Title: Gender-based violence and associated factors among women in Ethiopia: a systematic
review and meta-analysis
Version: 2 Date: 16 Apr 2025
Reviewer:  Claire Z. Kalpakjian
Reviewer's report:
This systematic review and meta-analysis address the question of the prevalence of gender based
violence (GBV) in Ethiopia. GBV is a critical problem, and a comprehensive understanding
of prevalence and associated factors, which this review addresses, is important for developing
interventions and policies to reduce rights violations. Overall, the methodological approach
to this review is solid and thorough. There are a number of points to clarify throughout the
manuscript, and I'm hopeful that my comments will be useful to the authors. The manuscript
would benefit from a review of English, which I believe can easily be done, and my comments
do not reflect the language itself except when there are methodological points that should be
clarified.
Introduction
The Introduction section addresses the question of prevalence, which is central to the review.
However, it is more of a recitation of various rates and less a synthesis of the extant literature.
And more importantly, the introduction does not make a case for why this review should be
undertaken. This is certainly not to say it should not be done; rather the authors should make a
clear case that understanding the prevalence and associated factors of GBV is critical to generate
solutions that will reduce the rates and the threat to women in Ethiopia.
Methods
Overall, the methodological approach is solid. The reporting follows the PRISMA checklist, and
the review was appropriately registered with PROSPERO. The major question with bearing on
the interpretation of results is around the inclusion criteria of the reviewed studies, which relates
to the important question of whether the studies themselves had inclusion criteria for women
experiencing GBV. More specifically, if studies that required participants to have experienced
GBV were included in the study, these studies would skew the prevalence rate. If the studies
that were included did not require women to have experienced GBV, then this is not a problem.
This should be clarified in the description of the inclusion criteria and how this was handled
in identifying eligible studies. A few minor points in terms of inclusion criteria that are not
reported are whether there were time limits, or more specifically, a year limit on retrieved
articles. Ultimately, the articles that were reviewed span the range from 2017 to 2023. Should
this be interpreted as there were no articles before 2017? Another question I had in terms of
inclusion criteria was #3, which refers to articles written and published in the English language,
which were “looked into”. It's not clear whether that was a criterion that the publication be in
English or that publications could be in any language that included English. This should be
relatively easy to clarify.
In terms of search strategy, one of the mesh terms was “magnitude”, although it is not clear why
this term specifically was used. Magnitude of what specifically? In terms of data extraction,
how was GBV defined for the purposes of data extraction? For example, was it yes or no? Did
the studies have to ask participants whether or not they had experienced GBV in the past or
currently? Also, there is a reference to associated factors at the end of the subsection, but these
should be described here, and how they were identified and extracted in the reviewed articles.
In terms of data synthesis, overall, the methods are rigorous and appropriate, although I did
wonder what was done in terms of the qualitative synthesis of the evidence that's referred to in
the second sentence of this subsection. How was this done? And where was the source of the
synthesized qualitative data? No syntheses are reported in Results.
In Table 1, the study designs are not defined earlier; this can be done in the text or in a footnote. I
am also curious that most of the sample sizes are quite large, although two mixed-method studies
were included. It should be clarified that the quantitative data from these studies were used in
the analysis. Also in Table 1, there is a column for sample size and a column for participants.
Most numbers are the same, but in several cases, they're slightly different, but it is not clear what
the difference is between these columns.
Results
Overall, the results are fairly straightforward to follow. In a few places in the discussion of the
factors associated with GBV, there are some inconsistency in the text describing the increased
odds for the various factors, for example in the first one with monthly pocket money there's a
2.6 fold increase and then directly after that the odds ratio of 2.6 is presented so it is somewhat
redundant, and a minor point, but easily clarified. It would also be helpful to define some of
these factors, as noted earlier in the methods. For example, what does tight family control refer
to? How was this assessed in the studies? Is this a binary factor? What does witnessed parents
refer to? What does young age refer to, and what were the cut-offs?
Discussion
The Discussion largely repeats the results, although comparable reviews and estimates are
referred to in the second paragraph. More importantly, two key aspects are missing from
this section. First, no limitations are noted anywhere in the Discussion section and should be
included. One key limitation or consideration in generalizing the results is that the reviewed
studies should not be considered representative of the entire population of women in Ethiopia.
If the studies are a close approximation given their sample size, how they were conducted, or
the representativeness of the regions, then this is an important point to discuss in the Discussion.
Also, it would be helpful to see more synthesis of the results beyond comparing them to other
reviews, and perhaps more importantly, how do these findings inform next steps in research
and policy? For example, learning about the associated factors that increase the risk of GBV
among women could inform interventions that target these factors to reduce risks. Presumably,
there could be government policies that take into account these issues that also reduce risks.
This is perhaps among the most important contributions that any systematic review can make
by highlighting gaps in the current literature and where the field needs to go next.