Reviewer's report
Title:Factors associated with Haemoglobin levels among Bangladeshi pregnant
women
Version:3Date:16 May 2014
Reviewer: Nuwan D Wickramasinghe
Reviewer's report:
- Major Compulsory Revisions
Overall
1. Throughout the article the importance of addressing the concept of “maternal
anaemia” is highlighted and that is substantiated by relevant previous
publications. Yet, the authors have discussed/analyzed on the variable
“haemoglobin status”. It would be better if they could alter their study to find out
about “maternal anaemia” rather than “haemoglobin status of pregnant women”.
Title
2. The title of the article includes “Bangladeshi pregnant mothers”. But the study
has been conducted in a selected area of Dhaka city. Hence the generalizability
of the study findings to the whole country is questionable (in the absence of
reasonable justification)
3. As suggested earlier a more appropriate title would be “Factors Associated
with Maternal Anaemia among Pregnant Women in Dhaka, Bangladesh”
Introduction
4. The objective of the study is not clearly laid down. It was mentioned “The study
was aimed to determine the hemoglobin status pregnant women who were
attending antenatal hospital”, whereas the study was aimed at determining the
associated factors for maternal anaemia among a group of pregnant mothers.
Methods
5. Setting-In the last sentence though it was mentioned that “represents the
subgroups of Bangladeshi pregnant women”, it is not clear as to how that setting
represents the different subgroups.
6. Study Population-Study population was not clearly defined, which is a main
drawback of this section. Whether any inclusion or exclusion criteria were used
or not, was not mentioned. In this study it’s of utmost importance to describe the
study population clearly in accordance with area of residence, parity, age,
gestational age etc as these variables were regarded as associated factors in the
literature.
7. Sample size calculation and sampling technique are very important aspects to
consider in a descriptive cross sectional study of this nature. Yet, those aspects
were not mentioned. For example the usage of a probability sampling technique
is a requirement in the case of interpretation of study findings in case of the
generalizability.
8. Statistical Analysis-The statistical tests used in the assessment of the
associated factors were not mentioned. (the fact that Chi squared test was used,
was only mentioned in the table results). As all necessary data were available
they could have calculated the odds ratios for each variable, which could have
been more informative.
Results
9. When presenting the statistical significance, the p value for each variable was
mentioned as less than (<) a certain value. In fact the absolute values have to be
mentioned such as p=0.031 etc.
10. The p values calculated (or either reported) for some variables are not
correct, which is a major drawback in the results section. For example age.
Hence, the calculations have to be made again and interpreted accordingly.
11. It was mentioned that raw variables such as age, education, living area as
significant associated factors rather than mentioning about the direction of
association. {eg: it would have been more informative if they could have come to
the conclusion that “maternal anaemia(rather than haemoglobin status) is
significantly associated with low income status”(rather than income)} This
limitation of interpretation was due to the application of Chi squared test as the
test of significance. If the authors had analyzed findings to calculate the measure
of association ie. Odds ratio for each variable, this limitation could have been
overcome.
12. It was mentioned that “The distribution of iron supplements of pregnant
women was showed in Table 4.” But, in fact it was illustrated in Table 3. Above
all the relevance of this analysis with regard to primary objective of the study is
not clear.
Discussion
13. Many of the studies mentioned in the discussion section for comparative
purposes have also had a very small sample size/s which might not be
appropriate to generalize the findings.
14. The limitations of the study which might hinder the applicability of study
findings were not discussed. And the measures taken to minimize the biases and
measures taken to improve the quality of data were not properly addressed.
Conclusion
15. Please refer comments mentioned under the results section regarding the
terminology ie. Maternal anaemia vs haemoglobin status.
16. With the results mentioned it is debatable how the authors have concluded
that “there is an urgent need to educate pregnant women and their families about
the importance of antenatal care” which is beyond the purview of this study.
- Minor Essential Revisions
Overall
17. Throughout the article the authors have used different spellings for the most
important variables of the study, viz “anaemia” and “Haemoglobin”, which have to
be corrected promptly.
Introduction
18. Most of the facts were repeated in this section, owing to the fact that it was
not written in an orderly manner. It would have been better if the introduction
section was written in several paragraphs to,
- introduce the main variables and the gravity of the problem
- highlight the prevalence of maternal anaemia(world, regional, local setting)
- describe the important associated factors according to the relevant literature
Results
19. When presenting the results in some instances only the absolute number or
the mere percentage was mentioned.
20. In the tables, the p value for each variable has to be mentioned rather than
just mentioning that it is not significant. Together with the p values the Chi values
could have been provided.
21. The figures given at the end are not properly labeled. In addition to that the
axes of the graphs are not labeled. Hence, this is not a proper graphical
illustration of the study findings.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests.