Title: Awareness of Down Syndrome Screening Among Educated Muslim Women Is
Associated With A Favorable Attitude Toward Testing.
Version: 1 Date: 20 Apr 2024
Reviewer's report:
You have done a great job. However the manuscript needs following considerations
1-Table 1 number of children -0 (99) that mean women were primigravidas?
2-Table-1 it seems that only women who are educated responded to the questionnere. This
creates a bias as the educated women are more likely to respond and more likely to be aware of
the situation. But we want to know bout the general population which has low level of education
or illiterate and they are the ones more likely to be unaware of the screening programs.
3-Any woman with previously having a child with Downs syndrome should be excluded as they
will be aware of the problem . As its said that 41% aware of DSS that group might involve
families with previously having a Downs baby and thus the degrees of bias gets higher ?
4-Women 31- 40years were not aware of DSS how to explain ?
5- Table – 2 heading kindly mention that the answer to the questions as YES is presented
6- Table-5 for each p value start witn 0.-----like 0.25 etc
7- Table 5 heading says knowledge and attitude but in description you are talking about
knowledge only kindly clarify as attitude score is mentioned in table -6
8- similarly all p values in table 6 must start with 0.---
9- As your title mentions muslim women did you excluded women from other religions from
being questioned in the study. As the OPD population may include non muslims resident
population/ did you included only women of Saudi origion and excluded other nationalities / or
your OPD just have Saudi Muslim women. Kindly mention in inclusion and exclusion criteria
10-“parents' ability to accept testing is influenced by their knowledge level, whichis associated
with a positive attitude toward testing.”
This statement as you derive from your results needs more explaination and how can you draw
that conclusion from your results kindly justify
11-
We found that having children is associated with lower knowledge levels in the study population,
contrary to reports from otherdeveloping countries where women with children were more likely
to have higher knowledge” .  This statement needs referencing  you cannot just say a sentence
without reference )”
12- Figure 1 can be omitted as its explained in the table already
13- Discussion need further exploration and comparison of results with other published literature
14- Methodology need more explaination its deficient especially in inclusion and exclusion
criteria . The proforma used was pretested or not , language translation was provided or not
15-
“Factors associated withknowledge about D.S. and prenatal screening were analyzed by
comparing the mean scores between the different factors' categoriesusing independent t-test or
OneWay ANOVA,”
16- The question still remains if their attitude towards screening is improved as you say by the
knowledge what impact it will have on practice as screening tests always need to be decided
based on the avaiablity and acceptance of possible options of treatment. Will it be feasible and
acceptable to do the screening depend on this aspect and the readers and researchers would
like to know this one aspect before screening is offered to the population otherwise it becomes
useless to provide such a huge amount of finance and timing to a screening programm.
Conclusion: I think its already known that knowledge may increase the acceptance of DSS but
what should be practiced by the mothers need to be known and the researchers must add practice
questions and departmental protocols for invasive tests and options for termination