Reviewer's report
Title:Using Verbal and Social Autopsies to Explore Health-Seeking Behaviour
among HIV-Positive Women in Kenya: A Retrospective Study
Version:4Date:27 February 2014
Reviewer: Ingvild Sandøy
Reviewer's report:
Re-review “ Using Verbal and Social Autopsies to Explore Health-Seeking
Behaviour among HIV-Positive Women in Kenya: A Retrospective Study”
This is an interesting paper that has improved a lot since I last saw it. I now only
have a number of minor comments.
Minor essential revisions
The abstract does not mention that information was obtained on 796 deaths.
Background, p. 4, first paragraph, line 11/12: “while casual sexual partners
account for 20%” should be rephrased to “while sex between casual sexual
partners accounts for 20%”.
p. 5, line 5: Please explain what you are referring to with “over-the-counter». Is it
pharmacies? Shops?
p. 5, line 9: remove “s” in “affects”
Methods: the authors must mention that the study was conducted only in rural
areas.
Methods, p. 6, lines 8-10: the word “leading” should be replaced by “preceding” in
the sentence “Death audits were conducted to estimate the prevalence of
maternal and newborn mortality and understand health-seeking behaviour
leading to deaths in the OBA study sites.” as the death may not necessarily be a
result of the health seeking behavior.
p. 6, line 14: please specify what you mean by “within the stipulated distance”
p. 6, lines 9-11: insert “an” before “immediate” in the sentence “our analyses
focused on 796 deaths where verbal and social autopsy interviews were
conducted with immediate caregiver of the deceased.”
p. 7, line 1: if only one caregiver was interviewed per dead woman, then “all
caregivers of women” should be rephrased to “one caregiver per woman”
p. 7, line 1: I am confused. Here you write that the social autopsy tool was
administered to caregivers of women who died 2006-2010. However, Table 1
indicates that deaths between 1996 and 2005 were also included. What is
correct?
Results: For each quote, the authors should mention the relationship of the
care-taker to the deceased woman.
Results: when the authors write in the Methods section that “We looked for
patterns and associations of the themes and compared and contrasted within
and between the different regions and age groups”, they need to provide a
comment in the Results section about what they found, even when they did not
find any differences.
Results, p. 12, in the section “Poor understanding of HIV-related opportunistic
infections” it would have been useful if the authors gave some examples of
AIDS-related complications that were misinterpreted as malaria so that the
reader can get an impression of whether this really is a matter of lack of
knowledge or whether the problem is that the symptoms are unspecific.
p. 12: the following sentences would fit better in the section with the heading
“Medical pluralism» than under “Poor understanding of HIV-related opportunistic
infections”: “The findings showed that women sought treatment in three ways,
namely; (i) going to a witchdoctor or traditional medicine man, (ii) taking
home-made remedies believing that it is a mild illness that will go away, and (iii)
going to a health facility. The following excerpts highlight some of the ways that
women sought care:”
Discussion, p. 20, line 16: please specify where the “similar studies were
conducted” so that the reader may judge whether the contexts were likely to be
similar.
Discussion, second paragraph on p. 20: I still feel the discussion of lack of
knowledge as a barrier to care seeking is very superficial. Almost the whole
paragraph is a mere repetition of the results. One aspect of this that could have
been interesting to see some reflections on is: how come so many people lack
knowledge about HIV symptoms when awareness of HIV has become so high?
Discussion, p.20, third paragraph: I find the text about disclosure and the
importance of social context to be vague, and I am not sure what point the
authors are trying to make. Can you make this text more clear? Which situation
does the following statement refer to “there was need to consider the social
context of HIV status disclosure“? What is the message?
p. 22, line 2: is 47% really a “small proportion”?
p. 22: please explain how “perceived ‘coercive’ testing” can create “social
distances between the women and the local community,”
p. 23, second paragraph: What data supports the statement “study found that at
the community level the [vital registration ] system is functioning quite well”?
Discretionary revisions
Results: In my opinion many of the non-significant findings are not worth
mentioning.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
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