Title: Reproductive Health of Syrian Refugee Women in Lebanon: A Descriptive Analysis of
the Sijilli Electronic Health Records Database
Version: 5 Date: 21 Oct 2022
Reviewer's report:
Thank you for the opportunity to review this manuscript again, it has very much improved.
Overall, this study is an important advancement in the literature in refugees' sexual and
reproductive health needs. After careful review of the materials, the purpose aligns well with
the methods, and the results of the study appear to be in line with the analysis conducted. Now
that issues with analysis have been addressed, I only have minor comments with regards to the
way content and findings are presented.
In the abstract: Consider removing the percentages to be consistent with the way the rest of the
findings are presented unless you plan to provide all percentages for all the factors listed and
percentages for the comparison groups as well. In the conclusion of the abstract, I wanted to
point out that I don't believe that age of first pregnancy increased among SR women - rather
they decreased (younger) based on the table %. With regards to this, in the results section,
authors state "When comparing the age at first pregnancy among the three groups, no significant
difference was observed" but the Table data shows significant p values comparing these groups.
Please clarify and be sure the finding presented in consistent. The authors emphasized younger
age post-displacement in the discussion section, so I believe this was an important finding. It
just needs to be clearer. Finally, there needs to be a comma between sentences: "While the
mean spacing between their pregnancies and breastfeeding rates have decreased after moving
to Lebanon. SR women are less likely to use contraceptives after their displacement."
In the results section: The authors may cut down the amount of data presented since numbers and
percentages are clearly presented in the Tables. Currently, the results is structured in this way:
1) socio-demographics (Table 1 data), 2) demographic and obstetric characteristics between
all groups (Table 2 data), 3) pregnancy outcomes of SR women between all groups (Table 3
data), and 4) contraception use (Table 4 and 5 data). For section 2 of findings, consider only
highlighting key relevant demographics (this doesn't need to be a whole paragraph) since there
is already an entire section explaining demographics.
In the discussion section: Consider a beginning this section with implications of the major and
key findings. My thoughts are that this study speaks to the need for more attention to differences
between pre- and post-displacement data on refugees' physical health outcomes and findings
in this study corroborates prior literature. What this study adds specifically, is that comparing
pre- and post-displacement data provides us with a better understanding of sexual/reproductive
outcomes in a refugee population residing in the precarious living environment of refugee camps
rather than other studies which focus on reproductive health of resettled refugees in high-income
countries. Findings are indicative of the difficult circumstances due to forced displacement,
that have consequences on reproductive and maternal outcomes. Displacement may have
physiological consequences on reproductive health, while limited access to reproductive and
antenatal health care contributes to poor obstetric outcomes.
Similarly, authors could also distill the subsequent discussion section, which is very lengthy,
down to 1-2 paragraphs for each major finding/issue (key implications, younger pregnancy age
after displacement, poor pregnancy outcomes, breastfeeding and contraception implications). I
don't have any specific suggestions as to how this section could be more concise and defer to
the authors and editors on style and length preferences.