Reviewer’s report
Title: 
Sexually transmitted infections related care-seeking behavior and
associated factors among reproductive age women in Ethiopia: further analysis of
the 2016 demographic and health survey.
Version: 
1 
Date: 
15 Mar 2020
Reviewer's report:
Thank you for submitting this manuscript about STI care-seeking in women in
Ethiopia. I really enjoyed reading the paper and can see it will be a valuable
addition to the literature when published. I feel the manuscript could be
strengthened with some revisions as follows:
Abstract:
1. Adding in a sentence with Ethiopia-specific data/information to replace one of
the sentences about the worldwide overview of STIs would better situate the
paper in its context
2. The objective should be added as the last sentence of the first paragraph
3. …"the determinants of care-seeking behavior" should be replaced with factors
associated with care-seeking behavior to reflect the nature of the data you
analysed and given the wide CI and levels of uncertainty in the data
Background:
4. The statement about chlamydia and gonorrhea can cause serious
complications…needs a reference at the end (?move one of the refs 2-5 at the
end of the next sentence if this relates specifically to chlamydia and gonorrhea).
5. The final paragraph needs to better contextualise the problem you present
within literature from Ethiopia including a critical appraisal of the available
literature to state clearly what this tells us, what is still missing/unknown and
what could be improved about the type of information available. E.g. the
following refs may be relevant (if journal access is a problem it may be worth
contacting authors directly for a copy/looking for other open access sources)
* Mengistu et al. 2013. Risks for STIs/HIV infection among Madawalabu
University students, Southeast Ethiopia: a cross-sectional Study. Reproductive
Health 10 (1),38.
* Tiruneh. 2008. Seroprevalence of multiple sexually transmitted infections
among antenatal clinic attendees in Gondar Health Center, northwest Ethiopia.
Ethiopian Medical Journal 46 (4), 359-366.
* Molla et al. 2009. Readiness of youth in rural Ethiopia to seek health services
for STIs. African Journal of AIDS research 8(2) 135-146
* Moges et al. 2013. STIs based on the syndromic approach in Gondar town,
northwest Ethiopia: a retrospective study. BMC Public Health 13 (1) 143
* Gebrekidan et al. 2017. Magnitude and predictors of self-reported STIs among
school youth in Bahir-dar, Northwest Ethiopia. Ethiopian Medical Journal 55
(2).
6. The manuscript would benefit from some information about STI healthcare
options e.g. services available and any barriers to access e.g. cost/geographical
location etc. This would help give some context to the sentence about those
taking self-prescribed drugs - where can these be accessed?
Methods:
7. Whilst interesting the administrative set-up info should only be kept in if you
mention it later on e.g. woredas and kebeles are not mentioned again in the
manuscript.
8. Under outcome variable you say 2014 EDHS data - is this a typo as the study
is based on 2016 data or are you referring to the consistency of variable use over
time (probably not relevant here as it is a one-off cross-sectional study).
9. Interpretation of the outcome variable information would be greatly assisted if
you include the exact question wording and response options e.g. in a separate
box/list for the STI symptoms and seeking treatment/advice questions. It is
unclear to me if it is confirmed diagnosis of STIs/suspected etc
10. Again, change determinants of STI related care-seeking behavior to variables
associated with care-seeking…
11. In the explanatory variable it would be good to cite some referenced
examples of the literature you mention.
12. The explanatory variable sentence is v long and hard to read as one. Can you
break it up with punctuation or present this information in another format?
Results:
13. Re-write following sentence to improve clarity "Nearly half of 235…"
14. Ensure all percentages have a % sign with them to distinguish from other
numbers
15. Ensure all percentages are presented in the same format e.g. 1 decimal place
for consistency
16. Add in a time frame when talking about the prevalence of care-seeking
behavior for STIs..is this ever/in the past 12 months etc
17. Can you include a statement about missing data for your outcome variables,
you mention the overall response rate but it would be useful to understand the
completeness of data in the dataset.
Discussion:
18. Confounding factors instead of differing factors
19. Re-write following sentence to improve clarity "The women of higher
educated husbands.." e.g. more highly educated husbands/husbands with a higher
level of education // husbands with no education; also re-write the sentence "This
might be due to educated husbands let their wives…"; also re-write sentence
"This might be due to rich women…"
20. I don't think it is a limitation to only focus on women in this paper given the
journal and the different health consequences of STIs for women than men but
you could discuss needing to know about partner STI care-seeking etc to prevent
risk of re-infection/onward transmission to women
21. It would also be worth mentioning in the limitations that lots of the factors
associated with care-seeking presented in the results have very wide CIs due to
the relatively small number of women reporting STIs in the sample therefore
there is greater uncertainty in the contribution of each factor/true value. 
Conclusion:
22. First sentence - Add on what this means about care-seeking for women in
Ethiopia. Extend what you have told us already.
23. Acknowledging the need to increase care-seeking for STIs is important but
the statement about designing health education messages does not seem to come
directly from your results. It would be better to talk about reviewing
interventions/strategies that have been implemented successfully in similar
settings/countries to reduce care-seeking barriers to see if they would be
transferable/relevant to the Ethiopian context.
General points:
Some general English language amendments/re-writes needed throughout
especially relating to singular/plural forms 
Are the methods appropriate and well described?
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 supported by the data shown?
If not, please explain in your comments to the authors.
No
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify what aspects
require further assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
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questions:
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salary from an organisation that may in any way gain or lose financially
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or in the future?
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organization that holds or has applied for patents relating to the content of
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paper?
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