Title: Prevalence and determinants of exposure to family planning messages among
reproductive age women in five Sub-Saharan African countries: A Multilevel Analysis of
2021-2023 Demographic and Health Surveys
Version: 2 Date: 11 Oct 2024
Reviewer's report:
This study examines the factors influencing the prevalence of family planning information
among women of reproductive age, using data from five sub-Sahara African countries. The
outcome variable is binary, indicating whether a participant has ever heard of family planning.
Both individual-level factors, such as age, education, income, number of children, and number of
antenatal care visits, as well as area-level factors, such as poverty and illiteracy, were analyzed.
Factors were initially screened using univariable logistic regression. A multilevel mixed-effects
logistic regression model was then employed to estimate odds ratios and quantify the impact of
these factors on exposure to family planning information.
The results indicate that education level, income, and healthcare visits and availability at
both the individual and area levels are positively associated with exposure to family planning
information. Women's age and number of children also have significant impacts. Furthermore,
country-level differences become significant after adjusting for individual-level factors.
The strength of this study lies in its large sample size (N = 63,266) and the use of recent
data collected between 2021 and 2023 from five countries, enhancing the relevance and
generalizability of its findings.
However, the study contains many aspects that remain unclear to readers and require further
clarification and improvement.
1. It would be beneficial to include a flowchart to clearly illustrate the data cleaning and,
if applicable, imputation process from the larger DHS dataset. This would also give readers
a clearer understanding of inclusion criteria and any potential biases that may have been
introduced during these steps.
2. The authors mention that the 63,266 observations were a weighted sample. It would be helpful
to further explain how the observations were weighted and provide the rationale for employing
these weights.
3. For Table 2, it would be helpful to present the summary statistics by the outcome variable, as
well as by country in the appendix. This would give readers a better understanding of the sample
and provide insight into potential country-specific differences in the data.
4. It would be helpful for the authors to explain how the categories were generated from the
wealth index.
5. Line 6 on page 6, authors mention “data leveling”. Are the authors referring to the process
of defining the categories?
6. On page 14, confidence interval for Ghana is incorrect.
7. As shown in Table 4, the adjusted odds ratios change substantially from Model II to Model
III. It would be beneficial for the authors to expand the discussion on potential reasons for this
shift. Additionally, they should consider discussing or testing whether a country-specific model
might be necessary.
8. In the discussion section, it would be beneficial to expand on how the authors suggest
improving the dissemination of family planning information, particularly in contexts with
limited budgets, based on the analysis results and the authors' expertise. For example, what might
be the most effective strategies? Who should be prioritized as the key target groups? The current
discussion is somewhat brief and would benefit from further elaboration.
9. It would be beneficial for the authors to conduct thorough proofreading to improve the overall
writing quality. The topic and the substantial amount of data used in this research have great
potential, but the writing quality significantly impacts the overall usefulness of the study.
Typos and minor issues to correct:
1. On page 3, the authors use the abbreviation 'SSA,' which I believe refers to 'Sub-Saharan
Africa.' To improve clarity for the reader, it would be helpful if the authors introduced 'SSA' in
parentheses immediately after 'Sub-Saharan Africa' at the beginning of the introduction section.
2. Line 5 on page 4, “sub African” should be corrected to “sub-Saharan African”
3. On page 12 and 13, “African country” should be corrected to “sub-Saharan African countries”
to make them consistent
4. In many sentences, 'country' should be revised to 'countries.' Please make these corrections
as needed.
5. n page 8, there are unnecessary spaces before Table 2.
6. Table 2 on page 8, “Total no child ever born” could be revised to “Number of children”
7. On page 10, figure 1’s title is in wrong formats
8. On page 14, there are unnecessary spaces before Discussion section.
9. Line 13 on page 14, “sab” should be corrected to “sub”