Reviewer’s report
Title: 
Violence against housemaids in an Ethiopian town during the early phase
of the COVID-19 pandemic: A cross-sectional study
Version: 
1 
Date: 
22 Feb 2022
Reviewer's report:
This study reports on the prevalence of physical and sexual violence among
housemaids in an Ethiopian community and the factors associated with this
violence using cross-sectional survey data. The topic is worthy of study as this is
a particularly vulnerable and neglected population. The manuscript is clearly
written and well organized except for some major formatting problems noted
below. I appreciate that the authors explained the concepts under study and
provided a detailed discussion of their methods. Despite these points, I suggest
several major modifications and clarifications to strengthen this manuscript and
make it ready for publication. I am particularly concerned about confusion in the
sexual violence reporting.
I have divided my suggested revisions into major and minor categories, with
major suggestions denoting changes that I think are important to strengthen the
paper and necessary for publication, and the minor category denoting points that
the author may want to adopt but that are not crucial to the integrity of the
article.
GENERAL /EDITORIAL
MAJOR: There are serious formatting errors in the PDF file shared with
reviewers. The in-text citations all have the same number, making it difficult to
figure out what citations were used and challenging to gauge how well-supported
the authors' statements are. 
MAJOR: In addition, a section of the results, pages 18 to 19, are repeated and
should be deleted
MINOR: Although the article is easy to follow, it would benefit from careful
proofreading. There are minor typographical and formatting errors throughout
the paper
ABSTRACT
MINOR: please review the use of the terms "risk" and "inversely" on line 43,
page 2. You are reporting probabilities or odds, not risks, and only age is
inversely related to probability violence. The other factors in this sentence are
positively associated with the probability of violence.
INTRODUCTION
MAJOR: the introduction could be significantly strengthened by adding more
context. Please add a few sentences on the status of housemaids in Ethiopia. For
example, the conditions under which they work, what do their contractual
obligations tend to look like, whether housework is more of an urban or rural
phenomenon, the legal protections they have, the current policies to protect
them, estimates of how many there are in the country, information on the
sociodemographic patterns in the types of women who fill these roles, etc. The
authors do not need to include all of this information, but incorporating this type
of background would help ground the study and strengthen the discussion of
your findings.
Similarly, more discussion on the prevalence of gender-based violence in the
country would be helpful. How serious a problem is it in the country? On line
93, page 5, you mentioned a study that shows that 100 girls had been raped in
three months, but it's not clear that that is an unusually high number. A national
or sub-national estimate or the citation of more than one study would help to give
the reader a picture of how bad this problem is in the country.
Finally, the study seems to be motivated, in part by an expected increase in
violence due to lockdowns. But there is no discussion of how severe the
lockdowns or economic dislocation in Ethiopia were during the COVID-19
pandemic. A few sentences on that would also be helpful context.
Your discussion section reports on several Ethiopian studies that have been done
on this topic, but the introduction doesn't state what the current state of the
knowledge is on the subject in Ethiopia or what gaps this particular study is
filling in that larger literature. Overall the study needs to be better motivated.
Simply stating that there is a lack of research on the topic without discussing the
state of that current research is insufficient.
METHODS
MINOR: Page 5, line 112: consider removing the description of elevation. It
doesn't seem relevant to this study. Consider adding a sentence or two more
about the socio-demographics of Kombolcha or the South Wallo zone. For
example, is it an urban or rural area? What is its religious or ethnic background? 
MINOR: page 8, lines 165-170: clarify if this is the definition that you used in
the study.
MAJOR: this may be at the discretion of the journal editor, but I believe the
ethics section should be moved or repeated in the methods section. The average
reader will have questions about how you could survey housemaids in their
employers' homes while ensuring their confidentiality and safety. I think you do
a good job of laying this out in the ethics statement in the disclosures section, but
most of that discussion should be in an ethics section in the methods. 
