Title: Herbal medicine use during pregnancy and child birth: Perceptions of women living in
Lilongwe rural, Malawi – A Qualitative Study.
Version: 0 Date: 23 Feb 2023
Reviewer's report:
This paper presents a topic of great interest to Malawi and the findings would go a long way
to support the prevention of obstetric complications as well as reduction of maternal mortality
rates among pregnant women in Malawi.
The paper is technically sound, has presented the key research questions clearly and relevant
literature has been reviewed and critiqued.
However, the paper has not presented any conceptual model underpinning this study.  This is
a major flaw  of the paper. Secondly, the researchers did not employ/use variety of methods
to collect data. Only  'Focus group discussions' were done. The richness of qualitative data  is
assured with Diversity of views and ability to triangulate the findings.
Abstract:
The design of the is described as a 'Cross sectional survey'. This is misleading . On  Page 3
of the Methods section, the design is described as 'a cross-sectional study which employed a
qualitative descriptive (QD) design'
Background :
Although it is well written, coherence in presentation is needed.  The presentation of the  global
(paragraph 1) and Malawi context (paragraph 3) should be followed by the paragraph presenting
current evidence and the study justification (paragraph 2).
The background should also include a detail of the  conceptual models  and their application
in this study.
The background section has typos, incomplete sentences and missing words . For example:
'Similarly, studies conducted in Malawi have reported that some herbal medicines have oxytocic
properties hasten labour leading to obstetric complications[16].
METHODS:
1.The description of the study design should be clear and distinct with proper justification/
scientific rationale for selecting this design.
2. Elements of how data were collected should move to the section on Data Collection.  This
is where the authors should describe the data collection methods and the type of data collected
and not in the design. Statements on Sample selection are not part of the study design should
move to section on Sampling.
3. Selection of the data collection methods.  Use of only one method of data collection that is
'Focus groups' only has weakened this study design and this is a major limitation of this study.
For example, the authors in the Results section have focussed on presenting individual reports
obtained through focus groups.
There's need for proper justification why FGDs were preferred over any other methods.  If the
authors interest was to obtain details of personal experiences, Indepth interviews could be done
in addition to FGDs. To elicit details of personal experiences, triangulate findings and check the
consistency /validity of views.
Considerations should have been made regarding the sensitivity of the topic .  Were all women
open to talk about personal experiences of use of herbal medicine in a group ?
How did the authors safeguard the privacy of information shared in a group?
4. Pretesting. Authors should include details on how this was done
5. Data Analysis.
Authors have not described their data analysis approach. Was it inductive or deductive? What
informed their analysis and how was this developed? There need here to describe the steps
followed to analyse data. Refer to Thematic content Analysis by Braun and Clarke (2006, 2019).
Data coding- How was this done (manually of electronically? Use of software?)
Please provide a Table detaining your analysis - Key codes, key themes
RESULTS
As mentioned earlier, results have  largely been presented as individual perspectives/
experiences. For example, Participant #2  FGD 2; Participant @5  FGD 2  etc etc.
One of the key purposes of FGDs is to generate consensus views regarding a phenomenon of
interest. The results fall short of giving the reader the level of agreement among participants on
a particular issue explored.
Although qualitative research is grounded on understanding participant voices, there's need to
show that the opinions/feelings and some experiences are shared by many other participants in
the group and not just one individual.
DISCUSSION
This is well done .  A few comments.
Paragraph 2: Perceived benefits on the use of herbal medicine.
Authors have included in this paragraph descriptions of oxytocic properties and their role in
causing strong contractions and faster labour. I suggest this be moved to paragraph 3 describing
complications and other adverse outcomes.
Check for spelling mistakes, some grammatical errors and missing words in the discussion but
also the whole document has to be proof- read and edited.