Title: The impact of social determinants of health on feminicide in the second-largest state of
the Brazilian Amazon: a spatial epidemiological analysis.
Version: 1 Date: 31 Aug 2024
Reviewer:  Tiago Canelas
Reviewer's report:
Dear Authors,
Thank you for submitting this paper and taking the time to work on such an important topic.
Although I see the value, relevance, and methodological appropriateness of analyzing the data
spatio-temporally, I believe this work needs further refinement before it can be published. One
of my concerns is the lack of self-reflection on the use of these techniques in a territory as large
as Pará.
Aim & Objective:
- The aim of the study is not always clear. Are you analyzing the data spatially, temporally, or
seeking an association between SDH and femicide?
Abstract & Introduction:
- There are sentences that do not align with the paper’s aim: “Spatiotemporal risk analysis was
employed to assess the influences of policies or other social phenomena on femicide in space
and time.” I do not think this accurately reflects what you have done in the paper.
- The conclusion in the abstract does not align with the rest of the content.
- There are some inconsistencies in the writing. For example, when describing strategies to fight
femicide, you state: “several other agencies, including the Specialized Reference Center for
Social Assistance (CREAS), the State Reference and Support Center for Women (CREAM),
and the Reference Center for Social Assistance (CRAS);” This is not a strategy per se.
- Several sentences in the manuscript need restructuring, for example, lines 78–81.
Need for further Eexplanation:
- Line 82: “femicide can have different identities”—what do you mean by this?
- Line 89: “in thinking of society”—what do you mean?
- Lines 89–92: You previously mention only one spatial study, but here you give the impression
that multiple studies show the usefulness of spatial studies.
- Lines 97–99: Incorrect placement.
Methods:
One of my biggest concerns is why you split the years. What was the reasoning behind this?
You mention avoiding annual fluctuations, but why not analyze everything together or in two-
year intervals? There is a lack of clarity.
Figures 1 & 2:
- “Spatial location” is redundant; location is inherently spatial.
- The map quality is poor, making the data hard to see due to overlaps.
- The scale in Map 1 is incorrect.
- The legends could be improved.
- There are missing citations. For example, where does the projected female population data
come from?
- Lines 62–64: Why is there no reference for these statements?
SDH:
- It seems you have included as many SDH variables as possible, why was the reasoning for this?
- There is no variables description (could it be good for an appendix)
- What's the challenge using an index such GINI and single variableS?
- The health categories seem to include overlapping variables. Also, child mortality is an
outcome. The difference between child mortality and mortality in childhood is unclear.
- Why did you make these SatScan adjustments? Some municipalities are the size of a country.
Results:
- It would be helpful to include tables showing the results of the OLS and spatial regression.
- I miss having an appendix with all the analyses, including variable selection and model
performance.
- You mention an expansion in crude rates, but how do you quantify this?
- GWR allows for variability of each variable within each unit of analysis, but this is not shown.
Discussion:
- Since this is a spatial analysis, it would be helpful to better describe what these results mean,
the pitfalls, and the significant limitation that municipalities in Pará are very large.
- There is a lack of citations for several statements.