Reviewer's report
Title:Environmental and cultural determinants challenge causal attribution for
serious burns to women in India: a qualitative study from two major burns units
Version:2Date:1 September 2014
Reviewer: Rebecca Wurtz
Reviewer's report:
Major compulsory revisions
Excellent investigation into a very important topic. However, I think the
presentation of the findings (the women’s narratives and the responses of the
clinicians and law enforcement personnel) could be organized more effectively.
You say “In this analysis, our objective was to understand the human background
to the epidemiology, and to examine what happens when women are admitted to
hospital, with a particular focus on the medicolegal process.” I would organize the
paper more explicitly along those lines.
The title 'Environmental and cultural determinants challenge causal attribution for
serious burns to women in India: a qualitative study from two major burns units”
doesn’t really describe what you did. I think something along the lines of “A
qualitative study of the epidemiology and the in-hospital medicolegal response to
female burn injuries in India” describes it more clearly
There is a fair amount of discussion in the results section, and perhaps
redundant discussion in the discussion section. I would tighten both sections
(results and discussion). I wish there was more about the women’s views on the
medicolegal process.
Line 105-106. “That burns were more common in women and clustered in young
marrieds was
undisputed.” I don’t think you can say this since you did not report on your total
burn population. I don't think you need to, since you cite numerous data that
support this in the first paragraphs of the introduction.
Line 45. “Three investigators (KH, JM and RD) conducted case studies.” I would
call these interviews. The case studies were what resulted from the interviews.
Did you tell the women the purpose of the interview? How were the 33 women
selected?
Line 59. “Respondent” implies a survey or questionnaire. I would use the word
“subjects” or “interviewees.”
Line 62 describes 12 police officers, but lines 66-67 describe 14.
Line 130. This section covers considerably more than accidents attributed to
unsafe equipment. I would break this section into several, including the social
restraint imposed by crowding, the physical risk posed by crowding and loose
clothing within the household, and the dangerous consequences of a
semi-regulated gas market.
Line 570. The concepts “firestarter nexus” and “narrative precedent” are valuable
but aren’t mentioned until the last few pages.
Discretionary revisions
Line 8. “The epidemiology is unusual….burns are a well known means of
women’s suicide or homicide.” This doesn’t seem to be an epidemiologic
statement. I would restate along the lines of “homicide and suicide are common
causes of burns in women.”
For non-Indian readers, could you explain the significance of less than 7 years of
marriage?
Line 23. I would add the following phrase to clarify this sentence: “Again, the sex
ratio [of victims] is the opposite of that seen in high-income countries, in which
men predominate.”
Line 30. “The third is that immolation is a well-known method of homicide,
particularly within public consciousness of dowry death.” The latter phrase does
not add anything.
Line 61. This is the first place that the term “key informant” is used. I would use it
earlier to describe the category of interviewees other than burn victims and their
relatives.
Line 111. “All respondents but one said that homicidal burns were now
uncommon.” I think you should distinguish between statements made by burn
victims and their families, and the key informants. Is “respondent” meant to refer
to police officers here?
Line 135. “Now, if this was a good area, there we would have cylinder blasts, and
generally there would be fewer accidental cases.” Unclear.
Line 141 “The assumption being that most burns were intentional and that social
pressure prevented families from setting fire to women.” Unclear. You mean that
the burns were intentionally self-inflicted?
Line 507. You make several statements in the discussion, which while perhaps
supported in the overall literature on this subject, aren’t directly supported in your
data. Such as “We draw particular attention to burning as a means of self-harm.
If there was a typical suicidal event, it was an act born of desperation, drawing on
a familiarity with the idea of self-immolation and the availability of kerosene.
Many women set fire to themselves when despair collided with opportunity, in a
context in which myths surrounding immolation left them with little idea of its
potential effects.”
Table. Very clearly presented. Not all sections sum to 33.
Figure 1 is a little confusing. I would make it more linear. “First this happens, then
either this happens or that happens.”
Figure 2 is quite interesting.
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.