Reviewer ’s report  
 
Title: Quality of care in family planning services in rural Mozambique with a focus on Long 
Acting Reversible Contraceptives: a cross -sectional survey  
 
Version: 1 Date: 05 Oct 2017  
 
Reviewer: Mohammad Afzal Mahmood  
 
Reviewer's report:  
 
Title:  
 
Considering the scope of this research i.e. mainly about knowledge and use of particular type of 
contraceptives, the title needs to be amended. It could be about knowledge and prac tices about 
long acting reversible contraceptive rather than 'quality'.  
 
 
Abstract:  
 
A secondary objective, information channels associated with knowledge about LARC, is 
mentioned. However, no results or discussion are provided.  
 
 
Line 83: Provide reference for the statement "Almost 1 out of 4 Mozambican women in a 
relationship has an unmet need for FP".  
 
 
97: Explain with clarity the misconceptions on the provider side (such as reluctance to offer 
LARCs to young, unmarried women) . Does it mean that the health care providers consider that 
LARCs are contraindicated or should be prescribed to young women because of certain social or 
medical reasons?  
 
 
97-98 What is meant by "informal payment"?  
 
 
There are too many parenthesis (bracket s), negatively influencing the flow and comprehension. 
If a phenomenon or concept is important it should be written as part of the narrative and not in 
the brackets.  
 
 
118. It would be better to write 'we wanted to assess satisfaction of FP clients and thei r 
knowledge of LARC. This is because using this single concept (Clients' knowledge about 
LARC) as proxy for quality of care is not justifiable  
127. Need to explain the reason for the focus on type II health care centers.  
133-142. It is not clear what t he 'training' initiatives are mentioned. Was this research conducted 
to evaluate the impact of those training? If yes, then there is need to report what was the situation 
in terms of knowledge and use of LARC prior to those training.  
 
 
145: There is need t o explain why it was assumed that the quality, knowledge about and/or use of 
LARCs would change during the few months between June and Oct 2015 and March 2016. In 
other words need to explain the rationale for the three rounds of the survey in this short pe riod of 
time.  
 
Table 1. Could be removed. Does not add much information.  
 
 
234. Methods discussed and given during consultations: There is a need to describe in some 
detail what contraceptive methods were available at those centers. If some of the contrac eptives 
are not available, the staff may not find it relevant to describe and counsel the clients on those 
methods.   
 
 
246. What were the 'screening tests'?  
 
 
347. As mentioned earlier the reason that the staff discussed mainly the oral and injectable coul d 
be that only these methods were available at those centers. It is not justified to claim that there 
is/was a provider bias because there were some disbeliefs about contraceptives. This section 
needs to be rewritten using information about the research se ttings and the literature that informs 
why staff may counsel the clients for one/some particular contraceptives.  
 
 
364. Shortcomings mentioned here appears to be assumption. They may be relevant in this 
research setting; however, in order for the reader to  comprehend the situation better it is 
important to describe the setting well. For example, what is the usual workload? Is there a high 
staff turnover in this setting?   
 
 
376: It is not clear what is meant by "information that they receive at the health cen tre reinforces 
their misconceptions…." There is a need to explain by providing some examples or by pointing 
to what incorrect information women had that might have been reinforced by the staff.  
 
 
378. The description of outreach health promotion activities in rural areas, ownership etc does 
not flow from the  results, and is not relevant.  
English language editing is needed  
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported 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 some language corrections before being published  
 
Declaration of competing interests  
Please complete a dec laration 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 
manusc ript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have  no comp eting interests' 
below. If you r reply is yes to any, please give details below.  
 
I am supervising a PhD student who is researching quality of family planning services in another 
country in Africa. While the research methods, data and research settings are entirely different 
and while I believe that supervising a r esearch or participating in manuscript development in the 
same research field as for this paper does not constitute a 'competing interest, I considered it 
appropriate to declare this.  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepte d for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.or g/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editor s, which will not be published.  
 
I agree to the open peer review policy of the journal