Title: Individual and community level factors associated with modern contraceptive utilization
among married women in the emerging region of Ethiopia: a multilevel mixed effects analysis
of the 2019 Ethiopia Mini-Demographic and Health Survey
Version: 0 Date: 06 Sep 2023
Reviewer's report:
Comments
Title:
- How and what criteria were used to define the region as “emerging” in Ethiopia?
- What was the reason for focusing on these studies rather than conducting the study considering
all regions in the country?
Abstract:
- In the results section of the abstract, the authors have included the following two variables -
those women who belong to poor and middle-wealth households and Women in clusters with
poor wealth status, separately. What is the difference between these two variables? Did you
check the collinearity in these variables?
Materials and methods
- Please provide a specific definition for emerging regions and provide a supporting reference
in the study area and data source.
- Provide a definition for the modern contraceptive in the variable’s measurement section.
- Please provide further information related to the sample size, if possible, show a figure of flow
on how the data of participants was cleaned, the criteria and number of participants for each
phase, and the final number of participants included in the study.
- What criteria were used to classify variables into individual- and community-level
factors? Some related research conducts aggregation of data to change individual variables
to community-level variables. For example, wealth and education can be converted into
community- wealth and community- literacy levels. Did the authors consider these kinds of
variables? Why? why not?
- Show the process of data collection and quality assurance methods used by the DHS study and
by the current research if it is applicable.
- In the analysis section, indicate if data has been weighted before analysis.
Results
- Please separate the sociodemographic and obstetric variables into separate tables.
- While presenting the modern contraceptive utilization, the authors state that “The proportion
of modern contraceptive utilization among married women was 21.97% (20.17, 23.88) in 2019.”
Please note that the report is for the years preceding the survey data collection. In this case, 2019
is the year in which the report was published, but not the data collection. Therefore, correct it
as such. In addition, please indicate such data collection period and related information in the
methods section.
- I also suggest the presentation of different types of contraceptive methods in the form of a
figure or table or maybe show the variations in different regions across the country.
- As it is presented in Table 2, the Proportional Change in Variance (PCV) is essential to
determine the power of variables included in each model in predicting teenage childbearing.
The model with the highest PCV value is considered to identify the factors associated with the
dependent variable. However, as presented in Table 2, the PCV value is higher for Model 2
(57%) and it was 52% for Model 3. How is a higher PCV value observed in the community-level
factors than in the combined model? despite this result, the authors have selected the third model
to explain the factors associated with the outcome variable. Can you explain the justification for
this and the criteria used for the selection of the model?
Discussion
- The discussion lacks the implications of the major findings of the study.
- Please provide justifications as to why there are differences in the use of contraceptive methods
in different regions of the country.
- I also suggest that the authors compare the contraceptive utilization between the emerging
regions with the other regions of the country. Do you expect a difference in the variation? what
are the possible reasons for this?