Title: Level of  exclusive breastfeeding and its enabling factors among lactating women who
delivered in health facilities of Asosa town, Ethiopia: A cross sectional study
Version: 2 Date: 26 May 2021
Reviewer:  Tebikew Yeneabat
Reviewer's report:
1. Title: Spelling error with the word “facilites” #needs to be corrected as facilities.
2. Abstract: the rate of EBF as reported by the Ethiopian Demographic Health Survey report
2019 was 59% (see https://dhsprogram.com/pubs/pdf/FR363/FR363.pdf  page 89). In the first
two lines of the result section, there is misleading wording regarding the interpretation of results
(26.0% is not less than a quarter). A reader understands quarter is equal to 25%, and thus 26%
is slightly higher than a quarter. The second line in the result section is not clear (“Less than a
quarter (26.0%) and over half (55.4%) had neither received antenatal nor postnatal care”.). This
sentence shall be re-written. From the inferential statistical results, if we use logistic regression
and found the odds ratio less than 1, it tells us a variable is negatively affecting the outcome
variable. However, the authors of this manuscript interpreted “three or more ANC attendance,
and ANC follow-up were enabling factors despite the odds ratio for these variables are less than
1. When a variable has odds ratio of less than 1, one could understand it as hindering factor
rather than enabling. The conclusion does not support the primary intent of the study. While the
title focuses on level of EBF, the study concluded women’s continuum of care is low.
3. Introduction: There is inconsistent text formatting. The first two paragraphs are bolded.
These first two paragraphs are with frequent grammatical and spelling errors. Avalable literature
were not well explored. An extensive literature review is critical to show what is needed to be
researched and what study design can answer the research question. It is not much recommended
to cite non-peer-reviewed research papers (if possible) as long as peer-reviewed research is
available.
4. Methods: grammatical and spelling errors (the Sudan, habitants, etc). It is unclear why the
authors use the proportion of women’s knowledge of EBF although the study is focusing on
the actual practice. What justifies allocating 80 participants to  health center and the rest to a
hospital? Who were the study population? Of course, it was described in the abstract section
that women who gave birth at health facilities in Asosa town were included. There is a need for
a detailed description of the study population in the methods section. The absence of detailed
information on how the research tools were developed, any sources where the tools were adapted
or adopted from, validity, reliability issues poses a serious question of the credibility of the
findings.
5. Results: The sub-title “Maternal behaviour…” does not go with its corresponding paragraphs.
Table 2: regarding ANC, it is not appropriate coding. A woman who has three ANC visits
will be missing according to the stated codes. [None, only once, twice, more than three]. In
these categories, “three times” is systematically missing. How was gestational age classified?
Why did not the authors consider WHO classification into three trimester? Or it could be
used as a continuous in terms of weeks. At what age of the infant that a mother was asked
whether her child/children was/were exclusively breastfed? Can we consider a woman who just
gave birth and reported she never gave anything to her child/children is exclusively breastfed?
Wide confidence intervals from the regression results indicate the imprecise estimation. The
manuscript did not have reports on model fitness (check whether basic assumptions have met
to report the results).
6. Discussion: In the first paragraph, while the study did not involve studying women’s
behaviour, the authors claimed they studied lactating women's behaviour. Behaviour is a broader
concept which is usually difficult to address through a cross-sectional quantitative study. The
authors need to revise what the study was focusing, check the results have addressed the study
objective(s), and conclusions are based on the results.