Title: Utilization of long-acting contraceptive methods and associated factors among married
women in Farta woreda, Northwest Ethiopia: A community-based mixed method study
Version: 2 Date: 29 Mar 2022
Reviewer's report:
Comments
This manuscript covers an important area of reproductive health among married women. Overall,
the manuscript reads well. However, authors may need to address the following issues:
1. Authors should define LNG-IUS when first mentioned in the manuscript.
2. Authors should reference the following sentences mentioned in the manuscript:
- “Even though the study design is similar (community-based cross-sectional study among
married women) the difference in the magnitude might be due to different reasons like the
difference in the residence of the study population”
- “Males are the most influential decision-makers in our society and this study also showed that
34% of the decision regarding current contraceptive method utilization is made by husbands
alone”
- “There are limited studies regarding the husband's education status and utilization of long-
acting contraceptive methods”.
- “In addition, they don’t want others to take their wealth when they pass so they need more
siblings to whom they could hand over their assets.”
- “This is because an attitude about something is the main factor determining what people intend
to do about that thing. And those who have a positive attitude towards LACM can easily break
different myths and misconceptions related to LACM and are willing to use those methods
anyways”.
- In sample size determination: “First nine kebeles among thirty-three kebeles were selected
using the lottery method”, authors should reference this method and explain why only nine
kebeles were selected.
- In the section on Reproductive health characteristics: “Three hundred thirty-three (61.2%) and
one hundred sixty-seven (30.7%) of the study participants were multi gravid and grand multi
gravid respectively, authors should state and reference the definitions of multi gravid and grand
multi gravid.
3. In operational definitions, the authors mentioned the following: “Long-acting contraceptive
methods- both reversible (intra-uterine device and implants) and non-reversible methods (tubal
ligation and vasectomy) are considered long-acting contraceptive methods.” Authors should
justify why a combination of LACM was used knowing that factors associated with reversible
and non-reversible methods may be different.
4. In the following sentence in Background, authors should write numbers using digits for easier
understanding. “About fourth-five point two percent of contraceptive users of the world count
on permanent or reversible long-acting contraceptive methods”
5. Authors should improve the justification of the importance of the study in the context of
Ethiopia. The following justification mentioned in the background is weak: “But evidence’s
from different studies in a different part of the country and the Mini Ethiopian Demographic
Health Survey (MEDHS) 2019 shows the utilization of long-acting contraceptive methods is
very low and a lot is expected to reach the target [17-21]”. Authors should provide, for example,
the current prevalence of LACM in Ethiopia and why it is a problem to be addressed.
6. In the following sentence mentioned in methods: “A Community-based cross-sectional study
design was employed supplemented by quantitative data from March 1-30, 2021 in Farta
Woreda”, authors should confirm if “supplemented by quantitative data” is the correct phrase
or “supplemented by qualitative data”
7. Authors should better explain population selection for a qualitative study, especially why
army leaders were selected as participants? Explain what assumption was made.
8. In the sentence “A sample size of 556 participants was determined by using the single
proportion formula by considering a population proportion p-value of 20.9% from a study
conducted in Adama” authors should rephrase the sentence as it sounds like the p-value is 20.9%.
9. Authors should better discuss the sudden change in odd ratios for the variables education
status (COR VS AOR) and desire for more children presented in Table 4.
10. Findings of the qualitative study were limited and authors may want to expand on findings
and explain and provide quotations on categories of factors identified.
11. Is the result of this sentence “The finding of this study displays the magnitude of long-
acting contraceptive method utilization was 14.3% 95% CI [11.5-17.6] presented anywhere in
the manuscript? How was the confidence interval estimated for this proportion?
12. In the sentence “It is also higher than a large survey conducted in Europe (11.3%) [28].”,
authors may want to use instead a setting similar to Ethiopia for comparison of LACM
utilization.
13. In the sentence “But unlike most studies, the educational status of women [20, 24, 30, 34, 39,
42] and knowledge of women about LACM [20, 23, 26, 36, 39, 43] doesn’t show statistically
significant association in this study. This may be due to the that men are influential decision-
makers in this society.”, authors should improve the justification as it seems limited regarding
the non-significant association found in logistic regression.
- In the limitations section, authors should provide an example of why social desirability might
have affected the study.
- Authors should consider adding sample size-related limitations in terms of generalisability for
example.
- Authors should mention qualitative data limitations as well, little is known about the interview
environment (location, and neighboring) and whether that had affected the study.