Reviewer ’s report  
 
Title: Reasons for Delay in Seeking Treatment among Women with  Obstetric Fistula in 
Tanzania: A qualitative study  
 
Version: 0 Date: 05 Mar 2019  
 
Reviewer: Joao Paulo Leonardo Pinto  
 
Reviewer's report:  
 
The study "Reasons for Delay in Seeking Treatment among Women with Obstetric Fistula in 
Tanzania: An Exploratory Cross -Sectional Design." addresses a very relevant issue that affects 
thousands of women in hazardous socioeconomic conditions around the globe  causing a negative 
impact in their quality of life.  
Having said that, the author should consider some suggestions:  
 
- English must be reviewed;  
 
- When the author mention : "Women and girls with untreated obstetric fistula experience 
multiple morbidity, i ncluding neurological damage (…)" this expression  is referred to 
psychological disorders, mental distress or organic disorders affecting bowel and/or urinary 
bladder?  
 
- Table 1: considerations:  
 Author should create a legend for table 1  
 Express quanti tative data in percentage and mean/SD to be more concise and to provide a clear 
understanding of such data.  
 Also, should expose, if collected, the time since onset of symptoms and  looking for  treatment. 
(mean time/SD). It would be an interesting data.  
 
- In the section " Sociocultural factors"  I'd suggest adding a paragraph introducing topics 
about Tanzanian religion and culture that may have an important role in this matter.  
 
- Sampling:  
 Need a better explanation on how subjects were enrolled until da ta saturation was achieved.  
 
 "All women with obstetric fistula admitted to CCBRT hospital who had delayed seeking 
treatment for more than 3 months since the onset of symptoms at the time of data collection were  
purposefully recruited to participate in thi s study"   
 
  How many women were invited? All women accepted to participate, and the data saturation 
was achieved by 18th woman interviewed? Or only 18 women agreed to participate, and data 
was collected from these women?  
 
  It would be interesting, if the re are a great number of non -participants, to discuss why women 
didn't agree in join in this study in your results or even in your conclusion.  
 
  How was defined 3 months as the cutting -point for delay?  
 
- "Community knowledge about obstetric fistula"  
 Family or members of community or even those who accompanied these women to the 
medical consultation were interviewed as well or this "community knowledge" is based on the 
women's report?  
 
Are the methods appropriate and well descri bed?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately sup ported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please  speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs so me language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
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3. Do you hold or are you currently applying for any patents  relating to the content of the 
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4. Have you received reimbursements, fees, funding, or salary from an organization that holds 
or has applied f or patents relating to the content of the manuscript?  
 
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below. If your reply is yes to any, please give details below.  
 
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