Title: Intimate partner violence and associated factors among reproductive age women in
Liberia: A cross-sectional study using a recent Liberian demographic and health survey
Version: 2 Date: 18 Apr 2022
Reviewer's report:
Dear authors,
Thank you for the opportunity to review this interesting paper. In general, the data as well as
the paper has a lot of potential to provide important aspects to the research field on IPV and
associated factors among women in reproductive age in Liberia. However, some parts of the
manuscript need further clarification and revision. Here are my comments and suggestions:
Title:
1. I recommend the authors to indicate the study’s design with a commonly used term (for
example “a cross-sectional study”) already in the title as it helps the reader to situate her/himself
and directly understand what type of design was used.
Abstract:
1. In the results section (line 34) the authors discuss the overall prevalence of IPV. However, it is
not clear from the methods section how the variable “IPV” has been combined/constructed. This
needs to be clarified in the methods section and throughout the paper. Please see my comments
for further advise and questions.
Introduction section
1. In the introduction section (line 74-75) the authors state that: “IPV has mental and physical
health consequences on women, particularly it leads to depressive symptoms, loss of social and
professional networks”. It is not clear how loss of social and professional networks are related to
mental and physical health consequences. Please try to clarify this part so that the relation “loss
of social and professional networks” has a clear connection to the first part of the sentence.
2. Line 76-77. The authors mention that studies on intimate partner violence have identified
“factors” and then they give some examples. I would suggest to specify whether “factors” refers
to risk-factors or associated factors. Line 76-80: I recommend the authors try to explain in which
way the different factors are associated with IPV. For example, is younger age associated with
IPV? Is higher or lower level of educational status associated with IPV? Please also explain what
is meant with “media exposure”. What type of media? In which way is media exposure related
to IPV? The authors also mention “the practice of intimate partner violence” at the end of the
sentence. Please try to explain what this means. Do you mean exposure to IPV?
3. Line 80-81. Is the life time prevalence referring to Liberia? Please clarify which country. The
authors do not specify whether the prevalence refers to exposure or perpetration of IPV. I would
suggest the authors to be specific and repeatedly clarify what they describe in the article, i.e.
exposure to IPV (or any other term synonym with exposure). In the same sentence, the authors
mention that there has been an increase of exposure to IPV between 2013 and 2019. As there
seem to have been a large increase in few years, this part would be improved if the authors
provided a short explanation of potential reasons behind this increase of life time exposure to
IPV.
4. On line 87, the authors mention that there were challenges regarding the implementation and
enforcement of gender and human rights related laws? What kind of challenges is this referring
to? Please provide some examples and a more detailed explanation.
5. Line 90. Please revise the aim and try to be more specific. For example, it is not clear what
this part in the sentence means: “intimate partner violence and associated factors-ever married
reproductive-age women in Liberia”. Please revise the whole sentence/aim.
Methods
1. The section of “Study design and settings” would largely improve if the authors could provide
more details. For example, how was the data collected? Through a questionnaire? If so, was
the questionnaire validated? In each particular household, how where the women who answered
to the survey approached and selected? How many interviews (or written questionnaires)
where performed per household? What inclusion and exclusion criteria were set? The authors
mention “reproductive age” of women but this does not explain the age-range. Were the women
interviewed/or responded to the questionnaire in privacy? How large was the sampling frame,
i.e. how many habitants did the area have where the survey was performed? What was the
response rate? The authors mention systematic sampling of households in “a West African
Country bounded by…” (line 97-98). Please explain which country you refer to here?
2. In line 105, the authors mention that a p-value less than 0.2 was used as a cut of point. Please
explain this decision and what this means.
6. The authors describe the dependent variables (different forms of IPV) but do not mention
where the variables come from, i.e. if any known instrument was used and if the instrument was
validated. Further, the authors do not provide any information about the time frame investigated.
Where the women asked if they where exposed to the different forms of violence during past
year or earlier in life or both? Where the women asked about frequency of exposure or was the
answer framed as “yes” or “no”. How were the questions about exposure to violence framed?
7. In the section where the independent variables are described, the authors mention that “the age
of the mother” (line 127) was included. I suggest that the authors write “the age of the included
women” since it otherwise will be somewhat unclear if the age refers to the included women or
to the mothers of the included women. Please also clarify and explain all the variables included
i.e. religion. How was this variable categorized?
- The authors mention “media exposure”. Please see my previous comments about that variable.
- In the last sentence of this section, the authors state that: “Those variables were identified after
reviewing different literature”. Please explain in which matter these variables where identified.
For example, where they identified as risk factors? Was the reviewed literature about exposure
to IPV? Please clarify these issues.