RESULTS
MAJOR: please clarify either in the results or in the methods section if you were
asking respondents whether they had ever experienced physical or sexual
violence or whether they experienced physical or sexual violence during the
COVID-19 pandemic. The survey instrument and your tables suggest that
respondents were asked about their experiences in general, not for a particular
time period. If this is the case, then you're going to have to modify your
statements about the level of violence experienced during the COVID-19
pandemic. For example, on page 15, line 265-166, you state that~ 46% of
housemaids have experienced "more physical violence" since the lockdown; that
doesn't seem correct. There is a similar problem on page 18, line 298. 
Similarly, respondents are asked to report their experiences of sexual and
physical violence for either their current employer or their past employer. But it's
not clear the employer characteristics questions that they were answering
concern their current employer or a former employer. It is possible that they
experienced the violence from a former employer but are reporting the
characteristics of their current employers, which would add error to the analysis
of the employer factors associated with violence. If it is not clear whether
respondents are reporting the characteristics of their current or past employers
(or their abusive or non-abusive employers), this lack of clarity should be
mentioned in the study limitations as a source of measurement error. 
MAJOR: page 18: Please either explain or remove the discussion of the first age
of sexual intercourse and the reasons for sexual intercourse from the tables and
results reporting. It's not clear what this has to do with whether or not the
housemaids have experienced sexual violence. It may seem to some as if the
respondents' sexual activity is being used to explain the violence they
encountered.
MAJOR: I do not understand the difference in the frequencies reported for sexual
violence (n= 46) and the frequency of reported rape (n = 52 ) and attempted rape
( n = 55 ), unwanted touching (n=69), etc. If sexual violence is the larger
umbrella category and you then asked about what type of sexual violence was
reported (rape, attempted rape, unwanted touching), then the frequency of sexual
violence should be higher than the frequency of rape and attempted rape, etc.
Please clarify. And please reorganize the table so that it's clear what the main
categories and subcategories are. If there was a survey error with some people
reporting rape, unwanted touching, etc., when they did not report sexual
violence, perhaps you should recalculate the sexual violence frequency to
accommodate the discrepancy and redo your analysis accordingly. 
MINOR: Page 11, lines 223: Please clarify that you are talking about parents
here, not the housemaids themselves.
MAJOR: Page 12, line 226. I could not find a mention of monthly income in
Table 2. Please revise
MINOR: page 19, lines 307 to 308: the contents of table 8 should be
summarized here rather than just referring the reader to look at the table.
MINOR: page 23 table 8: once again, please clarify the number of respondents
answering these questions (n=57?) 
and how they relate to the lower number of
people who reported sexual violence (n=52). I think it's adequate only to report
the yes categories here rather than both the yes and no categories.
DISCUSSION
MAJOR: Page 26: 
In discussing the agreement between your study and previous
studies, it is essential to give some idea of the *magnitude* of the differences in
prevalence/odds seen in other studies compared to yours. How much higher is
the prevalence you found compared to the other studies, for example? This is
particularly important for your discussion of the maids' age and employer gender
as factors because the odds ratios that you find have large confidence intervals
that approach 1, 
which suggests that the effect sizes may be quite modest. It
would be interesting to see how these modest effects compare to the findings of
other studies. 
In addition to citing individual studies, are there international reports on the
extent of this problem with global estimates that you can use? Similarly, can you
compare the prevalence figures you find to national statistics for women in
general? How do the rates of violence among maids compare with the rates in
the general population? 
MINOR: page 26, line 391: you state here that the high prevalence of violence
that you find compared to other studies might be related to the marginalization of
housemaids, but aren't the previous studies also studies of housemaids? Please
clarify
MINOR: page 26, line 403: can you expand on the physical and mental factors
that increase vulnerability?
MINOR: Page 27 lines 406 to 415: please add more citations for the discussion
of the association between violence and chat (e.g., for the sentences on lines 409
and 410)
MINOR: page 28: Given that you expect under-reporting of violence due to
social desirability bias and employers' presence, you should state somewhere that
your high prevalence numbers might be even higher than you report. 
MINOR: page 28, line 449, lines 453-454: Would it be possible to give a few
specific examples of policies that could be put in place to empower housemaids,
such as crisis hotlines, legal support, etc.? What interventions have been tried in
other settings?
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
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Yes
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from apparent manipulation?
Yes