Reviewer ’s report  
 
Title: DOUCHING PRACTICES AMONG WOMEN IN THE BOLGATANGA 
MUNICIPALITY OF THE UPPER EAST REGION OF GHANA  
 
Version: 1 Date: 05 Sep 2017  
 
Reviewer: Ami Zota 
 
Reviewer's report:  
 
Comments to Author  
This is an interesting and unique study on an important women's health topic - vaginal douching 
practices in Ghana. My most substantial comments relate to clarifying details about the study 
population as well as the approach towards ana lyzing the data. On a minor note, the manuscript 
is generally well written although there are some grammatical errors. For example, the word 
"commonest" is not a word and should be changed to most common.  
 
Major Comments  
Study area and participants  
1. The authors say that the female participants "were randomly selected in the Bolgatanga 
Municipality."  Specifically, what were your eligibility criteria (e.g. were there age 
restrictions, language or reading restrictions, residential location?)?  
 
2. Study are a and participants: Who contacted the eligible participants? Was it research 
assistants, professors, or health workers?  
 
3. How were eligible persons identified? Who identified the eligible participants?  
 
4. What percentage of contacted participants agre ed to participate?  
 
5. Can you provide more information about this region of Ghana, is it mostly industrial or 
agricultural. In term of national economy, how does it rank.  
 
Data analysis and results  
6. For Table 4, the percentages should add up to 100 as they go down vertically not 
horizontally. For example, a reader would want to know, within the "yes" category, what 
percentage of participants were aged 15 -20 versus over 51? Currently, it is difficul t to 
determine that because the percentages are tallied by row (percentage of women aged 15 -20 
who douched versus those who did not douche).  
 
7. In Table 4, you should collapse some of the education categories, because very few people in 
your study had no formal education. I would recommend converting the 5 categories into 3 
categories. Similarly, you have too many age categories with few numbers so the statistical 
test results will not be robust.  
 
8. For knowing the dangers of douching, you can only do a statistical comparison for the "yes" 
category not all three categories.  
 
9. For Table 5, consider collapsing the 5 categories into 3 categories (primary, secondary, and 
tertiary)a.  
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.  
 
Yes 
 
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 manuscript or would you recommend a n 
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 q uality of language in the manuscript:  
 
Needs some language corrections before being published  
  
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years re ceived reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any w ay 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 com peting interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests' below.  
 
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