In general, in both parts (about dependent and independent variables), the paper would largely
benefit from having each and every variable used in the analysis/ study (and displayed in the
tables) defined and explained in detail. How where these variables assessed, i.e. computed/
divided/categorized before the analysis?
- Also the paper would improve if authors clearly could describe which variables were
considered as confounders and why? This would help to understand more of the analysis and
results.
Results
1. In the results section, on line 135, I recommend the authors to write “age-range of 15-49
years”.
2. I suggest to revise the section under “socio-demographic characteristics of respondents” and
put the percentage first and after that the numbers in parenthesis. For example: “Out of the
women included in this study, 43.0% (n=902) of the women were residing in the south central
region of Liberia and 43.3% of the women had no formal education.” Further, if the number
of participants is clearly stated in the methods section (please see my previous comment about
response/participation rate) there is no need for repeating the numbers in text, since the % will
indicate the proportion.
3. Table 1:
- Please clarify in the heading (and sub-heading below) that it is about exposure to IPV and that
N=2 100 are females (the respondents).
- In addition, what type of IPV is used? In the dependent variable section various forms of IPV
where mentioned but here only “IPV” is visualized in the table. Was this a composite variable
of all forms of IPV? Please explain this in the Methods section and clarify in all tables.
- I suggest that the authors use one decimal when presenting the percentage (%) and that the
numbers are rounded off so that the total of percentage will be 100%. This makes the table easier
to understand.
4. Table 2. It is difficult to understand the text related to table 2 as there are no headings or
subheadings in table 2 of the manuscript. Please add the correct time- frames and sub heading
so that the table and text is clearly understood.
5. Table 3 would benefit largely from showing the dependent variable (IPV) in the table as well
as the time- frame used for IPV. For example, when it comes to age of the women, which age
group is not associated with IPV and what type of IPV (physical, psychological…) and what
time frame has been used when asking the women about exposure to IPV? Which age group
was the reference? This is not clear in the table or in the related text. In the methods section
different types of IPV where mentioned but in this table it is not clear how the variable IPV has
been constructed and used. This needs to be explained more in detail in the methods section and
stated in in the table.
- The authors mention that they used a multivariable logistic regression analyses and that the
model was fitted (line 162). However, it is not clearly explained if the variables where entered
all at the same time or step- by -step. Please explain this in the methods section.
-  The authors mention that the odds of IPV “were lowered” by 14%, 29% and so forth. I
suggest that the authors instead explain the Crude OR in text and how the Crude OR changed
after adjusting for potential confounders/independent variables. This would make it easier to
understand the findings.
- Please also explain all the variables in table 3 in the methods section. For instance, “Wealth
index” has three categories (poor, middle, rich). How is this measured? Is it measuring local
currency? How was the cut- off for the three categories decided?
6. Discussion section.
The authors discuss their finding (44.74) s in relation to previous research in Namibia, Sub-
Saharan Africa, India and Ethiopia and they suggest that the discrepancy may depend on
differences in sample size, study population and sociocultural differences among countries.
Since it is not clear from the methods section how the different forms of IPV where measured,
combined and analysed, it is difficult to know whether the discrepancy also could depend on the
way IPV has been categorized and used in the analysis? The paper would largely improve if the
authors could clarify that aspect in the methods section as well as discuss this in the discussion
part.
7. Line 219. The authors mention that older women may be “mature and can discuss openly
with their spouses”. It would be interesting if the authors could develop this part more and give
some examples.
8. Line 222-223. The authors mention that IPV has spatial variations in the country. Please
explain more in detail about these variations and why. What is included in sociodemographic
makeup that can affect IPV? Please try to explain and give some examples.
9. On line 225 the authors mention that households headed by female are less likely to experience
IPV as compared to those headed by males. Does this refer to any women heading the household
or the women included in this study? What is meant by “heading” the household? Does this
mean that the women is single, is the breadwinner or what does that term include? Please try to
describe this variable more in the methods section
10. Please check the sentence on line 231 as it seems not to be complete: “.. and will any
justification (…)”.
11. Line 248. I suggest that the authors write “The women´s attitudes towards wife-beating” so
that it is easier to understand that this is about the participating women´s attitudes (and not their
husbands/partners).
12. On line 257 the authors describe that alcohol may “mess up” the marital relationship. I
suggest to use another word or try to explain what is referred to with the term “mess up” in
this case.
13. On line 276, the authors mention: “experiencing intimate partner violence method”. I would
suggest to eliminate the word “method” since IPV is not a method.
14. On line 284, the authors mention that “some important variables” that could possibly affect
IPV was not to be found. What type of variables do the authors mean here? Please give some
examples of those variables lacking.
I wish the authors good luck with the revision!