Reviewer’ s report
Title: Prevalence and patterns of gender-based violence across adolescent girls and young women
in Mombasa, Kenya
Version: 0Date: 20 Jan 2020
Reviewer: Research Square Reviewer 1
Reviewer's report:
PEER REVIEWER ASSESSMENTS:OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for the
objective?No - there are minor issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically sound?
If not, can revisions be made to make the work technically sound?Probably - with minor revisions
PEER REVIEWER COMMENTS:GENERAL COMMENTS:
This paper looks at the prevalence and patterns of violence among young adolescent girls andwomen who have reported ever having had sex and their experiences of violence. Overall, it is aninteresting paper, where relatively little quantitative work has sort to delineate how different formsof sex (causal, transactional, sex work) have shaped violence patterns. I do think more informationis needed to clear explain some of the findings, and greater discussion could also lend clarity to thefindings.
REQUESTED REVISIONS:
There are a couple of small design issues that require further explanation in the study. In thedescription of the questionnaire, there needs to be greater clarity on the two main outcomes ofviolence, it reads like each item was a single binary item, and so these could be written outdirectly. If they are single items, this needs to be described as a significant limitation (under-estimation of the prevalence)
I don't like the description causal sex. As this could include girls who'd just had sex once, or where
in long term relationships. Please find a new term.
I also don't like the uncritical seperation of transactional sex and sex work. Studies suggest these
overlap and a big issue has been around thinking about whether they do clearly seperate out. Itcould be the authors say this was an issue and XX% of sex workers also reported transactional sex,and this is then revisited in the discussion. But currently it leaves the study design feeling a bitmixed.
I am troubled in the section on sexual violence that 19% of women who said they had experienced
sexual violence (which is defined in the methods section as forced to have sex) then say they didn'thave sex at that incident - this needs to be considered in the analysis/stats section and potentiallydiscussed in the discussion section about how women may have defined things differently (i.e. ifraped, women may not classify this as sex, so would depend on the question)
Condom use, to give a sense of whether the condom use is high or low, I think you need to try and
provide us with a % condom use at last sex, or something. As 25% for YCS who experiencedviolence is low, but is it really lower than condom use in general etc. it could be it's low in generalfor YCS and this is the same proportion?
I think there are a couple of issues with the analysis that need to be done to strengthen the paper.
Because of the classification of sex work and transactional sex being very different, a big point ismissed that these definitions often do probably slip, but more clearly defining the different risksfor them (violence c.f. condom use) would be really helpful in thinking this through.
I think you see a slightly more complex picture that needs to be described - condom use in
particular needs a little thought as here sex workers had the highest condom use post-violence,while those doing causal sex and transactional sex worse. I think this should be discussed ingreater detail, as it suggests that those at risk of HIV are those engaged in transactional sex becausethey have lower condom use and greater number of partners.
Also see note above about condom use, and we don't know if it is high or low post violence, as we
don't know the overall rate.
Statement about most common perpetrator of physical violence being partner, could possibly
reframed, to be that the most common perpetrator varied by different group, and among YCS washusband/partner [and it's only because YCS is the biggest group that you get the overall %], andthat YTS and YSW different and describe these. I think it's an important point. In the discussion
this also needs problematizing as you are just asking first and last perpetrator, and so may under-
estimate the rate of IPV in these populations (indeed some work in India highlights IPV is really
common among sex workers).
More minor issue is the opening sentence is wrong - it's not in Kenya, it's in Mombasa, among
AGYW who report ever having sex.ADDITIONAL REQUESTS/SUGGESTIONS:IntroductionLines 10-11: there are issues around the discussion of gender inequalities, authors state ownershipover women, but I think the situation is less clear than ownership, and maybe they want to focus
on control over women, (sometimes referred to as relationship power), and clearly emphasise
inequitable gender attitudes and norms are the key drivers (not just gender attitudes).
In paragraph two, I think the authors should be a bit more specific, and have the paragraph on
prevalence of IPV and non-partner sexual violence, the last sentence on no. sexual partners shouldnot be here. I would like an estimate of global violence against AGYW as well if possible.
Throughout the introduction, it would be good to mention the type of violence being described, as
non-partner sexual violence is different to physical violence from peers etc. Just be more specificwhere possible.
I think a major gap in the introduction is lines 43 onwards. They need to break it up covering more
clear: 1) AGYW are not homogenous; 2) relationship between causal sex, transactional sex andsex work (and specifically these two last ones as this is key). The relationship and differencesbetween transactional sex and sex work are more blurry than the authors state, and this has verybig implications for the interpretation. Work by Wamoyi and Stoebenau and others argue aboutthese understandings. I think the implication is how these are described and making a point aboutthe overlap between the two rather than seeing these as clear cut.
Line 54/55 - unsure what this was meant to convey and suggest cutting it
Definitions
Language of self-selection: women didn't self select, you used a questionnaire to categorise them -this is standard and I got worried about self-selection.
Casual sex - unclear what makes it casual (as it could be part of a long-term relationship)Assume the transactional sex questions came from the previous work of Dunkle et al in South
Africa, and these should be referenced
Variables
I really struggled to understand the section on variables. Please could it be re-written. Sorry, not tobe more specific.
Why is police arrest considered as violence? I certainly can understand that it may be harassment,
but not violence (in a public health framework). Could it be split out from the violence from police
and looked at seperately.
Results
First line, the YCS etc. aren't defined.
Table 1: needs descriptive statistics in the titleLine: "The pattern of sex during an episode of physical violence" I think this should be of those
reporting physical violence as it's not everyone.
Could some comment about referral to services be included if this was an option for women.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
NoDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
NoAre the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
NoAre 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 furtherassessment in your comments to the editors.
I am able to assess the statisticsQuality of written English
Please indicate the quality of language in the manuscript:
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