Reviewer ’s report  
 
Title: Discontinuation rate of implanon and its associated factors among women who ever used 
implanon in Dale District, Southern Ethiopia  
 
Version: 1 Date: 05 Mar 2018  
 
Reviewer: Mary Losch  
 
Reviewer's report:  
 
This study addresses am important to pic in contraceptive access and utilization.  Overall, the 
approach seems appropriate to the research question.  However, there are several points that need 
to be addressed in order to fully understand the process and possible weaknesses/limitations of 
the study.   
With regard to the sampling, the authors state that the "family planning registration book" for 
one health center was used for the sample frame.  We have no way of knowing the validity or 
completeness of that frame.  It may be quite inclusive an d entirely appropriate but without 
considerably more information about that listing and how it is compiled, that is not clear.  Also, 
it is not clear how researchers were provided with names of patients without their  permission.  
Although participants pro vided consent for the interviews, the provision of the medical 
information to individuals outside of the clinic (even researchers) would be considered a breach 
of privacy in many jurisdictions.  If such transfer of information is common for this area, 
evidence of this should be provided.   
The development of the questionnaire needs additional information - the authors indicate it was 
derived from other sources but no citations or details are provided nor is the question wording 
provided.   
The authors sta te that "data collectors were checked for completeness and consistency before 
leaving the interviewee" - does this mean that supervisors were present for all interviews?  What 
was the protocol for validation and "consistency" - not clear.  
The findings reg arding reasons for discontinuation include both "fearing of side effects" and 
"health concerns" - these seems to be overlapping constructs.  Without specific detail about the 
questions, it is difficult to assess the meaning of these findings.  
The discussi on notes that the discontinuation rate found in this study was "a bit higher" than 
other studies.  However, the earlier background info indicates that other studies of implant 
discontinuation were in the 5% range for the 12 -month study period.  The 23% rat e here is 
substantially higher.  The authors suggest a few possible reasons but given the difference, much 
more discussion is needed to provide some explanation for the difference.  Were the study 
methods different?  If the population differences are great , this should be noted earlier in the 
background section when reviewing other studies.   
The discussion of satisfaction with service is not clear.  The statements that satisfaction during 
the insertion were related to lack of satisfaction with choice, pri vacy and "explanation of service 
provider" are not connected to the findings in the study.  The factor of satisfaction with service 
during insertion is a significant predictor of discontinuation but how the authors took a leap to 
the factors underlying tha t lack of satisfaction is unclear.  Were other data and analysis 
conducted but not reported?   
If not, then these connections are speculation and should be presented as such.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments 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.  
 
No 
 
Are the conclusions drawn adequately supported  by the data shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
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 specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensive ly edited  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in an y way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare I have no competing interests  
 
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