Reviewer's report
Title:Factors influencing place of delivery for pastoralist women in Kenya: a
qualitative study
Version:3Date:15 March 2016
Reviewer: Kenneth Finlayson
Reviewer's report:
This is a very well conducted study and an interesting and eloquent account of
the research conducted. Although the factors identified by the authors are well
known, the range of interviewees and focus group participants included in the
study gives the research genuine scope and depth. The authors highlight the
importance of this area of research in the background and, although the results
are contextual, the article will be of interest to policy makers, aid agencies and
providers in low income countries in a variety of settings, especially other African
countries where rural maternal mortality ratio's are particularly high.
1. I don't have any suggestions for major compulsory revisions
2. There are a few minor essential revisions.
- Line 59 (Abstract). I suggest replacing the word 'themes' with topic guides as it
is a little confusing for the reader to find themes discussed in the methods
section. In this context the themes relate to the results.
- Line 159 (Methods). It may be unclear to some readers what the word Kiswahili
means - is it a local dialect or the name of a place. Some explanation should be
provided.
- Line 394 (Results). The meaning of the quotation isn't clear, '....so you find that
in love the majority like to deliver...'. Where does 'in love' fit into this quotation?
- I have reservations about the authors use of the terms 'factor' and 'theme' and
the way they appear to be used interchangeably. Do the authors feel they are
inter-changeable and, if so, why? Furthermore, the four key 'factors' (distance
from the clinic, quality of care, education and preference for home-birth) appear
to have been derived using a deductive approach based on a pre-identified
framework (tpoic guide). However, the final factor (preference for home-birth)
includes a number of sub-headings (sub-themes?) that appear to have been
identified using a more thorough (inductive?) methodological approach. Why is
this the only factor with a number of sub-headings when there appear to be
obvious sub-headings in the reporting of other factors?. e.g. 'cost of transport'
and 'poor infrastructure' are discussed under the distance factor and 'staff abuse',
'poor hospital conditions' and 'shame' are discussed under the quality of care
factor. Unfortunately, the analysis section (lines 184-189) is too brief and doesn't
shed any light on the rationale used to identify the themes or factors, 'The data
were inductively and deductively thematically analysed, with the initial analysis
informed by the theme guides. A subsequent analysis identified themes
embedded in the data'. This is a very descriptive summary and it remains unclear
to the reader exactly HOW the themes (factors?) were identified.
3. Discretionary revisions.
- A copy of the topic guide would be useful - either as a figure in the text or as
supplementary file.
- In terms of structure I am unaccustomed to finding the results and discussion
presented together. This may be an editorial decision but I would prefer to have
separate sections for the results and the discussion.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
'I declare that I have no competing interests'