discuss why.
You state that you followed Braun and Clark method of data analysis. These authors suggest
that transcribing data is the first step of becoming familiar with the data. If you did not transcribe
the data then you have missed one of those steps. If so please explain to the readers why you
chose this.
I would also recommend the rearrange the data analysis section. Start with the soft ware you used
and then describe Braun and Clark’s approach to data analysis and then describe how you created
your themes and codes. Also ensure to include information which steps you took strengthened
the quality of your study. See Hammarberg, K. et al (2016) ‘Qualitative research methods: When
to use them and how to judge them’ who has published a paper and you may find useful.
Results:
Overall, this section is written fairly clearly. There are a few spelling errors and at times the
descriptors used are not clear. E.g.
Page 12 – line 245
‘that she has a known doctor for their consecutive births and she feels empowered and has a
good relationship with her doctor.’
It is common to the term ‘previous births’ rather than ‘consecutive birth’
Page 8 – line 165
‘What you said the midwife-led unit would be interesting, I wish I could get her in my childbirth
period.’’ (Pregnant Women 1)’
This statement is unclear. Please review.
Discussion:
The discussion lacks the ‘so what’ message.
Yes, MLCC has shown to have benefits in maternity care but what makes this Model of Care
so advantages for low-and middle-income countries.
1) You suggested that less that 50% of women attend any pregnancy care in Ethiopia. Clearly
this has consequences in terms out health outcomes for women and children. Point out what
MLCC is likely to contribute in terms of maternal and infant morbidity and mortality in Ethiopia.
2) What are the costs? In terms of health care and what the costs to the community?
a. E.g. if a mother died in child birth, who looks after her other children, if she has some already?
Strengths and limitations:
Did you back translate the material? Research in another language poses unique challenges and
limitations. Please describe these and what you have done to avoid/minimize them.
Recommendations:
Apart from larger studies there are strong arguments for more actions that government could
implement.
MLCC programs have been evaluated based on Pilot programs. There are evaluations that have
been published in Australia. You could draw and their experiences to propose a pilot including
an evaluation.
Good luck