Title: Prevalence and determinants of maternal near miss in Ethiopia:  A systematic review and
meta-analysis, 2015-2023
Version: 1 Date: 23 Apr 2023
Reviewer's report:
I commend the authors on their research and am grateful for the opportunity to review their
manuscript. Their work has important implications for clinical practice and future research.It was
a pleasure to review this manuscript. The authors have tackled an important research question
and their findings have the potential to make significant contributions to the field .but,it is better
to revised thie manuscript to be in perfect manner for publication in BMC Journal.
The full recommendations are:
1.There is one suggestion for manuscript title to be more concise and informative:
Menopausal Symptoms and Associated Factors among Middle-Aged Women in Arba Minch,
Ethiopia"
2.The abstract appears to be well-written and informative. However, there are a few areas that
could be improved:
• Clarity in the objective: While the overall objective of the study is clear, it could be more
specific. For example, the abstract could state whether the study aimed to identify the prevalence,
severity, or associated factors of menopausal symptoms among middle-aged women in Arba
Minch DHSS.
• Lack of detail in the methods: The abstract provides limited information about the study
design and methodology, such as the data collection methods, inclusion/exclusion criteria, and
statistical analyses. Providing more detail in these areas would help readers better understand
the study's methodology and its limitations.
• Incomplete results: The abstract only provides the prevalence and severity of menopausal
symptoms and two associated factors. It would be helpful to provide more detailed results, such
as the specific symptoms that were most common, and the strength of the associations between
the factors and severity of menopausal symptoms.
• Use of abbreviations: The abstract uses several abbreviations without first defining them, such
as DHSS, AOR, and CI. It would be helpful to define these abbreviations upon first use to aid
in reader comprehension.
• Lack of conclusions: While the abstract provides some general conclusions and
recommendations, it does not explicitly state the implications of the study's findings. For
example, the abstract could mention how the study's findings could inform interventions or
policies to improve the health and wellbeing of middle-aged women in the study area.
3.There are a few areas that the author should consider revising to strengthen the introduction:
• The introduction would benefit from a clearer statement of the research question or objectives.
While the author briefly mentions the importance of identifying factors associated with symptom
severity, it is not clear what specific research questions or objectives will be addressed in the
manuscript. Adding a sentence or two at the end of the introduction that clearly states the research
question or objectives would be helpful.
• The author states that menopause is considered when FSH is greater than 40 UI/l and estradiol
is less than 20 pg/mL, but it is not clear where this definition comes from or how widely accepted
it is. The author should provide a reference for this definition and clarify whether it is used
universally or only in certain contexts.
• The introduction would benefit from more specific information on the types of metabolic,
cardiovascular, and bone fracture-related complications that can be associated with menopause.
Providing a few examples of these complications and their potential impact on women's health
would make the introduction more informative.
• While the author briefly mentions that menopausal symptoms can vary among different
cultures and ethnicities, more information on this topic would be helpful. Specifically, the author
could provide examples of specific symptoms that are more common in certain ethnic or cultural
groups, as well as any factors that may contribute to these differences.
the introduction provides a good overview of menopause and its associated symptoms, but could
benefit from some revisions to make it more informative and focused.
4.Methods section notes:
I think this section well structured to be reliable and measured for this manuscript questions
It's possible that the study may have also looked at the prevalence of menopause in this
population and the impact it has on their quality of life.
5.General notes on results section:
• The authors could consider conducting a longitudinal study to assess the causal relationship
between variables and menopausal symptoms.
• The authors could use objective measures, such as laboratory tests, to validate self-reported
data and minimize response bias.
• The authors could assess additional factors, such as physical activity level and dietary habits,
to provide a more comprehensive understanding of the factors that contribute to the severity of
menopausal symptoms.
• The authors could assess the duration of menopausal symptoms to provide additional insights
into the severity of menopausal symptoms.
• The authors could consider including menopausal women who are not attending Arba Minch
DHSS in future studies to improve the generalizability of the study findings.
6.Discussion section notes:
1. Discussion didn't explain
Whether this is the first Ethiopian study in this direction?or not?
2. Authors could compare thier results with other national in concerned to international studies
alone?
3. There are other limitation should be mentioned that highlighted in results section notes in
this report?
4. The future lines didn't constructed clearly to replicate or expand the study findings ?
Finally references notes:
1.authors didn't include any systematic review or even literture review in these references?
2.there some references taken from reports or websits should be clarified to be supported enough
or omitted immediately
3. The number of references accepted but the new references less than the oldest references.
All the best