Reviewer ’s report  
 
Title: Listening to their voices: understanding rural women's perceptions of good delivery care at  
the Mibil izi District Hospital in Rwanda  
 
Version: 0 Date: 16 Oct 2017  
 
Reviewer: ISAAC A BABARINSA  
 
Reviewer's report:  
 
1. This is a valuable study, although so mewhat flawed in design and execution, and 
consequently the conclusions drawn.  
 
 
 
2. The main issues with this study extends beyond the 'several limitations' described by the 
authors.  The Principle (?principal) Investigator, who undertook the field research is 
male. All the respondents were female. In African and other paternalistic settings, this in 
itself will distort the narrative and content  and subtle under - disclosure. Secondly, 
although there are doctors in this setting, none of them was interviewed. This says a lot, 
as they may be part of the problem! Indeed, this makes the 'triangulation' inadequate. It is 
almost impossible that the Head Midwife with whom the questions were crosschecked, 
did not know the Midwife -respondents. So I can imagine her admo nishing a junior 
respondent: " Who said that the women share beds?". We are not told why Mibilizi 
Hospital was chosen out of 39, and if the findings from this study could in some way 
reflect the picture in other parts of Rwanda.  
 
 
 
3. I see no reason for Tab le 1.  If the authors want it, it could be inserted as a statement.  
 
 
 
4. Transcriptions from in -depth interviews should ( ideally) be verbatim.  I am not sure 
therefore that this was the case, with words thrown in such as: 'isnt'…'ANC'….'couldn't 
reach'; and  one phrase such as..'labour ward to theater'. Did the respondents really use 
those words? Then, they must have had at least high school education.  
 
 
 
5. I also find it puzzling that the Midwife respondents had such an impressive vocabulary, 
such as: 'tempest uous' ---which is rather far -fetched and inappropriate in this 
circumstance, 'abject poverty strata'…'national wealth household categorization'..  
 
 
6. Although it is stated in the abstract that content analysis was performed by using Nvivo 
software, no furthe r reference of use, adaptation or challenges in the study was made 
again. (See: Zamawe FC. The implication of using Nvivo software in qualitative data 
analysis: evidence - based reflection. Malawi Medical Journal 2015, 27(1) 13 -15. ) 
 
 
 
7. Finally, the discuss ion repeatedly veers -off the specific findings of this study, and there 
are hints of confirmation bias.  
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your commen ts to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your co mments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessm ent in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
 
 
 
 
 
 
Declaration of competing interests  
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