Title: Trend, geographical distribution, and determinants of modern contraceptive Use among
married reproductive-age women, based on the 2000, 2005, 2011, and 2016 Ethiopian
Demographic and Health Survey
Version: 1 Date: 01 Aug 2023
Reviewer's report:
ID 04448595-b1e2-4c71-9131-433b5d817a79
Title: Trend, geographical distribution, and determinants of modern contraceptive utilization
among married reproductive-age women, Based on 2000, 2005, 2011, and 2016 Ethiopian
Demographic and Health Survey
General comment: The study was done on public health important issue as Ethiopia is still
in a plight of pervasive pregnancy-related maternal and neonatal death where the level of
contraceptive utilization is far below the optimal level. However, the manuscript has many
caveats to consider it for publication as it stands now.
Specific comments
I. Abstract
-In the method part of the abstract the authors described that the design of the study is
a population-based cross-sectional study. However, the study indicates that they only used
secondary EDHS data, and did not collect population-level data by themselves. This needs
correction
-in the conclusion section of the abstract the authors stated as  ‘… we need to work hard since
the contraceptive prevalence is below 50%’.  I think they should recommend for policy makers
and other stake olders rather as they may not solve all the problems by themselves.
II. Introduction
-Paragraph 8, ’ …The reigning trend in contraceptive use could be due to current changes in
demographic composition, including expansion of urbanization, education of girls, and other
development activities, or it could be due to changes in contraceptive utilization behavior.’ The
authors should cite reference/references
-the last paragraph of the introduction should come before the paragraph describing the aim of
the study.
Methods and materials
-Methodology should be corrected as methods: Research methodology is a descipline, whereas,
research method is a technique of conducting research
-Study design period and setting should be corrected as  ‘Study design and period’ as information
related to the setting can be described under the study area
-under the study design, period , and setting, the authors should check their design as I
commented on the abstract part.
-The authors should finalize the information relatted to the study setting under the study area,
and remove the ‘setting’ here
- The exclusion pregnant at the time of the survey. What does this mean?
-Under the data management, data processing, and data analysis methods of the method part the
authors should describe how they did data weighting
-the dependent variable under the method part is not inline with the dependent variable in the
conceptual framework
-The operational definition is not exhaustive. For example, the authors should have
unequivocally described how they did measure the knowledge of modern contraceptive use
Results
-Under the sociodemographich characteristics the authors stated that the standard deviation is is
8.6 (8.6 SD). There is no such standard deviation; standard deviation is not uni-directional
-In the tables the authors used only percentages, it is better to use frequencies and percentages
for ease of understanding.
-The information about clustering of modern contraceptive users is not clear; what are the
primary, secondary, and tertiary clusters?
-under factors associated with changes in modern contraceptive use the authors stated that they
used a p value of 20% to screen candidate variable for the multivariable analysis, however, in
the method they stated that it is 25%
-Table 4, the third column (contraceptive use percentage), it is better to indicate the frequencies
of users and none-user for the ease of calculating the crude analysis manually. I failed to identify
the candidate variables claimed by the authors as the table is not informative
-Table 4, Please check again the zero probabilities of the P value. I do think that the probability
might be very small and may not be absolutely zero. Better to report it as <0.001 if it is below
one chance out of 1000 observations
-Table 4, what is the reference group for educational status?
-Table 4, what is higher religion category?
-Table 4, check the number of living children
Discussion
-Almost all of your implications are your personal opinion/judgement which does not
scientifically sound; you better substantiate your implications with assertive evidence
- The study revealed that the trend of contraceptive utilization in Ethiopia is increasing, from
7.2% in 2000 to 39.5% in 2016. Cite reference/s for this
The reason for the increase may be due to increased women’s awareness about contraceptives
and the increased work of the government and other stakeholders towards family planning
services (27). The reference cited here is about children vaccination, and is not relevant here.
-…Women who reported not being educated and having primary and secondary education were
significantly more likely to have modern contraceptives than those educated at a higher leve.
I do think that this is against reality. In the intoduction part of this manuscript the authors
themselves indicated that the current increase in the magnitude of modern contraceptive use is
due to women’s long education and other factors. Therefore, they should re-check the data, or
otherwise, substantiate this result with assertive evidence.
- Muslim women have the highest odds of contraceptive use, followed by Catholics and
Protestants, compared with Orthodox Christians. This is also against the currently prevailing
pieces of evidences. The different studies done using the DHS datafrom different countries
including Ethiopia indicate that Muslim womem have lower odds of using modern contraceptive
as compared to Christian women in contrary to the current finding. Therefore, how do the authers
assert this finding?
- Some studies indicate different observations (22). You have only cited one reference
Conclusion
-look at the comment I gave you uder the conclusion part of the abstract